Risk factors for readmission of inpatients with diabetes: A systematic review

Abstract

We have limited understanding of which risk factors contribute to increased readmission rates amongst people discharged from hospital with diabetes. We aim to complete the first review of its kind, to identify, in a systematic way, known risk factors for hospital readmission amongst people with diabetes, in order to better understand this costly complication. Method The review was prospectively registered in the PROSPERO database. Risk factors were identified through systematic review of literature in PubMed, EMBASE & SCOPUS databases, performed independently by two authors prior to data extraction, with quality assessment and semi-quantitative synthesis according to PRISMA guidelines. Results Eighty-three studies were selected for inclusion, predominantly from the United States, and utilising retrospective analysis of local or regional data sets. 76 distinct statistically significant risk factors were identified across 48 studies. The most commonly identified risk factors were; co-morbidity burden, age, race and insurance type. Few studies conducted power calculations; unstandardized effect sizes were calculated for the majority of statistically significant risk factors. Conclusion This review is important in assessing the current state of the literature and in supporting development of interventions to reduce readmission risk. Furthermore, it provides an important foundation for development of rigorous, pre-specified risk prediction models.

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

“…This is the first SR with MA to demonstrate that gender, age, race, health insurance type, comorbidities including heart failure, respiratory disease, depression and renal disease, LOS as well as use of insulin therapy were significantly associated with 30-day unplanned hospital readmission. Our findings are consistent with those reported in a recent SR by Robbins et al, 50 which did not quantify the effects of the risk factors. In contrast, we had specifically quantified the effect of four different comorbidities (namely heart failure, respiratory disease, depression, and renal disease) and other patient characteristics which were significantly associated with increased risk of 30-day hospital readmission among adult patients with DM.…”

“…Our findings are consistent with those reported in a recent SR by Robbins et al , 50 which did not quantify the effects of the risk factors. In contrast, we had specifically quantified the effect of four different comorbidities (namely heart failure, respiratory disease, depression, and renal disease) and other patient characteristics which were significantly associated with increased risk of 30-day hospital readmission among adult patients with DM.…”

Racial and Ethnic Differences in 30-Day Hospital Readmissions Among US Adults With Diabetes

“…Consistent with prior studies of patients with diabetes, 8,38,39 younger patients had a higher risk of readmission compared with older patients once other risk factors for readmission, particularly comorbidities, were accounted for. This may reflect the unique challenges that younger people face when living with a chronic disease.…”

Predictors for self‐management in older adults with type 2 diabetic nephropathy

“…Another study found that the number of re‐admissions in the past year is related to self‐care behaviour (Linn, Azzolin, & Souza, ). The causes of re‐admission for patients with diabetes can be complicated (La Manna, Bushy, & Gammonley, ) and include comorbidities and age (Robbins, Keung, Sankar, Randeva, & Arvanitis, ). In short, the research findings illustrated the importance of self‐management, which has great potential to reduce re‐admission.…”