Depression, Malnutrition Linked to Readmissions

Hospitalists looking to reduce readmissions in high-risk patients should consider targeting mood status and malnutrition, according to the author of a study in this month’s Journal of Hospital Medicine.

The report found that depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3-6.8, P=0.01) and being underweight (adjusted OR, 12.7, 95% CI, 2.3-70.7, P=0.004) were significant predictors of readmission once adjustments were made for age, length, functional status, and length of stay (DOI: 10.1002/jhm.811).

The review was a relatively small cohort study based on 55 readmissions in an Australian teaching hospital. But it is the second in the past six months to hone in on mental status as a predictor of readmissions.

"It’s interesting that malnutrition and depression came up," says author Alison Mudge, MBBS, FRACP, a general physician at Royal Brisbane and Women’s Hospital in Queensland, Australia. "Those are two areas that we kind of sweep under the carpet. … There’s almost an assumption that those symptoms come with the territory."

Dr. Mudge says that until additional research is completed to provide HM groups with evidence-based advice on the best ways to counter the tide of readmissions, hospitalists should view their role as medical town criers calling attention to the warning signs. They should also take advantage of transitional-care programs that have been successful at other institutions, including such initiatives as SHM’s Project BOOST.

"If you’re already providing a transitional-care program but it’s primarily focused on medication reconciliation and social services, perhaps start thinking about what strategies might actually address nutrition, what strategies might actually address depression," Dr. Mudge says.

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