The risk factors for hospital re-admission in medical patients in Singapore

Unplanned hospital re-admissions are common, expensive and often unpreventable in the community. The study aimed to identify risk factors associated with unplanned hospital re-admission in Singapore. In a cross-sectional survey, 1509 patients admitted to the medical wards of a large acute hospital in Singapore during 2010 were recruited (78.8% response rate), data being collected using a structured questionnaire based on the Andersen behavioural model underlying healthcare use. The dependent variable was re-admission within 28 days, with independent variables in the four areas of predisposing characteristics, needs, enabling resources and health behaviour. Hierarchical logistic regression was used to evaluate the risk factors associated with unplanned hospital re-admission. There were 222 inpatients re-admitted (14.7%) within 28 days and the final model showed that patients who were unemployed (OR = 1.5; 95% CI = 1.1-2.1) and had chronic obstructive pulmonary disease (OR = 2.0; 95% CI = 1.1-3.7) with abnormal respiratory patterns (OR = 1.6; 95% CI = 1.1-2.2) were more likely to be re-admitted. Less likely to be re-admitted were patients doing regular daily activities (OR = 0.7; 95% CI = 0.5-0.9), those assisted by a social worker (OR = 0.3; 95% CI = 0.2-0.6), those referred to other health professionals when sick (OR = 0.6; 95% CI = 0.4-0.7) and those who had received health education programmes before discharge in the previous admission (OR = 0.7; 95% CI = 0.4-0.9). Unplanned re-admissions are a concern to healthcare providers because this suggests that patients are discharged with unresolved problems that reflect ineffective care in hospital. This study provides evidence to prompt more effective discharge educational care programmes that incorporate patients' enabling and need outcomes, thereby reducing re-admission rates. Community-based healthcare should play an important role in reducing patients' re-admission rates.