Researchers Identify Factors Associated With Readmission for Patients With Metastatic Cancer
Hospital readmission rates may be avoidable in some patients with metastatic disease. Researchers assessed patient factors more likely to be associated with increased readmissions, such as demographics, comorbidities, hospital type, payer, and discharge disposition, in a study presented at the ASCO Annual Meeting (http://abstracts.asco.org/199/AbstView_199_193836.html).
Researchers measured 30-day readmissions related to dehydration, cancer-related pain, and failure to thrive in patients with primary metastatic cancer on index admission to a New York State hospital between December 1, 2012, and December 31, 2014.
A total of 11,275 patients had 19,307 index hospitalizations, and the 30-day readmission rate was 24.5%, 8.9% of which (n = 424) was potentially preventable, according to the researchers.
African American (hazard ratio [HR] = 1.26; 95% CI = 1.17–1.35) and Hispanic patients (HR = 1.19; 95% CI = 1.09–1.31) had higher rates of readmission than Caucasian patients.
Factors associated with a decreased risk of readmission included:
- Older age (HR per 10 years of age = 0.94; 95% CI = 0.90–0.97)
- Female gender (HR = 0.95; 95% CI = 0.91–0.99)
- Having private insurance (HR = 0.87; 95% CI = 0.87–0.81)
- Discharge to hospice (HR = 0.62; 95% CI = 0.42–0.91).
Discharge home with services (HR = 1.21; 95% CI = 1.14–1.27) or to a skilled nursing facility (HR = 1.11; 95% CI = 1.01–1.23) were associated with a higher risk of readmission compared to patients going home without aid. Compared to those who went home without aid, patients discharged with services were more likely to have avoidable readmissions (HR = 1.31; 95% CI = 1.05–1.64), whereas those discharged to skilled nursing facilities were less likely to have avoidable readmissions (HR = 0.55; 95% CI = 0.37–0.81).
Index hospitalization at public hospitals increased the risk of readmissions (HR = 1.1; 95% CI = 1.02–1.18), whereas teaching hospitals did not (HR = 0.84; 95% CI = 0.77–0.920). Payer, gender, race, comorbidities, and index hospital type were not associated with readmission patterns.
“Although the overall rate of potentially preventable admissions among metastatic cancer patients is low, higher readmission rates among those discharged home with help suggests that services supplied are not sufficient to address their health needs,” the authors concluded.