Factors associated with unplanned admissions among patients with chronic conditions.

Abstract

Objectives: Value-based care models, such as the Medicare Shared Savings Program, have placed increasing emphasis on unplanned admissions among patients with multiple chronic conditions (UAMCCs) as a quality metric. However, there are limited data on which factors are associated with the highest risk of UAMCCs. This study sought to determine which factors were associated with increased risk of UAMCCs.

Study design: Retrospective study conducted among all adult patients with 2 or more chronic conditions defined by CMS presenting to 2 hospitals within a major Midwest health care system from November 1, 2022, to October 31, 2023.

Methods: Demographics, chronic conditions, primary care physician (PCP) visit utilization, and annual wellness visit (AWV) utilization were analyzed using multivariable logistic regression to identify associations with UAMCCs.

Results: Among 18,448 patients (55.8% women) included in the study, 3842 (20.8%) had at least 1 UAMCC. Patients with UAMCCs were more likely to have Medicare or Medicaid insurance; be widowed; speak Spanish; have a higher Charlson Comorbidity Index score; and have Alzheimer disease, atrial fibrillation, heart failure, chronic kidney disease, depression, chronic obstructive pulmonary disease, and/or stroke. When examining PCP visit measures, AWVs and having 1 or more PCP visits were associated with fewer UAMCCs.

Conclusions: Higher Charlson Comorbidity Index scores, several health conditions, and Spanish language were associated with increased UAMCCs. AWVs and having 1 or more PCP visits were associated with fewer UAMCCs.