Identification of Risk Factors for Potentially Preventable Re-hospitalization: Empirical Evidence from California and Florida

Objective: Policymakers have given substantial attention to reducing preventable readmissions because they may represent an opportunity to ensure quality of care and patient safety while lowering health care costs. The objective of this study is to examine factors associated with thirty-day potentially preventable hospital readmission (PPR). Data Sources/Study setting: This was an observational cross-sectional study of nonfederal acute-care hospital located in two states California and Florida, discharging Medicare patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia January through December 31, 2007. Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality. Study Design: The dependent variable of this study is condition-specific thirty-day potentially preventable hospital readmission (PPR). 3M’s PPR software was utilized to determine whether a readmission was potentially preventable. The independent variables of this study are clinical and socio-demographic characteristics of patients. We used multivariate hierarchical logistic models, clustered by hospitals, to examine factor associated with condition-specific, risk-adjusted, thirty-day PPR rates. Principal Findings: Multivariate results indicate that patients who were discharged to home health care or nursing home are more likely to be readmitted for a potentially preventable reason compared to those who were discharged to home (i.e., routine discharge) across all three conditions (p<0.001 for all). Patient with more severity, measured by history of prior admission, also had highter odds of 30-day PPR across all three conditions (p<0.001 for all). Patients with renal failure and chronic pulmonary disease as comorbid conditions had increased odds of 30-day PPR across all three conditions (p<0.001 for all). Conclusion: This work identified patient risk factors associated with the risk of PPR at patient-level analysis. Findings from this study may be served as useful sources to entities that are seeking ways to reduce the occurrences of PPRs.