Social factors tied to certain readmissions, mortality rates

In a new study published in the Journal of General Internal Medicine, it was found that after examining patients suffering from pneumonia and heart failure, a broad range of social factors affect the risk of post-discharge readmission and mortality.

The study authors examined data from 72 previous studies that evaluated the reasons patients may have died or been readmitted to the hospital for problems associated with pneumonia and heart failure over the last 30 years. They found that age, race, employment status, living situation and income level of a patient all may have played a part.

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According to Linda Calvillo-King, assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas and one of the study's authors, among the factors linked to the risk of being readmitted to the hospital for pneumonia were being older and non-white; having a low level of education; low income; and being unemployed. Also, older adults and men in general were associated with a higher mortality rate within the 30 days after being released from a hospital.

For heart failure patients on the other hand, higher readmission risks were linked to older people, or those that are African-American or Hispanic, said Calvillo-King.

The type of insurance a person had, marital status and economic status of a heart failure patient were factors tied to readmissions as well as mortality, according to the study.

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"With the new quality standard reports regarding readmissions being tracked by the (Centers for Medicare & Medicaid Services) and the amount of reimbursements being impacted (for heart failure and pneumonia patients) due to the new healthcare law, all hospitals are at risk," said Calvillo-King. "A lot of these social factors cannot be controlled, so this will affect all hospitals, especially safety-net hospitals."

Calvillo-King said there are certain programs hospitals can implement in order to potentially decrease their readmissions and mortality rates among patients with these particular social factors, however, they often require a financial investment from the hospital.

"Hospitals can give free medications for those that cannot afford them. Those medications could potentially prevent patients from needing to return to the hospital. Also, having home care nurses visit patients' homes or getting a case manager to identify high-risk patients," she said. "The problem is the cost of these programs for hospitals that don't have this extra money."

The study's authors suggest that CMS should account for some of these social factors when it comes to calculating the amount of reimbursement a hospital gets.

"We think it's important to see which social factors impact outcomes the most and include these factors into the reimbursement models," said Calvillo-King. "All of this should be accounted for."