Living Alone and Homelessness as Predictors of 30-Day Potentially Preventable Hospital Readmission

Details

• Journal Article:
  Preventing Chronic Disease (PCD)
• Personal Author:
  LaWall, Emiline ; Wu, Yan Yan ; Fan, Victoria Y. ; Ashton, Melinda ; Sentell, Tetine
• Description:
  Introduction
  
  The effect of social factors on health care outcomes is widely recognized. Health care systems are encouraged to add social and behavioral measures to electronic health records (EHRs), but limited research demonstrates how to leverage this information. We assessed 2 social factors collected from EHRs — social isolation and homelessness — in predicting 30-day potentially preventable readmissions (PPRs) to hospital.
  
  Methods
  
  EHR data were collected from May 2015 through April 2017 from inpatients at 2 urban hospitals on O‘ahu, Hawai‘i (N = 21,274). We performed multivariable logistic regression models predicting 30-day PPR by living alone versus living with others and by documented homelessness versus no documented homelessness, controlling for relevant factors, including age group, race/ethnicity, sex, and comorbid conditions.
  
  Results
  
  Among the 21,274 index hospitalizations, 16.5% (3,504) were people living alone and 11.2% (2,385) were homeless; 4.2% (899) hospitalizations had a 30-day PPR. In bivariate analysis, living alone did not significantly affect likelihood of a 30-day PPR (16.6% [3,376 hospitalizations] without PPR vs 14.4% [128 hospitalizations] with PPR; P = .09). However, documented homelessness did show a significant effect on the likelihood of 30-day PPR in the bivariate analysis (11.1% [2,259 hospitalizations] without PPR vs 14.1% [126 hospitalizations] with PPR; P = .006). In multivariable models, neither living alone nor homelessness was significantly associated with PPR. Factors that were significantly associated with PPR were comorbid conditions, discharge disposition, and use of an assistive device.
  
  Conclusion
  
  Homelessness predicted PPR in descriptive analyses. Neither living alone nor homelessness predicted PPR once other factors were controlled. Instead, indicators of physical frailty (ie, use of an assistive device) and medical complexity (eg, hospitalizations that required assistive care post-discharge, people with a high number of comorbid conditions) were significant. Future research should focus on refining, collecting, and applying social factor data obtained through acute care EHRs.
  
  
• Subjects:
  Adult Cross-Sectional Studies Female Humans Ill-Housed Persons Logistic Models Loneliness Male Middle Aged Outcome Assessment (Health Care) Patient Readmission Risk Factors Social Isolation

  More +
• Source:
  Prev Chronic Dis. 16
• DOI:
  http://dx.doi.org/10.5888/pcd16.180189
• ISSN:
  1545-1151
• Pubmed ID:
  30730829
• Pubmed Central ID:
  PMC6395076
• Document Type:
  Journal Article
• Funding:
  U54 MD007584/MD/NIMHD NIH HHS/United States ; U54 MD007601/MD/NIMHD NIH HHS/United States
• Place as Subject:
  Hawaii
• Location:
  Oceania
• Volume:
  16
• Collection(s):
  Preventing Chronic Disease
• Main Document Checksum:
  urn:sha-512:855e23d2886bf0eb4cd340ed6cd5ba62a8f165fc1910d9972c1f1ff35bc4f2a505280c1d6e8a862e05db360133a249024662a94af503b33caea718091476d1d8
• Download URL:
  https://stacks.cdc.gov/view/cdc/77101/cdc_77101_DS1.pdf
• File Type:
  [PDF - 392.79 KB ]