Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis -- Woz et al. 2 (2) -- BMJ Open

Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis -- Woz et al. 2 (2) -- BMJ Open

BMJ Openbmjopen.bmj.com

BMJ Open 2012;2:e000428 doi:10.1136/bmjopen-2011-000428

• Health services research
  • Research

Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis

OPEN ACCESS

1. Shaula Woz1,
2. Suzanne Mitchell1,
3. Caroline Hesko1,
4. Michael Paasche-Orlow2,
5. Jeffrey Greenwald2,
6. V K Chetty1,
7. Julie O'Donnell1,
8. Brian Jack1

+ Author Affiliations

1. ¹Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
2. ²Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA

1. Correspondence to Dr Suzanne Mitchell; suzanne.mitchell@bmc.org

• Received 4 October 2011
• Accepted 12 March 2012
• Published 18 April 2012

Abstract

Objective In the 30 days after hospital discharge, hospital utilisation is common and costly. This study evaluated the association between gender and hospital utilisation within 30 days of discharge.

Design Secondary data analysis using Poisson regression stratified by gender.

Participants 737 English-speaking hospitalised adults from general medical service in urban, academic safety-net medical centre who participated in the Project Re-Engineered clinical trial (clinicaltrials.gov identifier: NCT00252057).

Main outcome measure The primary end point was hospital utilisation, defined as total emergency department visits and hospital readmissions within 30 days after index discharge.

Results Female subjects had a rate of 29 events for every 100 people and male subjects had a rate of 47 events for every 100 people (incident rate ratio (IRR) 1.62, 95% CI 1.28 to 2.06). Among men, risk factors included hospital utilisation in the 6 months prior to the index hospitalisation (IRR 3.55, 95% CI 2.38 to 5.29), being unmarried (IRR 1.72, 95% CI 1.12 to 2.64), having a positive depression screen (IRR 1.53, 95% CI 1.09 to 2.13) and no primary care physician (PCP) visit within 30 days (IRR 1.64, 95% CI 1.08 to 2.50). Among women, the only risk factor was hospital utilisation in the 6 months prior to the index hospitalisation (IRR 3.08, 95% CI 1.86 to 5.10).

Conclusions In our data, male subjects had a higher rate of hospital utilisation within 30 days of discharge than female subjects. For men—but not for women—risk factors were being retired, unmarried, having depressive symptoms and having no PCP visit within 30 days. Interventions addressing these factors might lower hospital utilisation rates observed among men.

Footnotes

• SM is a consultant and speaker for the non-product health topics series on relationship centred care for Merck & Co.
• To cite: Woz S, Mitchell S, Hesko C, et al. Gender as Risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis. BMJ Open 2012;2:e000428. doi:10.1136/bmjopen-2011-000428
• Contributors SW was responsible for conception, design, acquisition of data, analysis and interpretation of results. She also made significant contributions to the drafting of the manuscript and revising for intellectual content and final approval of published version. SM was responsible for the analysis and interpretation of the results and made significant contributions to the drafting of the manuscript, its intellectual content and final approval of published version. CH was responsible for conception, design and acquisition of data and analysis and interpretation of the data. She contributed to the intellectual content of the manuscript and was responsible for approval of the final version of the article. MP was responsible for conception and design and analysis and interpretation of data. He also contributed significantly to the critical revisions of the manuscript and final approval of the submitted version. JG was responsible for conception and design and analysis and interpretation of data. He also contributed significantly to the critical revisions of the manuscript and final approval of the submitted version. VKC was responsible for conception and design, data analysis and interpretation, drafting of the manuscript and approval of the final version. JO was responsible for design, data collection, analysis and interpretation, drafting of the manuscript and final approval of published version. BJ was responsible for conception and design and analysis and interpretation of data. He also contributed significantly to the critical revisions of the manuscript and final approval of the submitted version.
• Funding This project was supported by the Agency for Healthcare Research and Quality grants 1UC1HS014289-01 and 1U18HS015905-01 (BJ) and National Heart, Lung, and Blood Institute, National Institutes of Health, grant 1 R01 HL081307-01 (BJ).
• Competing interests None.
• Ethics approval Ethics approval was approved by the Boston University Internal Review Board.
• Provenance and peer review Not commissioned; externally peer reviewed.
• Data sharing statement No unpublished data are available.

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