Contributing Variables of 30-Day Readmission and ER Utilization

Background: Patients in the United States, especially the elderly and frail, are vulnerable to poor outcomes from our current health care system. Fragmentation in delivery of care such as miscommunication and lack of follow-up can lead to oversight in diagnosis and disease management. Appropriate Transition of Care (TOC) services to address these issues reduce unnecessary readmission and frequent visits to the Emergency Department. These activities also improve the quality of care and are expected to reduce healthcare cost. Objectives: The purpose of this descriptive study was to identify if certain characteristics place patients at higher risk for 30-day readmission and ER Utilization. The aim of the study was to identify the impact of specific variables (age, gender, diagnosis, marital status, social support, and TOC nurse phone call follow up) on 30-day readmission and ER utilization in adults over 65 years old. Additional data was used to compare the cost of care for this patient population and whether there is any benefit to offering TOC follow-up to this patient cohort. Methods: A secondary data analysis analyzed clinical data collected over an 18-month time frame by a TOC nurse using a descriptive-correlational design. The subjects for this study are patients embedded in an Internal Medicine practice in Upstate New York over the age of 65 and admitted to the target hospital in the community. Statistical correlation with SPSS software using logistic regression was used to report the variables and determine their relationship to 30-day readmission and ER utilization. Results: A tracking tool collected 1,376 patients in the inpatient arm and 1,575 in the ER visit group. After applying the inclusion and exclusion criteria from the study, 367 patients were included in the 30-day readmission group and 525 patients were included in the ER Utilization data set. Readmission rate was 28.6% for the inpatient admission. Among all variables, TOC nurse phone calls made to patient within 48 hours of discharge was the only significant variable at the 5% level (p value = 0.03). In the ER Utilization group, 21.7% of the patients experienced frequent ER Utilization over a 30-day period. Among this group, married individuals and younger age significantly impacted frequent ER utilization (p values = 0.003 and 0.000, respectively). Conclusions: Follow up care can improve the quality of care and decrease cost through a reduction in 30-day readmission. While this service does not impact frequent ER utilization based on the available data, identifying patients who are vulnerable to frequent ER visits (unmarried and elderly) will direct further studies to this susceptible population. Additional studies should be conducted in a variety of patient populations to further identify the variables that impact care and decrease healthcare cost