title: Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study.
abstract: BACKGROUND
  There is a persistently high incidence of adverse events during hospitalization among Medicare beneficiaries. Attributes of vulnerability are prevalent, readily apparent, and therefore potentially useful for recognizing those at greatest risk for hospital adverse events who may benefit most from preventive measures. We sought to identify patient characteristics associated with adverse events that are present early in a hospital stay.
  
  
  METHODS
  An interprofessional panel selected characteristics thought to confer risk of hospital adverse events and measurable within the setting of acute illness. A convenience sample of 214 Medicare beneficiaries admitted to a large, academic medical center were included in a quality improvement project to develop risk assessment protocols. The data were subsequently analyzed as a prospective cohort study to test the association of risk factors, assessed within 24 hours of hospital admission, with falls, hospital-acquired pressure ulcers (HAPU) and infections (HAI), adverse drug reactions (ADE) and 30-day readmissions.
  
  
  RESULTS
  Mean age = 75(±13.4) years. Risk factors with highest prevalence included >4 active comorbidities (73.8%), polypharmacy (51.7%), and anemia (48.1%). One or more adverse hospital outcomes occurred in 46 patients (21.5%); 56 patients (26.2%) were readmitted within 30 days. Cluster analysis described three adverse outcomes: 30-day readmission, and two groups of in-hospital outcomes. Distinct regression models were identified: Weight loss (OR = 3.83; 95% CI = 1.46, 10.08) and potentially inappropriate medications (OR = 3.05; 95% CI = 1.19, 7.83) were associated with falls, HAPU, procedural complications, or transfer to intensive care; cognitive impairment (OR = 2.32; 95% CI = 1.24, 4.37), anemia (OR = 1.87; 95% CI = 1.00, 3.51) and weight loss (OR = 2.89; 95% CI = 1.38, 6.07) were associated with HAI, ADE, or length of stay >7 days; hyponatremia (OR = 3.49; 95% CI = 1.30, 9.35), prior hospitalization within 30 days (OR = 2.66; 95% CI = 1.31, 5.43) and functional impairment (OR = 2.05; 95% CI = 1.02, 4.13) were associated with 30-day readmission.
  
  
  CONCLUSIONS
  Patient characteristics recognizable within 24 hours of admission can be used to identify increased risk for adverse events and 30-day readmission.
authors.affiliation: Applied Health Services Research, Cedars-Sinai Health System, Los Angeles, CA 90048, USA. jeff.borenstein@cshs.org
authors.forename: Jeff
authors.initials: J
authors.lastname: Borenstein
authors.forename: Harriet Udin
authors.initials: HU
authors.lastname: Aronow
authors.forename: Linda Burnes
authors.initials: LB
authors.lastname: Bolton
authors.forename: Jua
authors.initials: J
authors.lastname: Choi
authors.forename: Catherine
authors.initials: C
authors.lastname: Bresee
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Braunstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D006278:Medicare / Q000639:trends*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology