Employment status top socioeconomic factor in readmissions

Employment status is the top socioeconomic factor affecting 30-day readmissions for heart failure, heart attacks or pneumonia, according to a new study from Truven Health Analytics.

As readmission penalties reach record highs, analyzing causes is more important than ever. Researchers, led by David Foster, Ph.D., collected 2011 and 2012 data from the Centers for Medicare & Medicaid Services and used a statistical test called the Variance Inflation Factor (VIF) for correlations among the nine factors in the Community Need Index (CNI): elderly poverty, single parent poverty, child poverty, uninsurance, minority, no high school, renting, unemployment and limited English. Their analysis found unemployment and lack of high school education were the only statistically significant factors in connection with readmissions, carrying a risk of 18.1 percent and 5.3 percent, respectively, according to the study.

In contrast, language limitations appeared to have a "protective effect" against readmissions, which researchers suggested may be due to non-English-speaking communities "taking care of their own" within the community rather than returning to the hospital for medical problems. 

To prevent readmissions going forward, hospitals should consider factoring in CNI indicators to develop a profile of patient populations at higher risk for 30-day readmissions. "This will enable hospitals to develop new treatment solutions that may lead to reduced readmissions and improve the health of these populations," they write. Moreover, "specific community factors, such as a higher proportion of extended families, could potentially have some positive impact on readmission rates and is worth further exploration," according to the authors.

Researchers continue to debate the importance of socioeconomic factors in readmissions. An April study published in Health Affairs found socioeconomic status may affect readmission rates significantly more than previously thought; combined with other community factors, such as physician mix and nursing home quality, it accounts for nearly half of the 60 percent of variations in readmission rates for myocardial infarction, heart failure and pneumonia, FierceHealthcare previously reported. However, a May report indicated socioeconomic factors do not affect readmissions for congestive heart failure,

To learn more:
- read the report (registration required, .pdf)