Mudge et al studied medical patients who had recurrent hospital admissions. They identified risk factors which can help to identify a patient who may benefit from more aggressive outpatient management. The authors are from Herson in Queensland, Royal Brisbane and Women's Hospital, Mater Health Services and the University of Queensland.
Patient selection:
(1) adult >= 50 years
(2) hospital admission with a prior admission in the previous 6 months
(3) exclusion of residential care, terminal illness, serious cognitive difficulty, serious language difficulty
(4) not a surgical patient
Outcome: another readmission within 6 months
Risk factors for recurrent readmission:
(1) chronic comorbid disease (adjusted odds ratio 3.4): heart failure, chronic renal impairment, diabetes
(2) depression (adjusted odds ratio 3.0) with geriatric depression scale >= 5
(3) underweight (adjusted odds ratio 12.7), with BMI < 18.5 kg per square meter
where:
• Obesity with BMI > 30 kg per square meter had an odds ratio of 2.6 at p value 0.07.
• Patients with chronic lung disease, peripheral vascular disease, stroke, ischemic heart disease and cancer had readmission rates of 35 to 49% but p values were > 0.12.
The presence of these risk factors can help to identify a patient who may be at risk for recurrent medical admissions and who should be triaged for careful follow-up.
