Table 2.
Studies of preventable readmissions with any cause index admission followed by any cause readmission among adults, United States, 2000-2009
| Citation | Reported readmission type (and explanation if provided) | Index condition* |
Readmit condition | Timeframe | Population and Setting | Design and Sample size | Data source(s) | Risk factors/associated factors | Conceptually linked admissions† | Strategy for patient linkage‡ | Used multivariate statistics§ |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Anderson, Clarke et al [53] | Unplanned | Any condition | Any condition | 31 days | Home health patients ≥65 years at home health agency in IL | Case series and qualitative (76) |
Chart review, Interviews |
Patient Elderly** Female** Development of new condition** Worsening of discharge condition** Respiratory conditions** Cardiac conditions** Gastrointestinal** Neurologic symptoms** |
No | Yes | No |
| Anderson, Tyler et al [54] | Unplanned | Any condition | Any condition | Up to 39 days | Transitional care unit patients after ≥3 day acute care stay at transitional care unit in IL | Case series (68) |
Chart review |
Patient Circulatory disorders** Respiratory disorders** Worsening of conditions** Multiple diagnoses** |
No | Yes | No |
| Arbaje et al [22] | Early | Any condition | Any nonelective readmission | 60 days | Medicare patients nationwide | Retrospective cohort (1,351) |
Medicare Beneficiary Survey, Medicare claim files |
Patient Living alone Lack self-management skills Unmet functional need No high school diploma Encounter Increasing length of stay |
Yes | Yes | Yes |
| Friedman et al [2] | Potentially preventable (preventable in most cases by ambulatory care of standard quality in the several weeks or months prior to admission) | AHRQ's prevention quality indicators | AHRQ's prevention quality indicators | 6 months | All patients in the Healthcare Cost and Utilization Project from NY, TN, PA, WI | Retrospective cohort (345,651) |
Hospital discharge data, Healthcare Cost and Utilization Project |
Patient African American Hispanic Encounter Medicaid Self-payer |
Yes | Yes | No |
| Goldfield et al [26] | Potentially preventable (which types of admissions were at risk of generating a readmission) | Any condition | Clinically related to index admission | 7, 15 and 30 days | All inpatient encounters in FL | Retrospective cohort (242,991) |
Hospital discharge data |
Patient Age greater than 75 years old Organizational Hospital |
Yes | Yes | Yes |
| Hasan et al [30] | Early | Any condition | Any condition | 30 days | ≥18 years and admitted by hospitalist or internist in six academic medical centers | Retrospective cohort (10,946) |
Interviews from multicenter trial, Hospital databases |
Patient Married Has regular physician Increasing Charlson index Increasing admission in last year Encounter Medicaid Medicare Self-pay Length of stay >2 days |
No | Yes | Yes |
| Novotny and Anderson [44] | Early | Any condition | Any condition | 41 days | English speaking patients ≥18 years from single IL medical center | Prospective cohort (1,077) |
Interviews, Hospital databases |
Patient Diabetes Increasing number of doctor visits in past year Increasing number of hospitalizations in past year Poor self-rated health status Increasing Charlson score Unemployed Depression Heart failure Marital status Encounter Increasing length of stay Medicare/Medicaid Discharge to home healthcare Discharge to healthcare facility |
Yes | Yes | No |
| Parker et al [39] | Unplanned | Any non-maternal, substance abuse or against medical advice discharge | Emergent or urgent admissions | 30 days | Kaiser Permanente pharmaceutical patients from multiple CA hospitals | Retrospective cohort (6,721) |
Existing study database |
Patient COPD Diabetes Diabetes with complications Paraplegia Metastatic solid tumor |
No | No | Yes |
| Schwarz [45] | Early | Multiple chronic illnesses | Any condition | 3 to 4 months | Patients ≥65 years and functionally impaired in 2 ADL from two hospitals | Prospective cohort (60) |
Chart review, Interviews |
Environment Social support negatively associated with readmission |
Yes | Yes | Yes |
| Timms et al [55] | Early | Any condition | Any condition | 30 days | Patients ≥65 years from single SC hospital | Case series (127) |
Chart review |
Patient Female** Heart disease** |
No | No | No |
| Weeks et al [5] | Unplanned | Any acute, short-stay admission | Any unexpected admission | 30 days | VA enrollees ≥65 years nationwide | Retrospective cohort (3,513,912) |
VA/Medicare combined dataset |
Patient Increasing age Male Increasing comorbidity (Elixhauser score) Index admission as a readmission (history of readmits) Encounter Increasing length of stay Organizational Index admission to VA hospital Environment Rural |
No | Yes | Yes|| |
* All exclusion criteria or specific diagnostic codes not reported - see original article for additional details.
** Study did not compare readmissions with non-readmissions so factors are from descriptive statistics/reports only
† Explicitly specified a biological, theoretical or conceptual model linking the readmission condition to the index condition (includes readmissions for same condition)
‡ Specified a strategy or research design to guard against loss to follow up
§ Used multivariate statistics
||Modeling technique did not account of non-independence of observations in analysis
AHRQ = Agency for Healthcare Research and Quality
VA = Veterans' Affairs
ADLs = Activities of daily living