Men More Likely To Be Readmitted to Hospital after Discharge, AHRQ-Funded Study Finds
Men are more likely than women to be readmitted to the hospital within a month after being discharged, according to a new study funded by AHRQ. The risk for returning to the hospital within 30 days is higher among men who are retired, unmarried, screen positive for depression or don’t visit a primary care physician for follow-up after their hospitalization, according to the study from researchers at Boston University School of Medicine. The article was published online in BMJ Open. Returning to the hospital within 30 days following discharge occurs frequently and is often linked to complications and longer recovery times. Nearly one in five Medicare patients returned to the hospital within 30 days after discharge from 2003 to 2004 at an estimated yearly cost of $17.4 billion, a 2009 study concluded. Previous research by the Boston University School of Medicine team found that hospital staff could lower the incidence of hospital readmission by 30 percent through specific, coordinated efforts, including providing clear instructions to patients about what they need to do once they leave the hospital and following up with patients after discharge. In the new study, the only risk factor that predicted whether men and women were likely to be readmitted to the hospital within 30 days was whether they had been hospitalized in the previous 6 months.
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Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis -- Woz et al. 2 (2) -- BMJ Open
BMJ Open 2012;2:e000428 doi:10.1136/bmjopen-2011-000428
- Health services research
Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysisOPEN ACCESS
- Shaula Woz1,
- Suzanne Mitchell1,
- Caroline Hesko1,
- Michael Paasche-Orlow2,
- Jeffrey Greenwald2,
- V K Chetty1,
- Julie O'Donnell1,
- Brian Jack1
+ Author Affiliations
- 1Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- 2Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Correspondence to Dr Suzanne Mitchell; firstname.lastname@example.org
- Received 4 October 2011
- Accepted 12 March 2012
- Published 18 April 2012
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.
Early hospital readmission is a common and costly occurrence in the USA. Men often use hospital emergency departments for usual source of medical care.
We aimed to study whether men are therefore more likely to be readmitted to the hospital within 30 days of an index discharge.
Men have higher rates of 30-day readmission to hospital than women in this study group. Men also were less likely to complete a follow-up appointment with their primary care physician after discharge.
Interventions that promote connecting men to primary care, address social isolation and screen for depressive symptoms may reduce the risk for early readmission among men.
Strengths and limitations of this study
This analysis was conducted with the Project RED data set, which included, and allowed controlling for certain clinical and social confounders in our analysis such as subjects' comorbidity burden, depression symptoms, homelessness, substance abuse and other similar risk factors, in our analysis.
This study is limited in that it was conducted at an urban safety-net hospital and may not be generalisable to other types of hospital systems.
We also relied on subject self-report of any rehospitalisation events outside of the study site, however, were able to confirm 91% of all events using our hospital electronic medical record system.