Readmission Rates and Determinants in a Higher-Risk In-patient GIM Population

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Janet G. Gilmour MD
Danielle A. Southern MSc
William A. Ghali MD MPH

improvement in readmission rates, higher-risk inpatients, gim population

Abstract

Unplanned readmission to hospital is a costly and frequent event. The authors sought to study readmission rates and determinants in a higher risk in-patient general internal medicine population. They undertook a medical record review of discharges from such a unit. The chart review data were then linked to administrative discharge data and used to query for any readmission within 3 months or 1 year. The authors found that 219 in-patients were discharged alive. Of these, 51 (23.3%) were readmitted to a hospital within 3 months of discharge. In extended Kaplan-Meier analysis, there was a 47.6% readmission rate by 12 months after discharge. Important variables predicting readmission were liver disease, metastatic cancer, and a change in most responsible physician. The latter was a risk factor independent of length of hospital stay. The authors demonstrate that patients admitted to a general internal medicine service are at high risk for readmission to hospital. A change in the most responsible physician during the index admission is an independent risk factor for readmission. Processes around the transfer of care of patients between physicians may provide an opportunity for improvement in readmission rates and overall quality of care.
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