title: An analysis of geriatric recidivism in the era of accountable care organizations.
abstract: BACKGROUND
  To date, there are almost 500 accountable care organizations (ACOs) across the United States emphasizing cost-effective care. Readmission largely impacts health care cost; therefore, we sought to determine factors associated with geriatric trauma readmissions (recidivism) within our institution.
  
  
  METHODS
  All admissions from 2000 to 2011 attributed to patients 65 years or older at our Level II trauma center, recently verified by Medicare as an ACO, were queried. Patients were classified as recidivist or nonrecidivist. The first admissions of recidivist patients were compared with the nonrecidivist admissions with respect to sex, age, race, primary insurance, admission Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), hospital length of stay, mechanism of injury (MOI), preexisting conditions, and discharge destination. Factors found to be significant predictors of recidivism in univariate analyses were subsequently incorporated into a multivariate logistic regression model. In addition, the second admission's MOI was compared with the first admission's MOI, and the proportion of first, second, and third admissions attributed to falls was calculated. A p < 0.05 was significant.
  
  
  RESULTS
  Between 2000 and 2011, a total of 4,963 unique patients were admitted to the trauma center at 65 years or older. This population was composed of 287 recidivists (5.8%) and 4,676 nonrecidivists (94.2%). When placed in a multivariate logistic regression, female sex, admission GCS score of 15, history of head trauma, and preexisting pulmonary disease were identified as significant predictors of recidivism. A trend toward increasing proportion of injuries attributed to falls was found with each subsequent trauma admission (81.5% [234 of 287] of first admissions, 88.2% [253 of 287] of second admissions, and 90.5% [19 of 21] of third admissions).
  
  
  CONCLUSIONS
  Our study identifies specific factors that should be targeted by social service and prevention resources to inhibit recidivism in the elderly. In the brave new world of ACOs, trauma centers must identify high-risk populations for the consumption of limited resources.
  
  
  METHODS
  Care management study, level IV. Prognostic study, level III.
authors.affiliation: From the Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Katelyn
authors.initials: K
authors.lastname: Rittenhouse
authors.forename: Carissa
authors.initials: C
authors.lastname: Harnish
authors.forename: Brian
authors.initials: B
authors.lastname: Gross
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Miller
authors.forename: Roxanne
authors.initials: R
authors.lastname: Chandler
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
mesh_terms: D060866:Accountable Care Organizations; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008171:Lung Diseases / Q000150:complications; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D014193:Trauma Centers; D014481:United States