Substance abuse, mental health issues may lead to readmissions


Many 30-day readmissions may not be linked to poor care, but instead to mental health issues, homelessness or substance abuse, according to a new study published in JAMA Surgery.

The research team analyzed data for 2,100 patient discharges at one Level 1 trauma center and safety-net hospital and found 173 of those patients were readmitted.

In close to one-third of the cases, patients fell into two groups, according to the study: injectable drug users who had new infections (about 17 percent of the readmissions) or people who did not have access to social support services, which led to issues with discharge and follow-ups (about 15 percent of the readmissions).

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Better documenting factors that lead to readmissions and doing better follow-ups with patients after discharge have been noted as ways to combat the issue, FierceHealthcare previously reported.

Other causes of patient readmissions idenitifed in the study included: infections not detectable during index admission (about 13 percent); illnesses related to the patient’s condition (about 9 percent); a preventable complication with care (about 9 percent); and deterioration of the patient’s condition (about 1 percent).

Hospitals may not be able to offer what’s needed for patients who need more social support after discharge, the study team wrote. "Many cases of readmissions may truly be unavoidable in current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the study authors wrote.

It will be important for hospitals to identify the most high-risk patients so that needed interventions or care can be offered, if possible, the study team said. The authors also said the results of the study call into question the effectiveness of using readmission data as a metric for care quality, especially as some hospitals are penalized for readmitting patients.

- read the study

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