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Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

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ABSTRACT

BACKGROUND

Hospital readmission within thirty days is common among Medicare beneficiaries, but the relationship between rehospitalization and subsequent mortality in older adults is not known.

OBJECTIVE

To compare one-year mortality rates among community-dwelling elderly hospitalized Medicare beneficiaries who did and did not experience early hospital readmission (within 30 days), and to estimate the odds of one-year mortality associated with early hospital readmission and with other patient characteristics.

DESIGN AND PARTICIPANTS

A cohort study of 2133 hospitalized community-dwelling Medicare beneficiaries older than 64 years, who participated in the nationally representative Cost and Use Medicare Current Beneficiary Survey between 2001 and 2004, with follow-up through 2006.

MAIN MEASURE

One-year mortality after index hospitalization discharge.

KEY RESULTS

Three hundred and four (13.7 %) hospitalized beneficiaries had an early hospital readmission. Those with early readmission had higher one-year mortality (38.7 %) than patients who were not readmitted (12.1 %; p < 0.001). Early readmission remained independently associated with mortality after adjustment for sociodemographic factors, health and functional status, medical comorbidity, and index hospitalization-related characteristics [HR (95 % CI) 2.97 (2.24-3.92)]. Other patient characteristics independently associated with mortality included age [1.03 (1.02-1.05) per year], low income [1.39 (1.04-1.86)], limited self-rated health [1.60 (1.20-2.14)], two or more recent hospitalizations [1.47 (1.01-2.15)], mobility difficulty [1.51 (1.03-2.20)], being underweight [1.62 (1.14-2.31)], and several comorbid conditions, including chronic lung disease, cancer, renal failure, and weight loss. Hospitalization-related factors independently associated with mortality included longer length of stay, discharge to a skilled nursing facility for post-acute care, and primary diagnoses of infections, cancer, acute myocardial infarction, and heart failure.

CONCLUSIONS

Among community-dwelling older adults, early hospital readmission is a marker for notably increased risk of one-year mortality. Providers, patients, and families all might respond profitably to an early readmission by reviewing treatment plans and goals of care.

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Acknowledgments

The authors would like to thank Dr Robert Arnold, MD, Department of Medicine, University of Pittsburgh for critical review. Grant support from AG032291 and the Pittsburgh Claude D. Pepper Older Americans Independence Center (P30 AG024827), National Institute on Aging. Dr Hardy receives support from a Beeson Career Development Award (AG030977). This paper was presented at the American Geriatrics Society 2010 Annual Scientific Meeting, May 13, 2010.

Conflict of Interest

Drs. Lum, Degenholtz, and Hardy declare that they do not have a conflict of interest. Dr. Studenski has consulted for Merck, Novartis, and GTX, received grant funding from Merck, and received textbook royalties from McGraw Hill.

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Authors and Affiliations

  1. Division of Geriatric Medicine, University of Colorado School of Medicine, Denver, CO, USA

    Hillary D. Lum MD, PhD

  2. Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Kaufmann Bldg, Ste 500, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA

    Stephanie A. Studenski MD, MPH & Susan E. Hardy MD, PhD

  3. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    Howard B. Degenholtz PhD

Authors
  1. Hillary D. Lum MD, PhD
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  2. Stephanie A. Studenski MD, MPH
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  3. Howard B. Degenholtz PhD
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  4. Susan E. Hardy MD, PhD
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Corresponding author

Correspondence to Susan E. Hardy MD, PhD.

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Lum, H.D., Studenski, S.A., Degenholtz, H.B. et al. Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries. J GEN INTERN MED 27, 1467–1474 (2012). https://doi.org/10.1007/s11606-012-2116-3

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  • DOI: https://doi.org/10.1007/s11606-012-2116-3

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