Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults

Abstract

ImportanceWhen an older adult is hospitalized, where they are discharged is of utmost importance. Fragmented readmissions, defined as readmissions to a different hospital than a patient was previously discharged from, may increase the risk of a nonhome discharge for older adults. However, this risk may be mitigated via electronic information exchange between the admission and readmission hospitals.ObjectiveTo determine the association of fragmented hospital readmissions and electronic information sharing with discharge destination among Medicare beneficiaries.Design, Setting, and ParticipantsThis cohort study retrospectively examined data from Medicare beneficiaries hospitalized for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, syncope, urinary tract infection, dehydration, or behavioral issues in 2018 and their 30-day readmission for any reason. The data analysis was completed between November 1, 2021, and October 31, 2022.ExposuresSame hospital vs fragmented readmissions and presence of the same health information exchange (HIE) at the admission and readmission hospitals vs no information shared between the admission and readmission hospitals.Main Outcomes and MeasuresThe main outcome was discharge destination following the readmission, including home, home with home health, skilled nursing facility (SNF), hospice, leaving against medical advice, or dying. Outcomes were examined for beneficiaries with and without Alzheimer disease using logistic regressions.ResultsThe cohort included 275 189 admission-readmission pairs, representing 268 768 unique patients (mean [SD] age, 78.9 [9.0] years; 54.1% female and 45.9% male; 12.2% Black, 82.1% White, and 5.7% other race and ethnicity). Of the 31.6% fragmented readmissions in the cohort, 14.3% occurred at hospitals that shared an HIE with the admission hospital. Beneficiaries with same hospital/nonfragmented readmissions tended to be older (mean [SD] age, 78.9 [9.0] vs 77.9 [8.8] for fragmented with same HIE and 78.3 [8.7] years for fragmented without HIE; P < .001). Fragmented readmissions were associated with 10% higher odds of discharge to an SNF (adjusted odds ratio [AOR], 1.10; 95% CI, 1.07-1.12) and 22% lower odds of discharge home with home health (AOR, 0.78; 95% CI, 0.76-0.80) compared with same hospital/nonfragmented readmissions. When the admission and readmission hospital shared an HIE, beneficiaries had 9% to 15% higher odds of discharge home with home health (patients without Alzheimer disease: AOR, 1.09 [95% CI, 1.04-1.16]; patients with Alzheimer disease: AOR, 1.15 [95% CI, 1.01-1.32]) compared with fragmented readmissions where information sharing was not available.Conclusions and RelevanceIn this cohort study of Medicare beneficiaries with 30-day readmissions, whether a readmission is fragmented was associated with discharge destination. Among fragmented readmissions, shared HIE across admission and readmission hospitals was associated with higher odds of discharge home with home health. Efforts to study the utility of HIE for care coordination for older adults should be pursued.

Improving patients’, carers’ and primary care healthcare professionals’ experiences of discharge communication from specialist palliative care to community settings: a protocol for a qualitative interview study

“…Effective communication between services during care transitions known as “discharge communication” is central to co-ordination of care to avoid the potential consequences of unmet needs, fragmented care, and poor patient and family experience. Miscommunications and unclear information can result in a lack of patient-centred care [ 7 ] and continuity of care [ 8 ], confusion and anxiety [ 9 ], and avoidable crises such as readmission as an emergency [ 10 ]; such readmissions may be unnecessary and/or preventable as they could be avoided or at least reduced with better co-ordinated care transitions [ 11 ] and improved communication and information continuity/sharing [ 12 ]. However, if communication is effective and involves patients in a way that respects their choices and needs, this can lead to benefits such as improved well-being [ 9 ], increased satisfaction [ 13 ], and better understanding of how to manage their symptoms [ 14 , 15 ].…”