Factors affecting unplanned readmissions from community hospitals to acute hospitals: a prospective observational study.
BACKGROUND
While the readmission rate from community hospitals is known, the factors affecting it are not. Our aim was to determine the factors predicting unplanned readmissions from community hospitals (CHs) to acute hospitals (AHs).


METHODS
This was an observational prospective cohort study, involving 842 patients requiring post-acute rehabilitation in 2 CHs admitted from 3 AHs in Singapore. We studied the role of the Cumulative Illness Rating Scale (CIRS) organ impairment scores, the Mini-mental State Examination (MMSE) score, the Shah modified Barthel Index (BI) score, and the triceps skin fold thickness (TSFT) in predicting the rate of unplanned readmissions (UR), early unplanned readmissions (EUPR) and late unplanned readmissions (LUPR). We developed a clinical prediction rule to determine the risk of UR and EUPR.


RESULTS
The rates of EUPR and LUPR were 7.6% and 10.3% respectively. The factors that predicted UR were the CIRS-heart score, the CIRS-haemopoietic score, the CIRS-endocrine / metabolic score and the BI on admission. The MMSE was predictive of EUPR. The TSFT and CIRS-liver score were predictive of LUPR. Upon receiver operator characteristics analysis, the clinical prediction rules for the prediction of EUPR and UR had areas under the curve of 0.745 and 0.733 respectively. The likelihood ratios of the clinical prediction rules for EUPR and UR ranged from 0.42 to 5.69 and 0.34 to 3.16 respectively.


CONCLUSIONS
Patients who have UR can be identified by the admission BI, the MMSE, the TSFT and CIRS scores in the cardiac, haemopoietic, liver and endocrine/metabolic systems.
Leong
Ian Y O
IY
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. ian_leong@ttsh.com.sg
Chan
Siew-Pang
SP
Tan
Boon-Yeow
BY
Sitoh
Yih-Yiow
YY
Ang
Yan-Hoon
YH
Merchant
Reshma
R
Kanagasabai
Kala
K
Lee
Patricia S Y
PS
Pang
Weng-Sun
WS
D000208:Acute Disease / Q000628:therapy; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012846:Singapore