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Patterns of Readmissions for Three Common Conditions Among Younger US Adults
Devraj Sukul1, Shashank S Sinha2, Andrew M Ryan3
1Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center, University of Michigan, Ann Arbor.
Insights
Hospital readmission rates for younger patients are linked to those of older Medicare beneficiaries. Reducing readmissions in elderly patients may also benefit younger populations, though tailored strategies are needed.
Area of Science:
- Healthcare Quality
- Patient Outcomes
- Health Services Research
Background:
- Thirty-day hospital readmissions are a key quality metric for elderly Medicare patients.
- Little is known about readmission patterns in younger patients or their link to elderly patient readmissions within the same hospital.
Purpose of the Study:
- To investigate readmission patterns in younger patients (18-64 years).
- To evaluate the association between hospital readmission rates in elderly Medicare patients and readmission risk in younger patients for acute myocardial infarction, heart failure, and pneumonia.
Main Methods:
- Utilized the 2014 Nationwide Readmissions Database.
- Employed hierarchical models to assess associations between hospital 30-day, risk-standardized readmission rates in elderly patients and readmission risk in younger patients.
Main Results:
- Overall 30-day unplanned readmission rates for younger patients were 8.5% (acute myocardial infarction), 21.4% (heart failure), and 13.7% (pneumonia).
- Younger patients' readmission risk was significantly associated with elderly Medicare patients' hospital readmission rates across all three conditions.
- A decrease in hospital readmission rates for the elderly correlated with reduced readmission risk for younger patients.
Conclusions:
- Readmission risk in younger patients shows a moderate association with hospital readmission rates for elderly Medicare beneficiaries.
- Initiatives aimed at reducing readmissions in older adults may positively impact younger patients.
- Further research is needed to identify specific mechanisms and tailor interventions for younger patient populations.
Background:
Thirty-day readmissions among elderly Medicare patients are an important hospital quality measure. Although plans for using 30-day readmission measures are under consideration for younger patients, little is known about readmission in younger patients or the relationship between readmissions in younger and elderly patients at the same hospital.
Methods:
By using the 2014 Nationwide Readmissions Database, we examined readmission patterns in younger patients (18-64 years) using hierarchical models to evaluate associations between hospital 30-day, risk-standardized readmission rates in elderly Medicare patients and readmission risk in younger patients with acute myocardial infarction, heart failure, or pneumonia.
Results:
There were 87,818, 98,315, and 103,251 admissions in younger patients for acute myocardial infarction, heart failure, and pneumonia, respectively, with overall 30-day unplanned readmission rates of 8.5%, 21.4%, and 13.7%, respectively. Readmission risk in younger patients was significantly associated with hospital 30-day risk-standardized readmission rates for elderly Medicare patients for all 3 conditions. A decrease in an average hospital's 30-day, risk-standardized readmission rates from the 75th percentile to the 25th percentile was associated with reduction in younger patients' risk of readmission from 8.8% to 8.0% (difference: 0.7%; 95% confidence interval, 0.5-0.9) for acute myocardial infarction; 21.8% to 20.0% (difference: 1.8%; 95% confidence interval, 1.4-2.2) for heart failure; and 13.9% to 13.1% (difference: 0.8%; 95% confidence interval, 0.5-1.0) for pneumonia.
Conclusions:
Among younger patients, readmission risk was moderately associated with hospital 30-day, risk-standardized readmission rates in elderly Medicare beneficiaries. Efforts to reduce readmissions among older patients may have important areas of overlap with younger patients, although further research may be necessary to identify specific mechanisms to tailor initiatives to younger patients.
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