Length of hospital stay and readmission likelihood increases by 2.9% in rural areas, review finds

Reviewed by James Ives, M.Psych. (Editor)Oct 5 2018

Hospital readmissions cost hospitals about $26 billion annually. Systems like the Hospital Readmission Reduction Program (HRRP) within the Affordable Care Act penalize hospitals with higher readmission rates for targeted diagnoses. Health care data reveal that health care facilities located in rural Southern Appalachia show readmission rates that are above the national average, which results in penalties to hospitals within this region. In order to assess and prevent the causes of these frequent hospital readmission, researchers performed a retrospective review of rural Southern Appalachia.

Researchers reviewed 15,500 patients admitted to rural Southern Appalachia hospitals from Jan. 1, 2014, to Oct. 31, 2017. In order to determine associations with readmission, univariate analyses and regression modeling were conducted on potential associated variables such as length of stay; age; gender; health care payer; discharge month/day/time; tobacco use; smoking cessation education; medication reconciliation upon discharge; and presence of comorbid diagnoses like diabetes mellitus, hypertension chronic renal failure and psychiatric disorders.

The authors found that every day spent in the hospital, readmission likelihood increases by 2.9 percent. Individuals discharged between 0100-1300 were less likely to be readmitted compared with those discharged between 1300-0100 (P<.0001). Former smokers were more likely than never smokers to be readmitted and if patients were provided with smoking cessation education at discharge decreased the likelihood of readmission. The discharge month analysis indicated a significant effect only for those discharged in March and August compared with January. Research also revealed that patients with a diagnosis of COPD, diabetes mellitus, hypertension, psychiatric disorders and chronic renal failure had an increased likelihood of readmission as well.

"Primary causes of hospital readmissions in rural Southern Appalachia are increased length of stay, discharges after 1300, history of smoking and presence of comorbid COPD, diabetes mellitus, hypertension, chronic renal failure and psychiatric disorders," says Dr. Christine A. Moore, lead researcher. "Some methods to prevent readmissions are decreasing length of stay, discharging patients before 1300, providing smoking cessation education and controlling comorbid diagnoses."