Healthcare News & Insights

Study looks at readmission causes for all payors

Most studies of readmissions focus on Medicare patients, and for good reason: Hospitals are penalized for high Medicare readmissions rates. However, to get readmissions under control, facilities must look at the full scope of the problem among all types of patients – not just senior citizens. 

New research sheds light on the factors that contribute to readmissions among other segments of the population, including younger people and those with private insurance.

The study, conducted by researchers at Beth Israel Deaconess Medical Center, was published in journal PLOS ONE.

Stats on readmissions

According to a news release about the study, using information from a nationwide readmissions database, researchers compared the causes and frequency of 30-day readmissions among various patients over an 11-month period.

Discharges were analyzed from over 2,000 different hospitals in 31 states among adult patients from three age groups: 18 to 44, 45 to 64 and 65+.

Out of more than 12.5 million discharges examined by researchers, approximately 1.8 million patients were readmitted within 30 days of their initial hospital stay. In all, these readmissions had an annual cost of $50.7 billion – $29.6 billion for Medicare patients and over $21 billion for non-Medicare patients.

The majority of readmissions (56%) were for Medicare patients. When broken down by age, patients aged 18 to 44 were more likely to be readmitted if they had Medicare. Those aged 45 to 64 and those aged 65 plus had a higher chance of being readmitted if they received Medicaid.

Top diagnoses

Overall, the most common diagnoses that led to readmissions across all age groups and payors were:

  • sepsis (4.7%)
  • heart failure (4.6%)
  • cellulitis (3.1%)
  • chronic bronchitis (2.8%), and
  • cardiac dysrhythmias (2.7%)

However, big differences existed when breaking readmission rates down by age. Younger adults aged 18 to 44 were most likely to be readmitted after hospital stays for psychiatric disease, complications of pregnancy and diabetes. Adults 45 to 64 were mostly readmitted after sepsis, heart failure and psychiatric disease. The top diagnoses causing those over 65 to be readmitted to the hospital were heart failure, sepsis, cardiac dysrhythmias and chronic bronchitis.

Knowing which conditions are closely related to readmissions can help hospitals create targeted strategies to address them and improve patient outcomes.

Drugs & mental illness

Another trend to note is the impact of a patient’s mental state on readmissions, as well as any past drug abuse. In the 18 to 44 age group, nearly 38% of those who were readmitted to the hospital had a history of psychiatric disease or substance abuse. The number rose slightly, to over 40%, for patients age 45 to 64. Nearly 19% of those 65 or older who were readmitted had a history of these issues.

Drug abuse and mental illness are both serious problems impacting society right now, so it’s no surprise they have such an effect in readmission rates. As hospitals take a bigger role in boosting population health and take more financial responsibility for readmission rates, it’s critical to look into ways to assist patients struggling with mental health issues or addiction.

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