title: Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center.
abstract: OBJECTIVE
  Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center.
  
  
  METHODS
  We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions.
  
  
  RESULTS
  We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values < .01).
  
  
  CONCLUSIONS
  We observed a high unplanned readmission rate among our population of patients with cancer. The risk factors identified appear to be related to severity of illness and open up opportunities for improving coordination with primary care physicians, oncologists, and other specialists to manage comorbidities, or perhaps transition appropriate patients to palliative care. Our findings will be instrumental for developing targeted interventions to help reduce readmissions at our hospital. Our data also provide direction for appropriate application of readmission quality measures in cancer hospitals.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX JMManzano@mdanderson.org.
authors.forename: Joanna-Grace M
authors.initials: JG
authors.lastname: Manzano
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sahitya
authors.initials: S
authors.lastname: Gadiraju
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Hiremath
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Heather Yan
authors.initials: HY
authors.lastname: Lin
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jeff
authors.initials: J
authors.lastname: Farroni
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Josiah
authors.initials: J
authors.lastname: Halm
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities; D015331:Cohort Studies; D005260:Female; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies