title: Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge.
abstract: BACKGROUND
  Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits.
  
  
  METHODS
  Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009-10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization.
  
  
  RESULTS
  Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n=7,167) and nondrinking (n=357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0-14.6%; and 14.2%, 95% CI 14.1-14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7-13.0%). Only nondrinkers had increased risk for ED visits.
  
  
  CONCLUSIONS
  Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits.
authors.affiliation: Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: ljchavez@uw.edu.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Chavez
authors.affiliation: Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: chuan-fen.liu@va.gov.
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.affiliation: Bates College, 2 Andrews Rd, Lewiston, ME 04240, United States. Electronic address: ntefft@bates.edu.
authors.forename: Nathan
authors.initials: N
authors.lastname: Tefft
authors.affiliation: Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: paul.hebert2@va.gov.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12700 East 19th Ave, Aurora, CO 80045, United States. Electronic address: brendan.clark@ucdenver.edu.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.affiliation: Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States. Electronic address: anna.rubinsky@va.gov.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.affiliation: Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States. Electronic address: lapham.g@ghc.org.
authors.forename: Gwen T
authors.initials: GT
authors.lastname: Lapham
authors.affiliation: Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States; Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States; Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States. Electronic address: bradley.k@ghc.org.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*
keywords: Alcohol screening; Emergency department; Post-discharge care; Quality; Readmissions; Unhealthy alcohol use