title: Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice.
abstract: BACKGROUND
  People use emergency department services for a wide variety of health complaints, many of which could be handled outside hospitals. Many frequent readmissions are due to problems with chronic disease and are preventable. We postulated that patient related factors such as the type of condition, demographic factors, access to alternative services outside hospitals and patient preference for hospital or non-hospital services would influence readmissions for chronic disease. This study aimed to explore the link between frequent readmissions in chronic disease and these patient related factors.
  
  
  METHODS
  A retrospective analysis was performed on emergency department data collected from a regional hospital in NSW Australia in 2008. Frequently readmitted patients were defined as those with three or more admissions in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on readmissions using multivariate analysis.
  
  
  RESULTS
  The emergency department received about 20,000 presentations a year involving some 16,000 patients. Most patients (80%) presented only once. In 2008 one hundred and forty four patients were readmitted three or more times in a year. About 20% of all presentations resulted in an admission. Frequently readmitted patients were more likely to be older, have an urgent Triage classification, present with an unplanned returned visit and have a diagnosis of neurosis, chronic obstructive pulmonary disease, dyspnoea or chronic heart failure. The chronic ambulatory care sensitive conditions were strongly associated with frequent readmissions. Frequent readmissions were unrelated to gender, time, day or season of presentation or country of birth.
  
  
  CONCLUSIONS
  Multivariate analysis of routinely collected hospital data identified that the factors associated with frequent readmission include the type of condition, urgency, unplanned return visit and age. Interventions to improve patient uptake of chronic disease management services and improving the availability of alternative non-hospital services should reduce the readmission rate in chronic disease patients.
authors.affiliation: Centre for Primary Health Care & Equity, School of Public Health & Community Medicine, University of New South Wales, UNSW, Sydney, NSW, Australia. s.kirby@student.unsw.edu.au
authors.forename: Sue E
authors.initials: SE
authors.lastname: Kirby
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Dennis
authors.forename: Upali W
authors.initials: UW
authors.lastname: Jayasinghe
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D057240:Patient Preference; D010359:Patient Readmission; D012189:Retrospective Studies; D055815:Young Adult