Factors associated with preventable readmissions
| Factors | Total sample N=276 | Preventable readmission or undecided N=165 (59.8%) | Non-preventable readmission N=111 (40.2%) | OR (95% CI) | P value | |||
| No. | (%) | No. | (%) | No | (%) | |||
| Patient characteristic | ||||||||
| Male sex | 182 | (65.9) | 107 | (64.8) | 75 | (67.6) | 1.13 (0.68–1.89) | 0.64 |
| Age, median (IQR), years | 70 | (60–78) | 71 | (61–78) | 69 | (59–77) | 1.00 (0.98–1.02) | 0.91 |
| Education level | ||||||||
| None | 77 | (27.9) | 52 | (31.5) | 25 | (22.5) | 1.37 (0.67–2.78) | 0.39 |
| Elementary education* | 141 | (51.1) | 78 | (47.3) | 63 | (56.8) | 0.81 (0.44–1.52) | 0.52 |
| Higher education† | 58 | (21.0) | 35 | (21.2) | 23 | (20.7) | 1.03 (0.57–1.86) | 0.92 |
| Charlson comorbidity index, median (IQR) | 5.0 | (3.0–6.0) | 4.5 | (3.0–6.8) | 5.0 | (3.0–6.0) | 1.00 (0.93–1.11) | 0.71 |
| Length of initial hospital stay (days), median (IQR) | 7.0 | (4.0–11.0) | 6.0 | (4.0–10.0) | 8.0 | (5.0–12.0) | 0.99 (0.97–1.02) | 0.50 |
| Admission to a medical ward | 160 | (58.0) | 90 | (54.5) | 70 | (63.1) | 0.70 (0.43–1.15) | 0.16 |
| Admission to a surgical ward | 116 | (42.0) | 41 | (36.9) | 75 | (45.5) | 1.42 (0.87–2.33) | 0.16 |
| Number of days between discharge and readmission, median (IQR) | 11.0 | (5.0–17.0) | 9.0 | (4.0–15.0) | 14.0 | (7.0–19.5) | 0.95 (0.92–0.98) | 0.002 |
| Caregiver support home | 23 | (9.2) | 12 | (8.1) | 12 | (11.0) | 0.71 (0.30–1.67) | 0.71 |
| Polypharmacy‡ | 178 | (64.7) | 104 | (58.4) | 74 | (41.6) | 0.83 (0.50–1.38) | 0.47 |
| Functional status at discharge | ||||||||
| Poor self-related health§ | 88 | (31.9) | 52 | (31.5) | 36 | (32.4) | 0.78 (0.41–1.46) | 0.43 |
| Fully dependent¶ | 60 | (21.7) | 37 | (22.4) | 23 | (20.7) | 1.56 (0.76–3.19) | 0.23 |
| Somewhat dependent¶ | 153 | (55.4) | 96 | (58.2) | 57 | (51.4) | 1.63 (0.90–2.95) | 0.11 |
| Independent¶ | 63 | (22.8) | 32 | (19.4) | 31 | (27.9) | 0.62 (0.35–1.09) | 0.62 |
| Discharge process | ||||||||
| Patient remember diagnosis | (n=272) | (n=162) | (n=110) | 1.96 (1.10–3.50) | 0.02 | |||
| No | 62 | (22.8) | 29 | (17.9) | 33 | (30.0) | ||
| Yes | 210 | (77.2) | 133 | (63.3) | 77 | (36.7) | ||
| Attended ≥1 follow-up appointment | (n=276) | (n=165) | (n=111) | 0.69 (0.42–1.14) | 0.14 | |||
| No | 171 | (62.0) | 108 | (65.5) | 63 | (56.8) | ||
| Yes | 105 | (38.0) | 57 | (34.5) | 48 | (43.2) | ||
| Follow-up appointment with PCP, specialist or nurse arranged or already scheduled on discharge | (n=272) | (n=164) | (n=108) | 0.51 (0.30–0.84) | 0.009 | |||
| No | 112 | (41.2) | 78 | (47.6) | 34 | (31.5) | ||
| Yes | 160 | (58.8) | 86 | (52.4) | 74 | (68.5) | ||
| Had medications reviewed before discharge | (n=263) | (n=157) | (n=106) | 0.32 (0.11–0.98) | 0.048 | |||
| No | 21 | (7.6) | 17 | (10.8) | 4 | (3.8) | ||
| Yes | 242 | (87.7) | 140 | (89.2) | 102 | (96.2) | ||
