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Hospital readmission risk factors 'evolve' over first month

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Risk factors for readmission change significantly over the course of the 30-day period following discharge from hospital, according to US researchers.

They suggests that there are two distinct phases of readmission risk, one after eight days and one after 30 days, which would better inform strategies to prevent patients returning to hospital.

“Our research found that risk factors for readmission evolved”

Kelly Graham

Researchers from the Beth Israel Deaconess Medical Center in Boston reviewed more than 13,000 discharges involving more than 8,000 patients in 2009-10.

They found that early readmissions – zero to seven days post discharge – were associated with markers of the acute illness managed during initial hospitalisation.

However, a patient’s chronic illness burden was more important in predicting late readmissions – eight to 30 days post discharge.

“Our research found that risk factors for readmission evolved during the first 30 days following hospital discharge,” said lead author Dr Kelly Graham.

“Readmissions in the first week were more highly associated with factors related to the initial hospitalisation than later readmissions,” she said.

The study, published in the journal Annals of Internal Medicine, also found that discharge between 8am and 12:59pm was associated with lower odds of an early readmission.

The authors noted that discharge in the first part of the day was likely to enable patients and their families more time to access community resources such as pharmacies and social care – thus reducing the likelihood of readmission.

The authors stressed that both hospital and outpatient settings needed systems of care that closely monitored patients during transfer from hospital teams back to primary care.

Dr Graham added: “Patients discharged from the hospital need support from and teamwork among hospitalists, primary care physicians, nurse practitioners, visiting nurses, pharmacists and others.”

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