Friday, November 2, 2012

Are social factors tied to hospital readmissions?

With hospital readmission rates being tied into reimbursement under the Healthcare law, there is new scrutiny of the causes behind readmission. Reuters recently published an article looking at non-medical causes for readmission. They report that  there may be several non-medical factors outside of hospitals' control that are linked to how heart and pneumonia patients fare once they're discharged, according to a fresh look at past research. The full article can be found here.
In the new study, published in the Journal of General Internal Medicine, researchers analyzed data from 72 previous papers examining the reasons people died after being released from the hospital, or were readmitted to the hospital, and found that age, race, employment status, living situation, education and income levels are just some of the factors that may play a role.
Researchers say they still don’t know how to accurately measure these factors.  The study’s lead author, Dr. Linda Calvillo-King, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas, and her colleagues gathered research that examined social factors and hospital readmissions in heart and pneumonia patients over about 30 years. Overall, the researchers were able to pull information from 20 studies looking at pneumonia and 52 looking at heart failure.
For pneumonia patients, among the factors linked to the risk of being readmitted to the hospital were being older and not white. Having a low level of education, low income and being unemployed were also tied to a higher risk of going back into the hospital.
Being older and being a man were each associated with a greater chance of dying within the 30 days after being released from a hospital, as was being a nursing home resident.
For heart failure patients, the risk of being readmitted to a hospital was tied to being elderly, African American or Hispanic.
The type of insurance a person had, their marital status and economic status were also among the factors tied to heart patients' risk of being readmitted to a hospital - as were risky behaviors, such as smoking and cocaine use.
Many of the same factors were linked both to a heart failure patient's risk of death after being hospitalized and the risk of readmission to the hospital.
Some studies also found that living far away from a hospital and feeling cold at home were linked to an increased risk of dying for heart failure patients.
The studies reviewed varied in sample size, demographics and social factors.  The researchers say future studies should focus on which factors are the most important, how they should be accounted for and how to address them
Particularly since CMS compares hospitals "according to 30-day readmission and mortality rates," the researchers write, identifying the social factors that affect patient outcomes and yet are beyond a hospital's control could make assessments of the care patients actually do get in the hospital more accurate.

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