Which factors are associated with unplanned hospital readmissions: a case-control study

Abstract

Background: In previous studies there were 30-day readmission rates of around 20%. It is not clear whether these readmissions are preventable and which factors contribute to it. Better understanding of patient and process factors related to preventable readmissions would enable us to improve the discharge procedure and reorganize care pathways to prevent these readmissions. Aim and research question: To find patient-, process-, and medication-related factors which lead to unplanned hospital readmissions. The research question of this study was: Which patient-, process- and medication-related factors are associated with unplanned hospital readmission in patients 18 years and older discharge from a general internal medicine ward? Method: A case control study is done with 35 cases and 35 controls. Using a self made case report form all the medical records a searched. Also earlier collected prospective data is included in this study. The included factors are divided in three levels. Patient-, process- and medication-related factors. Results: From the patient-related factors only chronic illness is a factor who can be associated with hospital readmissions. From the process-related factors mean length of stay in days, wanted to receive care after discharge and timely informed about discharge are significantly proven. The factors medication change and use prednisone are from the medication-related level and can be associated with unplanned hospital readmission. Conclusion: There are a lot factors investigated, but only a couple of them are significantly different. Normally it is common to include more controls against the cases into such a ratio of 1:3. Recommendations: It is a recommendation to extend this study with more controls and more depth in some factors. Now, it is still too wide examine. In the prospective data there were a lot of missing values, this should be less next time.