Predictors of 30-day unplanned hospital readmission among adult patients with diabetes mellitus: a systematic review with meta-analysis

Abstract

Adult patients with diabetes mellitus (DM) represent one-fifth of all 30-day unplanned hospital readmissions but some may be preventable through continuity of care with better DM self-management. We aim to synthesize evidence concerning the association between 30-day unplanned hospital readmission and patient-related factors, insurance status, treatment and comorbidities in adult patients with DM. We searched full-text English language articles in three electronic databases (MEDLINE, Embase and CINAHL) without confining to a particular publication period or geographical area. Prospective and retrospective cohort and case–control studies which identified significant risk factors of 30-day unplanned hospital readmission were included, while interventional studies were excluded. The study participants were aged ≥18 years with either type 1 or 2 DM. The random effects model was used to quantify the overall effect of each factor. Twenty-three studies published between 1998 and 2018 met the selection criteria and 18 provided information for the meta-analysis. The data were collected within a period ranging from 1 to 15 years. Although patient-related factors such as age, gender and race were identified, comorbidities such as heart failure (OR=1.81, 95% CI 1.67 to 1.96) and renal disease (OR=1.69, 95% CI 1.34 to 2.12), as well as insulin therapy (OR=1.45, 95% CI 1.24 to 1.71) and insurance status (OR=1.41, 95% CI 1.22 to 1.63) were stronger predictors of 30-day unplanned hospital readmission. The findings may be used to target DM self-management education at vulnerable groups based on comorbidities, insurance type, and insulin therapy.

Magnitude and predictors of hospital admission, readmission, and length of stay among patients with type 2 diabetes at public hospitals of Eastern Ethiopia: a retrospective cohort study

“…The LOS among patients having a history of insulin administration on the admission time was increased by more than three times compared to those who had no history of insulin administration. This finding is in agreement with the report of previous studies [ 53 , 72 , 73 ]. This finding might be related to the side effects of insulin (i.e., hypoglycemia).…”

Predicting and Preventing Acute Care Re-Utilization by Patients with Diabetes

“…Dozens of risk factors for readmission have been identified among patients with diabetes [ 19 – 22 •]. A recent systematic review and meta-analysis of 23 studies published through 2018 on more than 30 million patients provides the most complete data on a small set of commonly assessed risk factors [ 22 •].…”

“…Dozens of risk factors for readmission have been identified among patients with diabetes [ 19 – 22 •]. A recent systematic review and meta-analysis of 23 studies published through 2018 on more than 30 million patients provides the most complete data on a small set of commonly assessed risk factors [ 22 •]. The strongest risk factors identified were insurance type (Medicare/Medicaid vs. private), insulin use, hospital length of stay (LOS), and certain comorbidities (heart failure, respiratory disease, depression, and renal disease).…”

Predictors of Rehospitalization and Mortality in Diabetes-Related Hospital Admissions

“…In our paper, male gender was a predictor of readmission within 90 days of discharge. Similarly, Soh et al showed that male gender is the predictor of 30-day unplanned hospital readmission among adult patients with diabetes mellitus [13]. However, in the papers of Chen et al [14] and Karunakaran et al [15], gender was not a significant predictor of 30-day hospital readmission in diabetes patients discharged from hospitals.…”

“…Retrospective analysis of a large US database, by Berry et al [12], found that when considering all conditions, the readmission rate increased in young adults peaked by middle age and decreased at age 65 years. In turn, in a recently published systemic review and meta-analysis, age ≥65 predicted unplanned hospital readmissions within 30 days of discharge among adult patients with diabetes mellitus [13].…”