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Hoffman GJ, Liu H, Alexander NB, Tinetti M, Braun TM, Min LC. Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Netw Open. 2019;2(5):e194276. doi:10.1001/jamanetworkopen.2019.4276
To what extent do falls play a role in hospital readmissions for older patients, including those with acute geriatric risk factors?
This cohort study using Hospital Cost and Utilization Project data from 8.3 million Medicare beneficiaries found that fall-related injuries ranked as high as the third-leading readmission diagnosis, depending on the type of initial hospitalization. Fall injuries ranked still higher for patients with a high preexisting risk of falling and for those discharged home or to home health care rather than to a skilled nursing facility.
Fall-related injuries are leading diagnoses for hospital readmissions, particularly for at-risk older adults discharged home, highlighting the need for greater attention to transitional prevention strategies to avoid postdischarge falls.
Falls are common among older adults, particularly those with previous falls and cognitive impairment and in the postdischarge period. Hospitals have financial incentives to reduce both inpatient falls and hospital readmissions, yet little is known about whether fall-related injuries (FRIs) are common diagnoses for 30-day hospital readmissions.
To compare fall-related readmissions with other leading rehospitalization diagnoses, including for patients at greatest risk of readmission.
Design, Setting, and Participants
Retrospective cohort study of the Hospital Cost and Utilization Project’s Nationwide Readmissions Database of nationally representative US hospital discharges among Medicare beneficiaries aged 65 years and older from January 1, 2013, to November 30, 2014. The prevalence and ranking of FRIs compared with other diagnostic factors for 30-day unplanned hospital-wide readmissions were determined, overall and for 2 acute geriatric cohorts, classified by fall injury or cognitive impairment diagnoses observed at the index admission. Analyses were also stratified by patient discharge disposition (home, home health care, skilled nursing facility). Analyses were conducted from February 1, 2018, to February 26, 2018.
Main Outcomes and Measures
Unplanned hospital-wide readmission within 30 days of discharge.
From the database, 8 382 074 eligible index admissions were identified, including 746 397 (8.9%) in the FRI cohort and 1 367 759 (16.3%) in the cognitive impairment cohort. Among the entire 8 382 074-discharge cohort, mean (SD) age was 77.7 (7.8) years and 4 736 281 (56.5%) were female. Overall, 1 205 962 (14.4%) of index admissions resulted in readmission, with readmission rates of 12.9% for those with a previous fall and 16.0% for patients with cognitive impairment. Overall, FRIs ranked as the third-leading readmission diagnosis, accounting for 60 954 (5.1%) of all readmission diagnoses. Within the novel acute geriatric cohorts, FRIs were the second-leading diagnosis for readmission both for patients with an FRI at index admission (10.3% of all readmission diagnoses) and those with cognitive impairment (7.0% of all readmission diagnoses). For those with an FRI at index admission and discharged home or to home health care, FRIs were the leading readmission diagnosis.
Conclusions and Relevance
This study found that posthospital FRIs were a leading readmission diagnosis, particularly for patients originally admitted with a FRI or cognitive impairment. Targeting at-risk hospitalized older adults, particularly those discharged to home or home health care, is an underexplored, cost-effective mechanism with potential to reduce readmissions and improve patient care.
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