Predictors and Costs of 30‐Day Readmissions After Index Hospitalizations for Alcohol‐Related Disorders in U.S. Adults

Abstract

BACKGROUND\nIn 2015, the Hospital Readmissions Reduction Program mandated financial penalties to hospitals with greater rates of readmissions for certain conditions. Alcohol-related disorders (ARD) are the fourth leading cause of 30-day readmissions. Yet, there is a dearth of national-level research to identify high-risk patient populations and predictors of 30-day readmission. This study examined patient- and hospital-level predictors for index hospitalizations with principal diagnosis of ARD and predicted the cost of 30-day readmissions.\n\n\nMETHODS\nThe 2014 Nationwide Readmissions Database was used to identify ARD-related index hospitalizations. Multivariable logistic regression was used to estimate patient- and hospital-level predictors for readmissions, and a 2-part model was used to predict the incremental cost conditional upon readmission.\n\n\nRESULTS\nIn 2014, 285,767 index hospitalizations for ARD were recorded, and 18.9% of ARD-associated hospitalizations resulted in at least one 30-day readmission. Patients who were males, aged 45 to 64\xa0years, Medicaid enrollees, living in urban and low-income areas, or with 1 to 2 comorbidities had high risk of readmission. Index hospitalization costs were higher among readmitted patients ($8,840 vs. $8,036, p\xa0<\xa00.01). Predicted mean costs for readmissions on index stay with ARD were greater among those aged 45 to 64\xa0years ($1,908, p\xa0<\xa00.001), Medicare enrollees ($2,133, p\xa0<\xa00.001), rural residents ($1,841, p\xa0<\xa00.01), living in high-income areas ($1,876, p\xa0<\xa00.001), with 4 or more comorbidities ($2,415, p\xa0<\xa00.001), or admitted in large metropolitan hospitals ($2,032, p\xa0<\xa00.001), with large number of beds ($1,964, p\xa0<\xa00.001), with government ownership ($2,109, p\xa0<\xa00.001), or with low volume of ARD cases ($2,155, p\xa0<\xa00.001).\n\n\nCONCLUSIONS\nOne in 5 ARD-related index hospitalizations resulted in a 30-day readmission. Overall, costs of index hospitalizations for ARD were $2.3 billion, of which $512 million were spent on hospitalizations that resulted in at least 1 readmission. There is a need to develop patient-centric health programs to reduce readmission rates and costs among ARD patients.