The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.
Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.
"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."
For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.
Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.
"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”