- Patients at the highest risk of very frequent 30-day readmissions may not be the most likely suspects, according to a study published in the American Journal of Managed Care. Jeanne T. Black, PhD, MBA, of Cedars-Sinai Medical Center, found that patients with high numbers of readmissions averaged more than ten years younger than those with just one or two inpatient stays or a control group. Patients with more frequent readmissions were more likely to speak a first language other than English and more likely to be eligible for both Medicare and Medicaid, indicating opportunities to focus preventative care resources on targeted sub-groups of high-risk patients.
Using patient records collected by the medical center’s data warehouse, Black examined a retrospective cohort of 19,049 adult patients with discharges between July 2009 and December 2010 with non-surgical conditions. She divided the patients into three groups: a comparison group with one or two admissions within six months of initial discharge, a “frequent” admissions group with three to five inpatient stays, and a “very frequent” readmissions group with six or more hospital admissions within the identified timeframe.
Ten percent of the patients in the study experienced three to five hospitalizations, but they incurred 71.6% of the 30-day readmissions. The very frequent readmissions group, those with six or more stays, comprised 0.8% of the patient cohort and 17.3% of readmissions. Surprisingly, the average age of the very frequent readmissions group was 53.5 years, while the three-to-five admissions group averaged 65.8. The comparison group averaged 62.4 years.
Both groups with frequent readmissions were more likely than the comparison group to speak English as a second language. Russian, Farsi, and Spanish were the most common first languages for these patients. African-American patients made up 28.3% of the very frequent readmission subgroup and 21.1% of the frequent readmission subgroup, versus just 17.3% of the comparison group. Medicaid patients made up 27.6% of the very frequent admissions patients, more than double the 13.4% of frequent admissions patients and nearly triple the 10% of comparison patients.
“This analysis has several implications for efforts to reduce readmissions. Overall, it suggests that intervention strategies should take into account patients’ readmission histories,” Black concludes. “This analysis does suggest a simple way to identify which patients are at greatest risk of multiple 30-day readmissions: those who have already had 2 or more hospitalizations in the previous 6 months. The real challenge is not in predicting which patients are at highest risk, but in identifying which interventions are likely to be most effective for specific patients.”