An Observational Study of the Incidence and Factors Associated with Patient Readmission from Home Based Care Under the Hospital in the Home Program.

BACKGROUND Hospital in the Home (HITH) provides home-based care by hospital staff which reduces inpatient length of stay and promotes a better quality of life. The frequency and precipitants for readmission from HITH back to the acute inpatient service are currently poorly defined. AIMS To determine the incidence of hospital readmissions and risk factors for readmissions in a HITH program of a large hospital network. METHODS We conducted a retrospective cohort study of adult patients admitted to a large HITH service within a hospital network in Victoria, Australia from 1 July to 30 September 2017. We used logistic regression to determine if patient characteristics or specific clinical factors were associated with hospital readmission. RESULTS In a cohort of 605 patients under HITH, 72 were readmitted (incidence 11.9%). The median duration under HITH prior to readmission was 7 days (interquartile range, 3 to 23 days). Most readmissions were due to treatment failure, an associated complication or new clinical problem. In the univariable analysis, older age, direct admission from the Emergency Department, recent intensive care admission, high Charlson comorbidity index, advanced chronic kidney disease, negative pressure wound therapy and use of antihypertensives were factors associated with readmission. In the multivariable analysis, the variables independently associated with readmissions were the Charlson comorbidity index (OR 1.17, 95% CI: 1.08-1.25) and referrals from the Emergency Department (OR 0.18, 95% CI: 0.06-0.58). CONCLUSIONS Older age and greater comorbidity increased the odds of readmission, but patients from the Emergency Department were low risk compared to inpatient referrals.