Hospital Readmission Outcomes by Frailty Risk in Adults in Behavioral Health Acute Care

Area of Science:

• Geriatric Medicine
• Psychiatric Nursing
• Health Services Research

Background:

• Hospital readmissions are a significant concern in behavioral health settings.
• Identifying predictors of readmission is crucial for improving patient outcomes and reducing healthcare costs.
• Frailty is an emerging geriatric syndrome with potential implications for various health outcomes.

Purpose of the Study:

• To investigate if frailty predicts 30-day hospital readmissions in adults aged 50 years and older admitted for psychiatric diagnoses.
• To assess the predictive value of a 26-item frailty risk score (FRS-26-ICD) in this patient population.

Main Methods:

• Retrospective study of 1,063 adult patients (≥50 years) admitted to a behavioral health hospital between 2013 and 2017.
• Development of a frailty risk score (FRS-26-ICD) using electronic health record (EHR) data.
• Cox regression modeling to analyze predictors of 30-day readmission, including demographics, emergent admission, comorbidity, and FRS-26-ICD.

Main Results:

• The overall prediction model for readmission had modest performance (AUC = 0.671).
• While the FRS-26-ICD showed some predictive ability alone and with demographics, it lost significance when adjusting for other factors.
• The Elixhauser Comorbidity Index was a significant predictor of readmission (aHR = 1.26), whereas FRS-26-ICD was not.

Conclusions:

• Frailty may not be a significant independent predictor of 30-day readmission in older adults with psychiatric diagnoses when comorbidities are considered.
• Comorbidities, particularly those measured by the Elixhauser index, appear to be stronger predictors of readmission in this population.
• Frailty is a relevant syndrome in behavioral health that warrants further investigation for its role in risk prediction and care planning to prevent readmissions.