What risk factors can predict 30-day unplanned readmission in hospitalized otolaryngology patients?
Background: Hospital readmission impacts patients, health care providers, health care institutions, third-party payers and policy makers. From 2003 to 2004, 19.6 percent of Medicare beneficiaries discharged from the hospital were rehospitalized within 30 days, at a cost of $17.4 billion, according to the Centers for Medicare and Medicaid Services (CMS). The Affordable Care Act (ACA) has mandated that hospitals with excess readmission rates for patients with acute myocardial infarction, heart failure or pneumonia face a CMS penalty. Although only three conditions are currently addressed, in the future the ACA could expand the reimbursement policy to cover surgical patients. If risk factors for readmissions in otolaryngology patients can be identified, it would be possible to mitigate these risk factors to decrease readmissions.
Explore this issue:November 2013
Study design: Retrospective cohort study.
Setting: Washington University School of Medicine, St. Louis, Mo.
Synopsis: All patients discharged from the otolaryngology service between January 1, 2011 and December 31, 2011 at the Washington University School of Medicine were identified, and 1,058 met the criteria of an inpatient admission (i.e., they spent at least one night in the hospital). This study cohort together accounted for 1,271 admissions to and discharges from the otolaryngology service. Medical records were reviewed for the primary outcome measure of readmission, which was defined as unplanned admission within 30 days of discharge. Analysis demonstrated a readmission rate of 7.3 percent (93 patients). Risk factors identified included presence of a complication, new total laryngectomy, discharge destination of a skilled nursing facility, severe coronary artery disease or chronic lung disease and current illicit drug use.
Bottom line: This study identified risk factors for readmission specific to the otolaryngology population. Studies like this one are of fundamental importance in the new era of medical economics, in which cost containment is paramount. As risk factors for readmission are identified, future endeavors can focus on developing processes to mitigate these risk factors.
Citation: Graboyes EM, Liou TN, Kallogjeri D, Nussenbaum B, Diaz JA. Risk factors for unplanned hospital readmission in otolaryngology patients. Otolaryngol Head Neck Surg. 2013;149:562-571.
—Reviewed by Ravindhra Elluru MD, PhD