Predictors and outcomes of unplanned readmission to a different hospital

다국어 초록 (Multilingual Abstract)

<P><B>Objectives</B></P><P>To examine patient, hospital and market factors and outcomes associated with readmission to a different hospital compared with the same hospital.</P><P><B>Design</B></P><P>A population-based, secondary analysis using multilevel causal modeling.</P><P><B>Setting</B></P><P>Acute care hospitals in California in the USA.</P><P><B>Participants</B></P><P>In total, 509 775 patients aged 50 or older who were discharged alive from acute care hospitals (index hospitalizations), and 59 566 who had a rehospitalization within 30 days following their index discharge.</P><P><B>Intervention</B></P><P>No intervention.</P><P><B>Main Outcome Measures(s)</B></P><P>Thirty-day unplanned readmissions to a different hospital compared with the same hospital and also the costs and health outcomes of the readmissions.</P><P><B>Results</B></P><P>Twenty-one percent of patients with a rehospitalization had a different-hospital readmission. Compared with the same-hospital readmission group, the different-hospital readmission group was more likely to be younger, male and have a lower income. The index hospitals of the different-hospital readmission group were more likely to be smaller, for-profit hospitals, which were also more likely to be located in counties with higher competition. The different-hospital readmission group had higher odds for in-hospital death (8.1 vs. 6.7%; <I>P</I> < 0.0001) and greater readmission hospital costs ($15 671.8 vs. $14 286.4; <I>P</I> < 0.001) than the same-hospital readmission group.</P><P><B>Conclusions</B></P><P>Patient, hospital and market characteristics predicted different-hospital readmissions compared with same-hospital readmissions. Mortality and cost outcomes were worse among patients with different-hospital readmissions. Strategies for better care coordination targeting people at risk for different-hospital readmissions are necessary.</P>