Consultant Physician and Senior Lecturer Flinders University, research interests include clinical nutrition, health economics and clinical epidemiology.
Fragmentation Of Care After Hospital Discharge: Characteristics And Clinical Outcomes Of Index Versus Non-Index Hospital Readmissions In Australian Hospitals
North American studies suggests that 20-30% unplanned readmissions are to a hospital different from the previous admission (non-index hospital readmissions) and are associated with worse clinical outcomes for the patients. Risk factors and clinical outcomes of non-index hospital readmissions have not been studied in Australia. This study compared characteristics and clinical outcomes between index and non-index hospital readmissions in the Australian healthcare settings.
This retrospective cohort study included medical admissions from 2012-2016 across all major public hospitals in South Australia. Readmissions within 30-days to all public hospitals were captured using electronic health information system. In-hospital mortality and readmission length of hospital stay (LOS) were compared along with 30-day mortality and subsequent readmissions among patients readmitted to index or non-index hospitals.
Of 114105 index admissions, there were 20539 (18.0%) unplanned readmissions within 30-days of hospital discharge. Of these, 17519 (85.3%) were index readmissions and 3020 (14.7%) were non-index readmissions. Compared to index readmissions, patients in the non-index readmissions group had a lower Charlson-comorbidity index, shorter LOS and fewer complications during index admission and were more likely to be readmitted with a different diagnosis to the index admission. No difference in in-hospital mortality was observed but readmission LOS was shorter and 30-day mortality was higher among patients with non-index readmissions (OR 1.22, 95% CI 1.06 to 1.40). After adjustment for age, sex and CCI non-index readmissions had a 12% higher risk (OR 1.12, 95% CI 1.03 to 1.22) of having a combined clinical outcome of either readmission or death within 30 days of their first readmission as compared to index readmissions.
A substantial proportion of patients experienced non-index hospital readmissions. Non-index hospital readmitted patients had no immediate adverse outcomes but experienced worse 30-day outcomes.