CHICAGO — Nearly one-third of elderly general medicine patients were readmitted within 30 days in a retrospective analysis of 164 patients.
Neither inpatient providers nor a standardized algorithm accurately predicted which patients would be readmitted, Dr. Nazima Allaudeen and her associates reported in a poster at the annual meeting of the Society of Hospital Medicine.
“My take-home from this is [that] all of our patients are at risk,” she said in an interview. “Whatever intervention you're going to put in place—whether it be educating your patients more, making sure they have better social support, better patient medication—you really need to do it for everyone.”
Among 159 patients aged 65 years or older, discharged from the general medicine service at the University of California San Francisco Medical Center during a 5-week period beginning March 17, 2008, 52 (32.7%) were readmitted within 30 days. Five patients died during the 30-day postdischarge period.
The rate is much higher than was identified in a recent Northwestern University study in which nearly 20% of 11,855,702 Medicare beneficiaries were rehospitalized within 30 days (N. Engl. J. Med. 2009;360:1418-28).
The higher rate could be explained by the fact that data on unscheduled readmissions to other hospitals were captured—data often missed in other studies, said Dr. Allaudeen, of the Veterans Affairs Palo Alto (Calif.) Health Care System. The researchers reviewed electronic medical records at the local county hospital as well as their own institution, and telephoned patients or caregivers to determine readmission to outside hospitals. They also excluded patients who died during the 30-day postdischarge period.
In the current study, attending physicians did the best job of predicting who would be readmitted. Their mean predicted readmission rate of 32.5% fell just shy of the actual 32.7% rate. The predicted readmission rate was 41.5% using the probability of repeat admission (Pra) algorithm, which was calculated using eight variables extracted during chart review.
Readmissions cause significant distress to patients and caregivers, and are associated with considerable financial costs. The authors contend that it is especially critical for hospitals to have in place systematic interventions targeting general medicine patients now that Medicare may be changing reimbursement policies for hospital readmissions.
The authors disclosed no conflicts of interest.