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Quality of care factors associated with unplanned readmissions of older medical patients: a case–control study
Author(s) -
Scott I. A.,
Shohag H.,
Ahmed M.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12334
Subject(s) - medicine , comorbidity , charlson comorbidity index , retrospective cohort study , medical record , emergency medicine , case control study , pediatrics , incidence (geometry) , physics , optics
Background Unplanned readmissions befall up to 25% of acutely hospitalised older patients, and many may be potentially preventable. Aim To assess the type and prevalence of quality of care factors associated with potentially preventable readmissions to a tertiary hospital general medicine service. Methods A retrospective case–control study was undertaken of hospital records of patients 65 years or older admitted acutely between 1 J anuary 2005 and 31 D ecember 2010. Readmissions up to 30 days postdischarge (cases) were purposively sampled according to frequencies of primary discharge diagnoses coded during the study period. Non‐readmitted patients (controls), matched according to age, sex and primary discharge diagnosis on index admission, were selected in a 1.7:1 ratio. Results One hundred and thirteen cases and 198 controls were analysed, the former demonstrating a significantly higher comorbidity burden (mean (±standard deviation) comorbidity score 6.6 (±2.2) vs 5.6 (±2.4), P = 0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (55.7% vs 8.1%, P < 0.001). Among readmitted patients, 50 (44.3%) were associated with one or more quality factors versus 23 (11.6%) controls ( P < 0.001). The most common were: failure to develop/activate an advance care plan (18, 15.9% vs 2, 1.0%; P < 0.001); suboptimal management of presenting illness (13, 11.4% vs 0, 0%; P < 0.001); inadequate assessment of functional limitations (11, 9.7% vs 0, 0%; P < 0.001); and potentially preventable complication of therapy (8, 7.1% vs 1, 0.5%, P = 0.002). Conclusions Quality of care factors are more common among readmitted than among non‐readmitted older patients suggesting potential for remedial strategies. Such strategies may still have limited effects as older, frail patients with advanced diseases and multimorbidity will likely retain a high propensity for readmission despite optimal care.