Influence of frailty-related diagnoses, high-risk prescribing in elderly adults, and primary care use on readmissions in fewer than 30 days for veterans aged 65 and older

Jacqueline A Pugh, Chen-pin Wang, Sara E Espinoza, Polly H Noel, Mary Bollinger, Megan Amuan, Erin Finley Garcia, Mary Jo Pugh

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives To determine the effect of two variables not previously studied in the readmissions literature (frailty-related diagnoses and high-risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year). Design Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults. Setting All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06). Participants All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit. Measurements A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty-related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility-level variables were complexity, rural versus urban, and FY06 admission rate. Results The mean adjusted readmission rate was 18.3%. The new frailty-related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year. Conclusion Frailty-related diagnoses may help to target individuals at higher risk of readmission to receive more-intensive care transition services. HRME use does not help in this targeting. A higher number of face-to-face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies.

Original languageEnglish (US)
Pages (from-to)291-298
Number of pages8
JournalJournal of the American Geriatrics Society
Volume62
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Veterans
Primary Health Care
Hospital Emergency Service
Inappropriate Prescribing
Patient Transfer
Critical Care
Palliative Care
Geriatrics
Comorbidity
Inpatients
Mental Health
Hospitalization
Cohort Studies
Retrospective Studies
Demography

Keywords

  • early readmissions
  • frailty
  • high-risk prescribing in the elderly
  • primary care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Influence of frailty-related diagnoses, high-risk prescribing in elderly adults, and primary care use on readmissions in fewer than 30 days for veterans aged 65 and older. / Pugh, Jacqueline A; Wang, Chen-pin; Espinoza, Sara E; Noel, Polly H; Bollinger, Mary; Amuan, Megan; Finley Garcia, Erin; Pugh, Mary Jo.

In: Journal of the American Geriatrics Society, Vol. 62, No. 2, 02.2014, p. 291-298.

Research output: Contribution to journalArticle

Pugh, Jacqueline A ; Wang, Chen-pin ; Espinoza, Sara E ; Noel, Polly H ; Bollinger, Mary ; Amuan, Megan ; Finley Garcia, Erin ; Pugh, Mary Jo. / Influence of frailty-related diagnoses, high-risk prescribing in elderly adults, and primary care use on readmissions in fewer than 30 days for veterans aged 65 and older. In: Journal of the American Geriatrics Society. 2014 ; Vol. 62, No. 2. pp. 291-298.
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abstract = "Objectives To determine the effect of two variables not previously studied in the readmissions literature (frailty-related diagnoses and high-risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year). Design Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults. Setting All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06). Participants All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit. Measurements A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty-related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility-level variables were complexity, rural versus urban, and FY06 admission rate. Results The mean adjusted readmission rate was 18.3{\%}. The new frailty-related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year. Conclusion Frailty-related diagnoses may help to target individuals at higher risk of readmission to receive more-intensive care transition services. HRME use does not help in this targeting. A higher number of face-to-face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies.",
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AU - Pugh, Jacqueline A

AU - Wang, Chen-pin

AU - Espinoza, Sara E

AU - Noel, Polly H

AU - Bollinger, Mary

AU - Amuan, Megan

AU - Finley Garcia, Erin

AU - Pugh, Mary Jo

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AB - Objectives To determine the effect of two variables not previously studied in the readmissions literature (frailty-related diagnoses and high-risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year). Design Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults. Setting All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06). Participants All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit. Measurements A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty-related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility-level variables were complexity, rural versus urban, and FY06 admission rate. Results The mean adjusted readmission rate was 18.3%. The new frailty-related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year. Conclusion Frailty-related diagnoses may help to target individuals at higher risk of readmission to receive more-intensive care transition services. HRME use does not help in this targeting. A higher number of face-to-face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies.

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