Factors associated with unplanned hospital readmission among patients 65 years of age and older in a medicare managed care plan

Marcantonio, Edward R.; McKean, Stephen; Goldfinger, Michael; Kleefield, Sharon; Yurkofsky, Mark; Brennan, Troyen A.

doi:10.1016/s0002-9343(99)00159-x

Cited by 249 publications

(230 citation statements)

References 22 publications

Supporting

Mentioning

208

Contrasting

Unclassified

Order By: Relevance

“…Among the 304 readmissions, the median (IQR) time to readmission was 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) days. The most common readmission diagnoses by CCS Level 3 category were congestive heart failure, pneumonia, coronary atherosclerosis without acute myocardial infarction, cardiac dysrhythmias, and obstructive chronic bronchitis, which together accounted for 25 % of readmissions.…”

Section: Resultsmentioning

confidence: 99%

“…Among all hospitalized Medicare beneficiaries (including community-dwelling and institutionalized elders, as well as younger disabled Medicare beneficiaries), nearly one in five were readmitted within 30 days, and over one-third were readmitted within 90 days. 1 These readmitted individuals have been described in some detail; research has identified early readmission risk factors for general 2,3 and geriatric populations, [4][5][6] as well as those with specific diseases such as heart failure, 7 stroke, 8 and chronic obstructive pulmonary disease. 9 Individuals readmitted early are more likely to have multiple medical comorbidities, greater length of stay during the index hospitalization, and additional recent hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

“…Among hospitalized older adults, early readmission has also been associated with age greater than 80, depression, and poor patient education upon discharge. 4 Despite the increased attention to readmissions, few previous studies have examined whether early readmission predicts survival. Any hospitalization is known to increase risk of mortality in the year following discharge, 10 and other predictors of outcome after hospitalization are emerging, but the effect of early readmission on mortality remains unknown.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

et al. 2012

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

et al. 2012

View full text Add to dashboard Cite

“…Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care [9]. On the basis of available evidence in other settings of healthcare delivery [13,16,20,22,26,27,29,32,36,40,41], it is likely that patients with low health literacy presenting to a hand surgeon are at greater risk for poor treatment adherence, suboptimal outcomes, and misuse of resources; future studies should confirm these assumptions in this patient population. To the extent that asking more questions yields more information for patients, the observed difference in question-asking may reveal a source of health-literacy disparities in access to health information.…”

Section: Discussionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

110

View full text Add to dashboard Cite

Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, À4; 95% CI, À7 to À1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

show abstract

“…[5][6][7][8][9] Collectively, the research suggests that a successful care transition depends on the patient's ability to manage their discharge care plan upon returning home. The knowledge, skills, confidence and inclination to assume responsibility for managing one's health and healthcare needs is often referred to as patient activation.…”

Section: Introductionmentioning

confidence: 99%

Patient Activation and 30-Day Post-Discharge Hospital Utilization

et al. 2013

View full text Add to dashboard Cite

BACKGROUND: Patient activation is linked to better health outcomes and lower rates of health service utilization. The role of patient activation in the rate of hospital readmission within 30 days of hospital discharge has not been examined. METHODS: A secondary analysis using data from the Project RED-LIT randomized controlled trial conducted at an urban safety net hospital. Data from 695 Englishspeaking general medical inpatient subjects were analyzed. We used an adapted, eight-item version of the validated Patient Activation Measure (PAM). Total scores were categorized, according to standardized methods, as one of four PAM levels of activation: Level 1 (lowest activation) through Level 4 (highest activation). The primary outcome measure was total 30-day post-discharge hospital utilization, defined as total emergency department (ED) visits plus hospital readmissions including observation stays. Poisson regression was used to control for confounding. RESULTS: Of the 695 subjects, 67 (9.6 %) were PAM Level 1, 123 (17.7 %) were Level 2, 193 (27.8 %) were Level 3, and 312 (44.9 %) were Level 4. Compared with highly activated patients (PAM Level 4), a higher rate of 30-day post-discharge hospital utilization was observed for patients at lower levels of activation (PAM Level 1, incident rate ratio [IRR] 1.75, 95 % CI,1.18 to 2.60) and (PAM Level 2, IRR 1.50, 95 % CI 1.06 to 2.13). The rate of returning to the hospital among patients at PAM Level 3 was not statistically different than patients with PAM Level 4 (IRR 1.30, 95 % CI, 0.94 to 1.80). The rate ratio for PAM Level 1 was also higher compared with Level 4 for ED use alone (1.68(1.07 to 2.63)) and for hospital readmissions alone (1.93 [1.22 to 3.06]). CONCLUSION: Hospitalized adult medical patients in an urban academic safety net hospital with lower levels of Patient Activation had a higher rate of post-discharge 30-day hospital utilization.

show abstract

Factors associated with unplanned hospital readmission among patients 65 years of age and older in a medicare managed care plan

Cited by 249 publications

References 22 publications

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Patient Activation and 30-Day Post-Discharge Hospital Utilization

Contact Info

Product

Resources

About