Evaluation of Screening Tool to Identify Patients at High Risk for Thirty Day Readmission
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Date
2014-05
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Publisher
The Ohio State University
Abstract
Abstract
Background: Unplanned hospital readmissions are common, expensive and often preventable. The ability to identify patients at high risk for readmission allows healthcare workers to implement targeted readmission prevention strategies.
Purpose: The purpose of this project was to evaluate the effectiveness of a 30-day readmission -risk - screening tool in predicting readmission.
Methods: The project used a retrospective chart review from all patient discharges from one calendar year. Data were collected at St. Luke's hospital in Maumee, Ohio. Eligible records were for adult inpatients over 18 years of age whose insurance type was Medicaid or Medicare and who were readmitted within 30 days of their discharge. Patients in observation status, those discharged to hospice care, or those who died during their hospitalization were excluded. Of 1,123 patients with a 30 day readmission over one year, 160 records were systematically sampled to analyze 33 risk variables which were selected by a group of hospital leaders.
Results: The frequency of each risk factor’s occurrence was calculated. The top ten items were identified and both Chi-square and odds ratio analyses were calculated for these items. The top ten most common risk factors were: polypharmacy (66%) (p Value .031), difficulty with chronic symptom management (55%) (p Value .013), aggregate of >5 clinical factors (48.7%) (p Value .018), dyspnea (40%) (p Value .257), CAD (51.9%) (p Value .574), and chronic/acute kidney disease (39.4%) (p Value .215).
Interpretation: This project identified both valuable and poorly performing items on a risk-for-readmission tool in order to hone the instrument for use in an 11-hospital system. The ability to target high risk patients for intensive discharge preparation in order to reduce early readmission rates is critical given the use of this factor as a measure of a hospital’s quality of care as well as a source of sanctions in reimbursement.
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Keywords
Risk for Readmission, Assessment for high risk for readmission, Reduce 30-day readmission, Predictors of Readmission, Risk Screening Tool for Readmission, Readmission Risk Variables, Patient Readmission, Rehospitlaization