2009 Southern Regional Meeting Abstracts

Purpose of Study: Centers for Medicaid and Medicare services are proposing to add hospital readmissions as a quality measure by the year 2010 due to the significant burden for patients and healthcare system. We aimed to study the characteristics of all readmissions within 30 days of discharge from hospitalist service in one year.
Methods Used: This was a retrospective study of all readmissions within 30 days after discharge from the hospitalist service during the year 2007. The review was done by seven physicians. Patients readmitted were identified from the University Health Consortium database. Factors for readmission were categorized as: patient factor (e.g. non compliance with treatment), physician factor (e.g. inadequate treatment), disease factor (e.g. end stage obstructive lung disease), and system issue (e.g. lack of primary care physician).
Summary of Results: The total number of readmissions in year 2007 was 239. Fifty five percent of all readmissions were men, 54.4% were Caucasians, 43.9% were African Americans and 1.7% were Hispanics. Seventy one percent of readmissions were for the same diagnosis as the original admission and 37.1% of readmissions were thought to be preventable. Fourteen percent of patients were discharged to skilled nursing facility while the majority of patients were discharged to home (59.8%) or home with home health services (13 %). A new medication was introduced in 15.9% of patients before discharge. The reasons for readmission were acute exacerbation of chronic illness (32.3%), medical non compliance (19.5%), new diagnosis or problem (18.2%), end stage illness (8.2%), failure of outpatient regimen (7.7%), substance abuse (6.4%), medication overdose or side effect (3.6%), and patient leaving against medical advice (2.7%). Patient factor caused 18.8% of readmissions, physician factor caused 2.9% of readmissions, disease factor caused 36.4% of readmissions, and a combination of more than one factor caused 33.8% of readmissions.
Conclusions: More than one third of our readmissions were thought to be preventable, however a combination of factors contribute to most readmissions. Interventions targeting multiple levels in the discharge process are necessary to reduce the readmission burden to our patients and health care system.