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Postdischarge Environmental and Socioeconomic Factors and the Likelihood of Early Hospital Readmission Among Community-Dwelling Medicare Beneficiaries

Correspondence: Address correspondence to Alicia I. Arbaje, MD, MPH, Assistant Professor and Associate Director of Transitional Care Research, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: aarbaje{at}jhmi.edu

Purpose: This study attempts to determine the associations between postdischarge environmental (PDE) and socioeconomic (SES) factors and early readmission to hospitals. Design and Methods: This study was a cohort study using the 2001 Medicare Current Beneficiary Survey and Medicare claims for the period from 2001 to 2002. The participants were community-dwelling Medicare beneficiaries admitted to hospitals, discharged home, and surviving at least 1 year after discharge (n = 1,351). The study measurements were early readmission (within 60 days), PDE factors, and SES factors. PDE factors consisted of having a usual source of care, requiring assistance to see the usual source of care, marital status, living alone, lacking self-management skills, having unmet functional need, having no helpers with activities of daily living, number of living children, and number of levels in the home. SES factors consisted of education, income, and Medicaid enrollment. Results: Of the 1,351 beneficiaries, 202 (15.0%) experienced an early readmission. After adjustment for demographics, health, and functional status, the odds of early readmission were increased by living alone (odds ratio or OR = 1.50, 95% confidence interval or CI = 1.01–2.24), having unmet functional need (OR = 1.48, 95% CI = 1.04–2.10), lacking self-management skills (OR = 1.44, 95% CI = 1.03–2.02), and having limited education (OR = 1.42, 95% CI = 1.01–2.02). Implications: These findings suggest that PDE and SES factors are associated with early readmission. Considering these findings may enhance the targeting of pre-discharge and postdischarge interventions to avert early readmission. Such interventions may include home health services, patient activation, and comprehensive discharge planning.

Key Words: Care transitions • Cohort study • Discharge planning • Socioeconomic factors • Unmet need