| Nearly one-fifth of Medicare beneficiaries are readmitted within 30 days of a hospital stay. Readmissions contribute to the rising health care costs and they serve as a proxy for overall inpatient quality of care. Policy makers and payers interested in the efficacy of strategies to improve care coordination have scrutinized readmission rates for some time, yet this analysis attends to several remaining gaps in the literature. First, the rising prevalence of diabetes may be an underappreciated driver for readmissions. Second, many abdominal surgery patients require post-operative care, yet the point of care delivery and level of care needed has not been well described for these surgeries.;Two retrospective analyses were conducted: 1) 30-day readmissions among patients with and without diabetes, and 2) 30-day readmissions and emergency department (ED) visits among patients undergoing abdominal surgery. The study utilized 2008-2010 New York State hospital discharge data from the Statewide Planning and Research Cooperative System. Relative risks were computed in multivariable analyses using generalized estimating equations for both studies.;Readmission risks were higher across the top 10 diagnosis-related groups (DRGs) for patients with diabetes regardless of their reason for admission. A total of 1,546,269 discharges were included in the study, of which 18% of patients with diabetes experienced one or more readmissions compared to 11% of patients without diabetes. Risk factors included the patient being discharged to a setting other than home, Charlson co-morbidity score, and payer.;A total of 66,231 discharges were included in the abdominal surgery study. Of those, 9,432 (14%) patients visited an ED within 30 days and 6,048 (9%) patients were readmitted. Risk factors for both outcomes included race, age, Charlson co-morbidity score, length of stay, payer, discharge destination, and hospital bed size. Females had a lower readmission risk. The most common reason for ED visits and readmission were pain and treatment of infections, respectively.;Identification of key contributors to readmission can inform quality improvement strategies for post-surgical acute care. Our findings suggest that the hospitalization is an opportunity to optimize the diabetes treatment regimen by focusing on medication reconciliation, discharge planning and effective communication between providers and caregivers. |