| Felt all concerns were addressed before discharge | (n=275) | (n=165) | (n=110) | 0.30 (0.17–0.54) | <0.001 | |||
| No | 93 | (33.8) | 72 | (43.6) | 21 | (19.1) | ||
| Yes | 182 | (66.2) | 93 | (56.4) | 89 | (80.9) | ||
| Remember talking with physician or nurse about recommendations at discharge | (n=249) | (n=149) | (n=100) | 1.41 (0.80–2.48) | 0.23 | |||
| No | 36 | (24.2) | 36 | (24.2) | 31 | (31.0) | ||
| Yes | 113 | (75.8) | 113 | (75.8) | 69 | (69.0) | ||
| Patient satisfied, mean (SD)** | 8.1 | (2.0) | 7.8 | (2.3) | 8.6 | (1.4) | 0.77 (0.67–0.90) | 0.001 |
| Discharged to skilled nursing facility | (n=276) | (n=165) | (n=111) | 3.89 (0.85–17.9) | 0.08 | |||
| No | 263 | (95.3) | 154 | (93.3) | 109 | (98.2) | ||
| Yes | 13 | (4.7) | 11 | (6.7) | 2 | (1.8) | ||
| Same-day discharge reported | (n=252) | (n=70) | (n=182) | 2.74 (1.18–6.46) | 0.019 | |||
| No | 182 | (72.2) | 104 | (68.0) | 78 | (78.8) | ||
| Yes | 70 | (27.8) | 49 | (32.0) | 21 | (21.2) | ||
| Felt they were discharged before ready | (n=254) | (n=147) | (n=107) | 0.36 (0.21–0.64) | <0.001 | |||
| No | 168 | (60.9) | 84 | (57.1) | 84 | (78.5) | ||
| Yes | 86 | (31.2) | 63 | (42.9) | 23 | (21.5) | ||
| Reported improved overall health condition from index admission to index discharge | (n=263) | (n=155) | (n=108) | 0.84 (0.45–1.56) | 0.84 | |||
| No | 53 | (20.2) | 33 | (21.3) | 20 | (18.5) | ||
| Yes | 210 | (76.1) | 122 | (78.7) | 88 | (81.5) | ||
| Follow-up care | ||||||||
| Contacted healthcare professional before readmission | (n=276) | (n=165) | (n=111) | 0.74 (0.45–1.21) | 0.23 | |||
| No | 119 | (43.1) | 76 | (46.1) | 43 | (38.7) | ||
| Yes | 157 | (56.9) | 89 | (53.9) | 68 | (61.3) | ||
| Feeling concern | (n=276) | (n=165) | (n=111) | 2.20 (1.34–3.67) | 0.002 | |||
| No | 155 | (56.2) | 80 | (48.5) | 75 | (67.6) | ||
| Yes | 121 | (43.8) | 85 | (51.5) | 36 | (32.4) | ||
| Depression†† | (n=264) | (n=160) | (n=104) | 0.73 (0.44–1.20) | 0.21 | |||
| No | 132 | (50.0) | 85 | (53.1) | 47 | (45.2) | ||
| Yes | 132 | (50.0) | 75 | (46.9) | 57 | (54.8) | ||
*Elementary education included primary or secondary education.
†Higher education included post-secondary or university education.
‡Polypharmacy: regular use of at least six medications daily.
§Self-related health: in general, would you say your health is: excellent, very good, good, fair or poor.
¶Functional status: (a) can you get out of bed or chair yourself; (b) can you dress and bathe yourself; (c) can you make your own meals and (d) can you do your own shopping (yes and no).
**Patient satisfaction with hospital discharge team. Responses were recorded on a scale of 0–10, from ‘very unsatisfactory’ to ‘very satisfactory’.
††Depression. PHQ-2 score ≥3.
IQR, interquartile range; PCP, primary care physician; PHQ-2, the Patient Health Questionnaire; SD, standard deviation.