Characterization, Categorization, and 5-Year Mortality of Medicine High Utilizer Inpatients

Area of Science:

• Internal Medicine
• Health Services Research
• Geriatrics

Background:

• Frequently admitted patients to Medicine inpatient services are a poorly understood subset of readmitted individuals.
• Characterizing this patient group is crucial for developing targeted interventions.

Purpose of the Study:

• To characterize frequently hospitalized patients, including their mortality rates.
• To gain a better understanding of this distinct patient population for improved healthcare management.

Main Methods:

• An observational study defined frequent hospitalization as 4 or more nonelective admissions within a 6-month period.
• Data collected included patient demographics, clinical conditions, comorbidities (age-adjusted Charlson Comorbidity Index - CCI), healthcare utilization, costs, and mortality over 5 years.
• Descriptive statistics were employed to analyze the gathered data.

Main Results:

• 153 patients accounted for 781 hospitalizations, over 4000 hospital days, and approximately $9 million in charges within 6 months.
• Comorbidities were common, with over 40% having mental health disease or chronic narcotic dependence.
• Mortality was high: 29% died within 1 year and 50% within 5 years, with significantly higher CCI scores in deceased patients.

Conclusions:

• Frequent hospitalizations identify distinct patient groups requiring tailored management, such as palliative care for end-stage disease progression and telemanagement for chronic conditions.
• Individualized care management plans are recommended for all frequent admissions, particularly those with chronic conditions or pain.
• An age-adjusted CCI score of 4 or 5 may help identify patients who would benefit from palliative care consultations for end-of-life planning.