title: Understanding 30-day re-admission after hospitalisation of older patients for diabetes: identifying those at greatest risk.
abstract: OBJECTIVE
  To identify factors that contribute to older Australians admitted to hospital with diabetes being re-hospitalised within 30 days of discharge.
  
  
  METHODS
  A retrospective cohort study of Department of Veterans' Affairs administrative data for all patients hospitalised for diabetes and discharged alive during the period 1 January - 31 December 2012.
  
  
  METHODS
  Causes of re-hospitalisation and prevalence of clinical factors associated with re-hospitalisation within 30 days of discharge.
  
  
  METHODS
  Multivariate logistic regression analysis (backward stepwise) was used to identify characteristics predictive of 30-day re-hospitalisation.
  
  
  RESULTS
  848 people were hospitalised for diabetes; their median age was 87 years (interquartile range, 77-89 years) and 60% were men. 209 patients (24.6%) were re-hospitalised within 30 days of discharge, of whom 77.5% were re-admitted within 14 days of discharge. 51 re-hospitalisations (24%) were for diabetes-related conditions; 41% of those re-admitted within 14 days had not seen their general practitioner between discharge and re-admission. Factors predictive of re-hospitalisation included comorbid heart failure (adjusted odds ratio [aOR], 1.49; 95% confidence interval [CI], 1.03-2.17; P = 0.036), numbers of prescribers in previous year (aOR [for each additional prescriber], 1.06; 95% CI, 1.01-1.08; P = 0.031), and two or more hospitalisations in the 6 months before the index admission (aOR, 1.79; 95% CI 1.15-2.78; P = 0.009).
  
  
  CONCLUSIONS
  Older people hospitalised for diabetes who have comorbid heart failure, multiple recent hospitalisations, and multiple prescribers involved in their care are at greatest risk of being re-admitted to hospital within 30 days. Targeted follow-up during the initial 14 days after discharge may facilitate appropriate interventions that avert re-admission of these at-risk patients.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA gillian.caughey@unisa.edu.au.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Caughey
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA.
authors.forename: John D
authors.initials: JD
authors.lastname: Barratt
authors.affiliation: Royal Adelaide Hospital, Adelaide, SA.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Kemp-Casey
authors.affiliation: University of South Australia, Adelaide, SA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors