Identifying risk of readmission in hospitalized elderly adults through inpatient medication exposure.

OBJECTIVE: To use electronic health record (EHR) data to examine the association between inpatient medication exposure and risk of hospital readmission. DESIGN: Retrospective, observational study. SETTING: Tertiary and quaternary care academic health system in Durham, North Carolina. PARTICIPANTS: All individuals aged 60 and older who were residents of Durham County, North Carolina and were hospitalized and discharged alive from Duke University Hospital between 2007 and 2009 (N = 4,627). MEASUREMENTS: Independent variables were inpatient exposure to individual medication classes. Primary outcome was readmission to a Duke Health System hospital within 30 days. RESULTS: Readmission rate was 21% (n = 955). In adjusted models, exposure to anticonvulsants (odds ratio OR 1.26, 95% confidence interval (CI) = 1.08-1.48), benzodiazepines (OR = 1.23, 95% CI = 1.04-1.44), corticosteroids (OR = 1.26, 95% CI = 1.07-1.50), and opioids (OR = 1.25, 95% CI = 1.06-1.47) was associated with greater likelihood of readmission. Exposure to antidepressants (OR = 1.85, 95% CI = 1.16-2.96) and opioids on the cardiology service (OR = 1.76, 95% CI = 1.01-3.07) and exposure to opioids on the medicine service (OR = 1.94, 95% CI = 1.17-3.22) were associated with greater odds of readmission than for individuals on the surgery service. CONCLUSION: Exposure of hospitalized elderly adults to certain medication classes was associated with greater likelihood of readmission. Incorporating medication data from EHRs may improve the performance of hospital readmission prediction models.

Duke Scholars

Author Juliessa Pavon Medicine, Geriatrics and Palliative Care

Author Eleanor Schildwachter McConnell School of Nursing

Author Susan Nicole Hastings Medicine, Geriatrics and Palliative Care