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Nursing home, hospice exposure predicts all-cause, hypoglycemia-related hospital readmission
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Patients hospitalized for hypoglycemia were more likely to be readmitted within 30 days of discharge when exposed to a nursing home or hospice setting, according to recent study findings.
In a multicenter analysis of electronic medical records from 116 hospitals, researchers also found that chronic comorbidities, including hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, mood disorders and dementia, were predictors of all-cause and hypoglycemia-related readmission.
“The regression results of this study will allow clinicians to more easily determine what risk factors place a patient with diabetes at increased risk for readmission,” Matthew F. Emons, MD, medical director, quality improvement at Cerner Corporation, Beverly Hills, California, and colleagues wrote. “Subsequently, these patients can be targeted for greater inpatient education prior to discharge and more intensive initiatives focused on transitions of care outside the hospital setting.”
Emons and colleagues identified 4,476 patients with diabetes and hypoglycemia-related ED and inpatient encounters with discharge dates between January 2009 and March 2014. Patients with an ED visit immediately preceding the inpatient encounter were counted as inpatients, with data merged to create a single hospital encounter. Primary endpoint was all-cause hospital readmission within 30 days; secondary endpoint was hypoglycemia-related readmission within 30 days. Researchers used multivariable logistic regression to identify risk factors for both outcomes.
Researchers found that 1,095 (24.5%) of admitted patients were readmitted within 30 days; 158 of those cases (14.4%) were hypoglycemia-related. The greatest predictor of all-cause readmission was recent hospitalization or confinement in a shared nursing facility or hospice facility within the previous 90 days (OR = 1.99; P < .001). When compared with patients aged 65 to 74 years, patients aged 25 to 34 years were more likely to be readmitted for any cause (OR = 2.33; P < .001), followed by patients aged 35 to 44 years (OR = 1.996; P < .001).
“It is notable that young adults were at increased risk for readmission, even after adjusting for other factors, including diabetes type and comorbid conditions,” the researchers wrote. “While it is speculative, we theorize that the young adults and patients with substance abuse or mood or cognitive disorders are less likely to adhere to their treatment regimen.”
Black patients were also more likely to be readmitted for all causes vs. other race categories (OR = 1.43; P = .011). Researchers found that comorbidities, including chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, hypertension and mood disorders, also were predictors of all-cause readmission.
Predictors of hypoglycemia-related readmission also included recent exposure to a hospital, nursing home or hospice facility (OR = 2.299; P < .001), and age, with patients aged 35 to 44 years more likely to be readmitted for hypoglycemia vs. those aged 65 to 74 years (OR = 3.48; P < .001). Hypertension (OR = 1.89; P= .019) and delirium/dementia and other cognitive disorders (OR = 1.79; P = .038) were other common predictors for hypoglycemia-related readmission.
Researchers found that obesity was protective against 30-day hypoglycemia-related readmission (OR = 0.51; P = .017). – by Regina Schaffer
Disclosure: Eli Lilly and Co. funded this study. Emons and two other researchers are employees of Cerner Corp., which Eli Lilly and Co. contracted for this study. Cerner Corp. owns and maintains the Health Facts database used in this analysis. Two other researchers are employees and stockholders of Eli Lilly and Co.
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