Predicting non-elective hospital readmissions: A multi-site study

Objective: To determine clinical and patient-centered factors predicting non-elective hospital readmissions. Design: Secondary analysis from a randomized clinical trial. Clinical setting. Nine VA medical centers. Participants. Patients discharged from the medical service with diabetes mellitus, congestive heart failure, and/or chronic obstructive pulmonary disease (COPD). Main outcome measurement. Non-elective readmission within 90 days. Results: Of 1378 patients discharged, 23.3% were readmitted. After controlling for hospital and intervention status, risk of readmission was increased if the patient had more hospitalizations and emergency room visits in the prior 6 months, higher blood urea nitrogen, lower mental health function, a diagnosis of COPD, and increased satisfaction with access to emergency care assessed on the index hospitalization. Conclusions: Both clinical and patient-centered factors identifiable at discharge are related to non-elective readmission. These factors identify high-risk patients and provide guidance for future interventions. The relationship of patient satisfaction measures to readmission deserves further study. (C) 2000 Elsevier Science Inc.