Risk factors for early unplanned hospital readmission in the elderly

Study objective:To determine the prevalence of early (in 14 days or less) readmissions to the hospital, and to identify risk factors for readmission.Design:Matched case-control. Cases (n=155) were readmitted to the hospital within 14 days of a hospital discharge, while controls ( n=155) were not. Controls and cases were matched by week of hospital discharge.Patients:Two-year sequential sample of male veterans aged 65 years and over admitted to the Seattle Veterans Affairs (VA) Medical Center.Measurements:Data about 31 potential risk factors were abstracted from the medical records.Results:Three risk factors associated with readmission risk were identified and include two or more hospital admissions in the previous year [odds ratio (OR)=3.06], any medication dosage change in the 48 hours prior to discharge (OR=2.34), and a visiting nurse referral for follow-up (OR=2.78). One protective factor—discharge from the geriatric evaluation unit (GEU) (OR=0.09)—was also determined.Conclusions:Early unplanned readmissions were frequent at this VA facility. Since the strongest risk factor for readmission was the number of admissions in the previous year, readmissions appeared most commonly among high utilizers of inpatient VA care. This risk factor and others may be useful in identifying a group at high readmission risk, which could be targeted in intervention studies. The reduced readmission rate associated with the GEU suggests one potential intervention to decrease readmission risk.