Background: Health-related social needs (HRSN) exacerbate poor health in patients with chronic medical conditions. The population of frequently hospitalized patients is heterogeneous, but many have unmet health related social needs. Multidisciplinary programs for this population emphasize longitudinal patient-provider relationships and intensive case management. Studies of these interventions have failed to demonstrate improved readmissions outcomes but have had success in building trust, screening for and addressing HRSN, and improving quality of life for frequently hospitalized patients. We sought to identify the impact of HRSN on hospital readmissions in a cohort of frequently hospitalized patients.
Methods: We performed a retrospective chart review of a cohort of frequently hospitalized patients previously studied in a randomized trial to identify HRSN. The study had three inclusion criteria: A) 3 or more 30-day inpatient hospital readmissions in a 12-month period, B) 2 or more readmissions plus referral from a care team member, or C) 2 readmissions plus 3 observation stays. Patients already followed by a multidisciplinary team (i.e. oncology, transplant) were excluded. The HRSN screened for included insurance status (dual-eligibility for Medicare and Medicaid), food insecurity, medication access issues (use of medication voucher), transportation insecurity (use of transportation voucher), and homelessness . We also examined chronic diseases such as sickle cell anemia, COPD, CHF, mood disorders, and substance use disorders. Univariate analysis and multiple logistic regression analysis were performed, with number of readmissions after 180 days as the independent variable.
Results: Univariate analysis found a statistically significant association between 180-day readmission and patients with current or former alcohol use [OR 2.6 (95% CI 1.3-5.2), p < 0.006], use of a transportation voucher [4.4 (95% CI 1.3-14.6), p< 0.02], use of a medication voucher [2.6 (95% CI 1.1-6.2), p< 0.03], and food insecurity [4.45 (95% CI 1.8-11.1), p< 0.001). In multiple logistic regression analysis, associations were found between readmission and patients with current or former alcohol use [3.5 (95% CI 1.4-8.6)], transportation insecurity [5.1 (95% CI 1.1-23.4)] or food insecurity [5.7 (95% CI 1.5-21.6)]. All other associations were not significant.
Conclusions: Prior studies have identified food insecurity as an important factor in readmissions; fewer studies have looked at the impact of transportation insecurity on readmissions. Within our study cohort, we found that both food and transportation insecurity were associated with readmissions at the end of the 180-day study period. This may indicate that reducing readmissions is more challenging for patients with food and/or transportation insecurity. Future interventions for frequently hospitalized patients may consider focusing on patients with these specific HRSN to more successfully reduce hospital readmissions.