3107 — Rehospitalization After Hip Fracture: Predictors and Prognosis from a National Veterans Study

French DD (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Bass E (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Bradham DD (? Cooperative Studies Program Coordinating Center at Perry Point, MD and University of Maryland School of Medicine, Baltimore; Department of Epidemiol), Campbell RR ( VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Rubenstein LZ (UCLA David Geffen School of Medicine and the Director of the VA Greater Los Angeles Healthcare System (GLAHS) Geriatric Research, Education and Clinic)

Objectives:
The goal of this research was to estimate the risk and long-term prognostic significance of 30-day readmission post discharge among a 4-year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for co-morbidities.

Methods:
National Medicare and VHA facilities were analyzed. The study cohort was 41,331 veterans with a HFx first admitted to a Medicare eligible facility during 1999-2002. We linked HFxs with all their other Medicare and VHA inpatient discharge files to capture dual inpatient use. We used logistic regression to examine the relationship between 30-day readmission and age, gender, inpatient length of stay, and selected Elixhauser comorbidities.

Results:
Approximately 18.3% (7,579/41,331) of HFx patients were readmitted within 30-days. Of those with 30-day readmissions, 48.5% (3,675/7,579) died with 1-year, compared to 24.9% (8,388/33,752) of those without 30-day readmissions. Readmission risk was significantly increased in the presence of specific comorbidities, ranging from 11% increased risk for patients with fluid and electrolyte disorders (95% CI=1.04-1.20) to 43% for renal failure (95% CI=1.29-1.60). For this cohort, cardiac arrhythmias (24%), chronic pulmonary disease (28%) congestive heart failure (16%) were relatively common co-morbidities and all impacted the risk of 30-day readmission.

Implications:
Results suggest that HFx patients in our study cohort with 30-day readmissions were nearly twice as likely to die within one year. Identification of several predictive comorbidities at discharge and examination of reasons for subsequent readmission suggests that readmission was largely due to active co-morbid clinical problems or non-surgical illness from the initial discharge.

Impacts:
These comorbidity findings have implications for the current Centers for Medicare and Medicaid Services (CMS) pay for performance initiatives (P4P), especially those related to better coordination of care for patients with chronic illnesses. These comorbidity findings for elderly HFx patients may also provide data to enable CMS and healthcare providers to more accurately differentiate between comorbidities and hospital-acquired complications under the current CMS initiative related to non-payment for certain types of medical conditions and hospital acquired infections.