Learning about 30-day readmissions from patients with repeated hospitalizations.

Objectives: To examine the population of inpatients with multiple hospitalizations at a large urban medical center in order to understand the types of patients who are at highest risk for 30-day readmission.
Study Design: Descriptive retrospective cohort analysis using hospital administrative data.
Methods: Bivariate analysis of clinical and sociodemographic characteristics of 19,049 adult inpatients discharged with a medical MS-DRG between July 1, 2009, and December 2010, and all subsequent inpatient admissions in the 180 days following each index discharge.
Results: Patients with 6 or more stays (very frequent readmissions) represented 0.8% of patients and 17.3% of 30-day readmissions. Those with 3 to 5 stays (frequent readmissions) comprised 9.4% of patients and 54.3% of 30-day readmissions. These patients differed significantly from those who had fewer hospitalizations with respect to age, race/ethnicity, gender, English proficiency, and insurance type.
Conclusions: Most 30-day readmissions are experienced by patients who have multiple, frequent hospital admissions. Efforts to reduce readmissions must look beyond the current focus on a single hospital discharge and transition period.