title: Patient Factors Predictive of Hospital Readmissions Within 30 Days.
abstract: BACKGROUND
  Under the Affordable Care Act, the Congress has mandated that the Centers for Medicare and Medicaid Services reduce payments to hospitals subject to their Inpatient Prospective Payment System that exhibits excess readmissions. Using hospital-coded discharge abstracts, we constructed a readmission measure that accounts for cross-hospital variation that enables hospitals to monitor their entire inpatient populations and evaluate their readmission rates relative to national benchmarks.
  
  
  METHODS
  Multivariate logistic regressions are applied to determine which patient factors increase the odds of a readmission within 30 days and by how much. This study uses deidentified discharge abstract data from a database of approximately 15 million inpatient discharges representing 611 acute care hospitals from Premier healthcare alliance over a 2-year period (2008q4-2010q3). The hospitals are geographically diverse and represent large urban academic centers and small rural community hospitals.
  
  
  RESULTS
  This study demonstrates that meaningful risk-adjusted readmission rates can be tracked in a dynamic database. The clinical conditions responsible for the index admission were the strongest predictive factor of readmissions, but factors such as age and accompanying comorbid conditions were also important. Socioeconomic factors, such as race, income, and payer status, also showed strong statistical significance in predicting readmissions.
  
  
  CONCLUSIONS
  Payment models that are based on stratified comparisons might result in a more equitable payment system while at the same time providing transparency regarding disparities based on these factors. No model, yet available, discriminates potentially modifiable readmissions from those not subject to intervention highlighting the fact that the optimum readmission rate for any given condition is yet to be identified.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kroch
authors.forename: Michael
authors.initials: M
authors.lastname: Duan
authors.forename: John
authors.initials: J
authors.lastname: Martin
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bankowitz
mesh_terms: D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge; D058991:Patient Protection and Affordable Care Act; D010359:Patient Readmission / Q000639:trends*; D010361:Patients; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States