A greater number of different chronic conditions increases hospital readmissions and costs
Research Activities, August 2009, No. 348
The rate of hospital readmissions and hospital cost per person in a year depends on the number of different chronic conditions a patient may have, concludes a new study. Agency for Healthcare Research and Quality (AHRQ) researchers Bernard Friedman, Ph.D., H. Joanna Jiang, Ph.D., and Anne Elixhauser, Ph.D., reviewed data for approximately 4.4 million adults from AHRQ's Healthcare Cost and Utilization Project (HCUP) who had been hospitalized in six different States. The initial admissions occurred during January through November 2002.
Twenty percent of all adults were readmitted before the end of the year. Annual hospital costs were more than twice as high for these readmitted individuals. In addition, the percentage of people with five or more different chronic conditions was 50 percent higher among those with readmissions compared with people with no readmissions. Individuals readmitted tended to be older, with more illness severity at the time of their first admission. Congestive heart failure accounted for the highest probability of being readmitted (33.8 percent). Low rates of readmission were found for people with back pain (12.3 percent) and chest pain of unknown cause (13.9 percent). Hypertension was present in half of all people with three chronic conditions.
The researchers also found that patients covered by Medicare and Medicaid had the highest likelihood of readmission and generated more costs compared with the privately insured. Those paying for their own health care out-of-pocket (self pay) had a lower rate of readmission and lower costs compared with privately insured patients. Costs for hospital care increased as the number of chronic conditions increased. Compared with people with no or only one chronic condition, the total hospital cost was about 11 percent higher for those with two conditions. This increased significantly to 46 percent for people with seven or more conditions. Concentrating new health care services on patients with a high number of different chronic conditions could significantly reduce readmissions and total hospital costs.
See "Costly hospital readmissions and complex chronic illness," by Drs. Friedman, Jiang, and Elixhauser, in the Winter 2008/2009 Inquiry 45, pp. 408-421.
Reprints (ARHQ Publication No. 09-R064) are available from the AHRQ Publications Clearinghouse.