Role of chronic medical conditions in readmissions

December 23, 2013

Researchers cite identification and monitoring of known underlying chronic medical conditions as opportunities to reduce readmission rates and improve patient safety.

Not only are hospital readmissions a costly problem for patients and for the health care system, with studies showing nearly 20 percent of Medicare patients are readmitted to the hospital at an annual cost of $17 billion, but they also pose a significant opportunity for improved patient care and safety. They also represent a complex, multi-faceted issue that still needs to be better understood. In new findings from Brigham and Women's Hospital (BWH), researchers find that the most frequent reasons for readmission were often related, either directly or indirectly, to patients' underlying chronic medical conditions (comorbidities), providing a new opportunity for focus in reducing readmission rates. This research is published online in the British Medical Journal on December 16, 2013 and will appear in the January print edition.

"We know that the reason for readmission is often different from the reason that the patient was initially hospitalized. Our research shows that the five most frequent reasons for readmission were often related to patients' existing chronic medical conditions, underscoring the need for post-discharge care to focus attention not just on the primary diagnosis of the previous hospitalization but also on these comorbidities," said Jacques Donzé, MD, MSc, a research associate in the Division of General Internal Medicine at BWH and lead author of the new research.

Researchers evaluated the primary diagnoses and patterns of 30-day readmissions and potentially avoidable readmissions according to seven most common comorbidities in medical patients (chronic heart failure, ischemic heart disease, atrial fibrillation, diabetes mellitus, cancer, chronic obstructive pulmonary disease, and chronic kidney disease). They analyzed data from 10,731 discharges, of which, 2,398 or 22 percent, were followed by a 30-day readmission at three hospitals within the same hospital network. Among the readmissions, 858, or 8 percent, were categorized as potentially avoidable.

Among the potentially avoidable readmissions, the overall three most common reasons for readmission were infection, cancer and heart failure. Heart failure and infection were the two most frequent main readmission diagnosis for the seven chronic medical conditions studied, accounting for 21 to 34 percent of all potentially avoidable readmissions. Interestingly, almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. For example, patients discharged with a comorbidity of cancer were most frequently readmitted for care of their cancer or possibly related complications like infection, metabolic disorder, gastro-intestinal disorder, or renal failure. Heart failure was the most frequent main readmission diagnosis for patients with five of the seven chronic medical conditions studied.

Particularly important, researchers note that patients with cancer, heart failure, and chronic kidney disease had a significantly higher risk of potentially avoidable readmission than those without those comorbidities.

"Transitions of care should not only focus on the acute condition responsible for the hospitalization, but also on patients' underlying chronic conditions that may increase the risk of new, acute complications," said Donzé. "Our research suggests that interventions could include close follow-up and monitoring of patients' comorbidities in the post-discharge period, when we know that patients are particularly vulnerable."
-end-
This research was funded by the Swiss National Science Foundation and the Swiss Foundation for Medical-Biological Scholarships. The Swiss Science National Foundation and the Swiss Foundation for Medical-Biological Scholarships had no role in the design and conduct of this study, the analysis or interpretation of the data, or the preparation of the manuscript.

Brigham and Women's Hospital

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.