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Cited by 23Hospital Admissions and OutcomesHealthcare Policy and ManagementChronic Disease Management Strategies

Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults

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Turbow, Sara D., Ali, Mohammed K., Culler, Steven D., Rask, Kimberly J., Perkins, Molly M., Clevenger, Carolyn K., Vaughan, Camille P.·2023·JAMA Network Open
DOI 10.1001/jamanetworkopen.2023.13592PMC PMC10189568
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Abstract

Importance: When an older adult is hospitalized, where they are discharged is of utmost importance. Fragmented readmissions, defined as readmissions to a different hospital than a patient was previously discharged from, may increase the risk of a nonhome discharge for older adults. However, this risk may be mitigated via electronic information exchange between the admission and readmission hospitals. Objective: To determine the association of fragmented hospital readmissions and electronic information sharing with discharge destination among Medicare beneficiaries. Design, Setting, and Participants: This cohort study retrospectively examined data from Medicare beneficiaries hospitalized for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, syncope, urinary tract infection, dehydration, or behavioral issues in 2018 and their 30-day readmission for any reason. The data analysis was completed between November 1, 2021, and October 31, 2022. Exposures: Same hospital vs fragmented readmissions and presence of the same health information exchange (HIE) at the admission and readmission hospitals vs no information shared between the admission and readmission hospitals. Main Outcomes and Measures: The main outcome was discharge destination following the readmission, including home, home with home health, skilled nursing facility (SNF), hospice, leaving against medical advice, or dying. Outcomes were examined for beneficiaries with and without Alzheimer disease using logistic regressions. Results: The cohort included 275 189 admission-readmission pairs, representing 268 768 unique patients (mean [SD] age, 78.9 [9.0] years; 54.1% female and 45.9% male; 12.2% Black, 82.1% White, and 5.7% other race and ethnicity). Of the 31.6% fragmented readmissions in the cohort, 14.3% occurred at hospitals that shared an HIE with the admission hospital. Beneficiaries with same hospital/nonfragmented readmissions tended to be older (mean [SD] age, 78.9 [9.0] vs 77.9 [8.8] for fragmented with same HIE and 78.3 [8.7] years for fragmented without HIE; P < .001). Fragmented readmissions were associated with 10% higher odds of discharge to an SNF (adjusted odds ratio [AOR], 1.10; 95% CI, 1.07-1.12) and 22% lower odds of discharge home with home health (AOR, 0.78; 95% CI, 0.76-0.80) compared with same hospital/nonfragmented readmissions. When the admission and readmission hospital shared an HIE, beneficiaries had 9% to 15% higher odds of discharge home with home health (patients without Alzheimer disease: AOR, 1.09 [95% CI, 1.04-1.16]; patients with Alzheimer disease: AOR, 1.15 [95% CI, 1.01-1.32]) compared with fragmented readmissions where information sharing was not available. Conclusions and Relevance: In this cohort study of Medicare beneficiaries with 30-day readmissions, whether a readmission is fragmented was associated with discharge destination. Among fragmented readmissions, shared HIE across admission and readmission hospitals was associated with higher odds of discharge home with home health. Efforts to study the utility of HIE for care coordination for older adults should be pursued.

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  • Inconsistencies in the standard of care from admission and during the hospital stay were associated with reduced patient wellbeing and potential inequitable access to care, which increased the risk of readmission.

    “Inconsistencies in the standard of care from admission and during the hospital stay (potentially explained in part by a lack of standardised information exchange) were associated with reduced patient wellbeing and potential inequitable access to care, which increased the risk of readmission [28, 39–43].”

    From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [39]

    The Introduction (page unavailable) links fragmented readmissions to unavailable prior records, poorer outcomes, and a higher risk of subsequent readmission; the Conclusions link information discontinuity to suboptimal discharge destinations. The paper does not establish inconsistencies in the standard of care during admission or the hospital stay, reduced patient wellbeing, or inequitable access as a pathway increasing readmission risk. (LLM, conf=0.86)

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  • Key features of discharge planning included developing meaningful care plans, which were communicated to all involved in the transition, informed by the patient's goals of care and provided opportunities for follow-up in the community.

    “Key features of discharge planning included developing meaningful care plans, which were communicated to all involved in the transition, informed by the patient’s goals of care and provided opportunities for follow-up in the community [28, 39, 43–61].”

    From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [39]

    The Discussion (page unavailable) says information from prior visits may reveal a patient’s goals of care, and the Conclusions say electronic information exchange may improve transitions between hospitals. The paper does not describe developing meaningful discharge care plans, communicating them to everyone involved, or arranging community follow-up. (LLM, conf=0.82)

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Authors
Turbow, S. D., Ali, M. K., Culler, S. D., Rask, K. J., Perkins, M. M., Clevenger, C. K., & Vaughan, C. P.
Affiliations
  • Emory University (US)
  • Alliant Health Solutions, Atlanta, Georgia
  • United States Department of Veterans Affairs (US)
Corresponding author
Turbow, Sara D.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2023-05-16
Volume
6
Issue
5
Pages
e2313592
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2023.13592
PMC
PMC10189568
OpenAlex
W4376642940
Cited by
23
References
54
Citations by year
2026: 5 · 2025: 10 · 2024: 7 · 2023: 1
FWCI
7.05
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Doris Duke Charitable Foundation
  • Eli Lilly and Company
  • Emory University (UL1 TR002378)
  • National Institutes of Health (UL1TR002378)
  • National Institute on Aging (K23AG065505)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
hospital readmission, health information exchange, electronic health records, discharge disposition, older adults, Medicare beneficiaries, skilled nursing facilities, non-home discharge, Alzheimer's disease, discharge planning, hospital readmission prevention
MeSH terms
Aged, Alzheimer Disease, Female, Medicare, Hospices, Humans, Male, Patient Discharge, Patient Readmission, Retrospective Studies, United States, Cohort Studies

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