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Understanding 30‐day re‐admission after hospitalisation of older patients for diabetes: identifying those at greatest risk
Author(s) -
Caughey Gillian E,
Pratt Nicole L,
Barratt John D,
Shakib Sepehr,
KempCasey Anna R,
Roughead Elizabeth E
Publication year - 2017
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja16.00671
Subject(s) - diabetes mellitus , medicine , gerontology , intensive care medicine , emergency medicine , pediatrics , endocrinology
Objective: To identify factors that contribute to older Australians admitted to hospital with diabetes being re‐hospitalised within 30 days of discharge. Design, setting and participants: A retrospective cohort study of Department of Veterans' Affairs administrative data for all patients hospitalised for diabetes and discharged alive during the period 1 January – 31 December 2012. Main outcome measures: Causes of re‐hospitalisation and prevalence of clinical factors associated with re‐hospitalisation within 30 days of discharge. Methods: Multivariate logistic regression analysis (backward stepwise) was used to identify characteristics predictive of 30‐day re‐hospitalisation. Results: 848 people were hospitalised for diabetes; their median age was 87 years (interquartile range, 77–89 years) and 60% were men. 209 patients (24.6%) were re‐hospitalised within 30 days of discharge, of whom 77.5% were re‐admitted within 14 days of discharge. 51 re‐hospitalisations (24%) were for diabetes‐related conditions; 41% of those re‐admitted within 14 days had not seen their general practitioner between discharge and re‐admission. Factors predictive of re‐hospitalisation included comorbid heart failure (adjusted odds ratio [aOR], 1.49; 95% confidence interval [CI], 1.03–2.17; P = 0.036), numbers of prescribers in previous year (aOR [for each additional prescriber], 1.06; 95% CI, 1.01–1.08; P = 0.031), and two or more hospitalisations in the 6 months before the index admission (aOR, 1.79; 95% CI 1.15–2.78; P = 0.009). Conclusion: Older people hospitalised for diabetes who have comorbid heart failure, multiple recent hospitalisations, and multiple prescribers involved in their care are at greatest risk of being re‐admitted to hospital within 30 days. Targeted follow‐up during the initial 14 days after discharge may facilitate appropriate interventions that avert re‐admission of these at‐risk patients.