title: Quality of care factors associated with unplanned readmissions of older medical patients: a case-control study.
abstract: BACKGROUND
  Unplanned readmissions befall up to 25% of acutely hospitalised older patients, and many may be potentially preventable.
  
  
  OBJECTIVE
  To assess the type and prevalence of quality of care factors associated with potentially preventable readmissions to a tertiary hospital general medicine service.
  
  
  METHODS
  A retrospective case-control study was undertaken of hospital records of patients 65 years or older admitted acutely between 1 January 2005 and 31 December 2010. Readmissions up to 30 days postdischarge (cases) were purposively sampled according to frequencies of primary discharge diagnoses coded during the study period. Non-readmitted patients (controls), matched according to age, sex and primary discharge diagnosis on index admission, were selected in a 1.7:1 ratio.
  
  
  RESULTS
  One hundred and thirteen cases and 198 controls were analysed, the former demonstrating a significantly higher comorbidity burden (mean (±standard deviation) comorbidity score 6.6 (±2.2) vs 5.6 (±2.4), P = 0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (55.7% vs 8.1%, P < 0.001). Among readmitted patients, 50 (44.3%) were associated with one or more quality factors versus 23 (11.6%) controls (P < 0.001). The most common were: failure to develop/activate an advance care plan (18, 15.9% vs 2, 1.0%; P < 0.001); suboptimal management of presenting illness (13, 11.4% vs 0, 0%; P < 0.001); inadequate assessment of functional limitations (11, 9.7% vs 0, 0%; P < 0.001); and potentially preventable complication of therapy (8, 7.1% vs 1, 0.5%, P = 0.002).
  
  
  CONCLUSIONS
  Quality of care factors are more common among readmitted than among non-readmitted older patients suggesting potential for remedial strategies. Such strategies may still have limited effects as older, frail patients with advanced diseases and multimorbidity will likely retain a high propensity for readmission despite optimal care.
authors: Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia.
authors: I A
authors: IA
authors: Scott
authors: H
authors: H
authors: Shohag
authors: M
authors: M
authors: Ahmed
mesh_terms: D000368:Aged; D001315:Australia; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000592:standards; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration; D011787:Quality of Health Care; D012307:Risk Factors; D013997:Time Factors
keywords: older medical patient; quality of care; unplanned readmission