Risk Factors Resulting in Readmissions for Hospitalized Patients with Diabetes in Pennsylvania

Diabetes is a common condition in the United States that can lead to serious complications. Christopher S. Hollenbeak, PhD, a professor in the Departments of Surgery and Public Health Sciences at Pennsylvania State University College of Medicine, is currently using hospital readmission data from the Pennsylvania Health Care Cost Containment Council (PHC4) to study and design an intervention to reduce hospital readmissions for various conditions with a primary focus on those with diabetes. In explaining the intervention process in more detail, Dr. Hollenbeak noted that the focus is to reduce readmissions for patients with diabetes by achieving optimal control of blood glucose while patients are in the hospital.

Dr. Hollenbeak shared some of his study¹ results, “We found that patients with diabetes were about 20% more likely to be readmitted compared to comparable patients without diabetes.” Dr. Hollenbeak noted that most of the readmissions were for diabetes-related complications, including infections, heart failure, and cardiovascular conditions, like myocardial infarction. Among those with diabetes, there were several other factors associated with an increased risk of readmission including being transferred from another hospital, having an urgent or emergent procedure, and having numerous comorbidities. Patients with any of these occurrences were at greater risk of readmission. One surprising result noted by Dr. Hollenbeak was that longer hospital stays were associated with an increased risk of readmission. He added, “I frequently hear discussions about reducing readmissions that suggest keeping a patient in the hospital just a little longer so that the condition that will eventually cause the readmission can be caught in the inpatient setting, and our results say this may not be helpful.” Dr. Hollenbeak plans to extend this work by studying and publishing trend findings.

In addition to the work on diabetes, Dr. Hollenbeak has used PHC4 data to answer numerous health services and outcomes research questions that are important in Pennsylvania and nationally, including contributions to the scientific literature documenting the importance of specialty training for patient outcomes, the importance of hospital and surgeon volume on outcomes, the value of public reporting, and more recently, risk factors for patient readmissions. Commenting on readmissions in particular, Dr. Hollenbeak stated, “Recent national policies that limit reimbursement to hospitals with particularly high readmission rates have made it more important than ever to understand and identify the factors that lead to readmissions and how to prevent them. PHC4 data has been an excellent source for these studies.” Continuing, he added, “The critical aspect of PHC4 data for our research is that patients can be tracked across hospitals. We can tell when a patient is readmitted to a hospital other than the one associated with the initial admission and very few data sets have a measure of readmission that is as reliable.”

For several years, Dr. Hollenbeak was a consultant for PHC4, in which he explained, “This gave me insights into the data, the high quality of the data and the staff who maintained it, and creative ways it could be used for research.” While he noted that no discharge data set can provide the rich clinical data elements required to address many research questions, he went on to state, “if you have research questions that can reasonably be answered with discharge data, and if you have an interest in health care in Pennsylvania, then I would definitely recommend PHC4 data. The data set is very high quality and reliable.” In closing, Dr. Hollenbeak recognized that the high quality of the PHC4 data reflects favorably on both the “work of the Pennsylvania hospitals that submit the data and the excellent work of PHC4 staff.”

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¹Risk factors associated with 30-day readmission and length of stay in patients with type 2 diabetes, published in Journal of Diabetes and Its Complications, 2017 Jan;31(1):122-127.

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