Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status.
Frequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore.



An observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions.



A total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions.



Our study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk.
Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.|Family Medicine Clerkship, Duke-NUS Medical School, Singapore.
Lian Leng
LL
Low
Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.|Family Medicine Clerkship, Duke-NUS Medical School, Singapore.
Wei Yi
WY
Tay
Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.|Family Medicine Clerkship, Duke-NUS Medical School, Singapore.
Matthew Joo Ming
MJ
Ng
Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.|Family Medicine Clerkship, Duke-NUS Medical School, Singapore.
Shu Yun
SY
Tan
Department of Emergency Medicine, Singapore General Hospital, Singapore.|Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Nan
N
Liu
Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.|Family Medicine Clerkship, Duke-NUS Medical School, Singapore.
Kheng Hock
KH
Lee
D000328:Adult; D000368:Aged; D015897:Comorbidity; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D010359:Patient Readmission; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore; D012923:Social Class
frequent admissions; readmission; socioeconomic