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Quality of care factors associated with unplanned readmissions of older medical patients - a case-control study.
Intern Med J. 2013 Dec 10;
Authors: Scott IA, Shohag H, Ahmed M
Abstract
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 January 1, 2005 and December 31, 2010. Readmissions up to 30 days post-discharge (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: 113 cases and 198 controls were analysed, the former demonstrating a significantly higher co-morbidity burden (mean [+/- SD] co-morbidity score 6.6 [+/-2.2] versus 5.6 [+/-2.4], p=0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (54.8% vs 8.0%, 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 multi-morbidity will likely retain a high propensity for readmission despite optimal care.
PMID: 24320739 [PubMed - as supplied by publisher]