Predictors and costs of thirty-day readmissions after index hospitalizations for alcohol-related disorders in US adults.

BACKGROUND: In 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.

METHODS: The 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 two-part model was used to predict the incremental cost conditional upon readmission.

RESULTS: In 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 45-64 years, Medicaid enrollees, living in urban and low-income areas, or with 1-2 comorbidities had high-risk of readmission. Index hospitalization costs were higher among readmitted patients ($8,840 vs. $8,036, P<0.01). Predicted mean costs for readmissions on index stay with ARD were greater among those aged 45-64 years ($1,908, P<0.001), Medicare enrollees ($2,133, P<0.001), rural residents ($1,841, P<0.01), high-income ($1,876,, P<0.001), 4 or more comorbidities ($2,415, P<0.001), or admitted in large metropolitan hospitals ($2,032, P<0.001), large number of beds ($1,964, P<0.001), government-owned ($2,109, P<0.001), or with low volume of ARD cases ($2,155, P<0.001).

CONCLUSION: One in five 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 one readmission. There is a need to develop patient-centric health programs to reduce readmission rates and costs among ARD patients. This article is protected by copyright. All rights reserved.