Objective: To determine clinical and patient-centered factors predicting no
n-elective hospital readmissions. Design: Secondary analysis from a randomi
zed clinical trial. Clinical setting. Nine VA medical centers. Participants
. Patients discharged from the medical service with diabetes mellitus, cong
estive heart failure, and/or chronic obstructive pulmonary disease (COPD).
Main outcome measurement. Non-elective readmission within 90 days. Results:
of 1378 patients discharged, 23.3% were readmitted. After controlling for
hospital and intervention status, risk of readmission was increased if the
patient had more hospitalizations and emergency room visits in the prior 6
months, higher blood urea nitrogen, lower mental health function, a diagnos
is of COPD, and increased satisfaction with access to emergency care assess
ed on the index hospitalization. Conclusions: Both clinical and patient-cen
tered factors identifiable at discharge are related to non-elective readmis
sion. These factors identify high-risk patients and provide guidance for fu
ture interventions. The relationship of patient satisfaction measures to re
admission deserves further study. (C) 2000 Elsevier Science Inc. All rights
reserved.