Format

Send to

Choose Destination
J Hosp Med. 2014 May;9(5):310-4. doi: 10.1002/jhm.2173. Epub 2014 Feb 14.

Risk factors for potentially avoidable readmissions due to end-of-life care issues.

Author information

1
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

Abstract

BACKGROUND:

Repeated hospitalizations are frequent toward the end of life, where each admission should be an opportunity to initiate advance-care planning to high-risk patients.

OBJECTIVE:

To identify the risk factors for having a 30-day potentially avoidable readmission due to end-of-life care issues among all medical patients.

DESIGN:

Nested case-control study.

SETTING/PATIENTS:

All 10,275 consecutive discharges from any medical service of an academic tertiary medical center in Boston, Massachusetts between July 1, 2009 and June 30, 2010.

MEASUREMENTS:

A random sample of all the potentially avoidable 30-day readmissions was independently reviewed by 9 trained physicians to identify the ones due to end-of-life issues.

RESULTS:

Among 534, 30-day potentially avoidable readmission cases reviewed, 80 (15%) were due to an end-of-life care issue. In multivariable analysis, the following risk factors were significantly associated with a 30-day potentially avoidable readmission due to end-of-life care issues: number of admissions in the previous 12 months (odds ratio [OR]: 1.10 per admission, 95% confidence interval [CI]: 1.02-1.20), neoplasm (OR: 5.60, 95% CI: 2.85-10.98), opiate medications at discharge (OR: 2.29, 95% CI: 1.29-4.07), Elixhauser comorbidity index (OR: 1.16 per 5-point increase, 95% CI: 1.10-1.22). The discrimination of the model (C statistic) was 0.85.

CONCLUSIONS:

In a medical population, we identified 4 main risk factors that were significantly associated with 30-day potentially avoidable readmission due to end-of-life care issues, producing a model with very good to excellent discrimination. Patients with these risk factors might benefit from palliative care consultation prior to discharge in order to improve end-of-life care and possibly reduce unnecessary rehospitalizations.

PMID:
24532224
DOI:
10.1002/jhm.2173
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Frontline Medical Communications Inc
Loading ...
Support Center