Predictors of 30-day unplanned hospital readmission among adult patients with diabetes mellitus: a systematic review with meta-analysis

• Published in: BMJ open diabetes research & care Vol. 8; no. 1; p. e001227
• Main Authors: Soh, Jade Gek Sang, Wong, Wai Pong, Mukhopadhyay, Amartya, Quek, Swee Chye, Tai, Bee Choo
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 11.08.2020; BMJ Publishing Group
• Subjects: Adults; Age groups; Clinical Care/Education/Nutrition; Comorbidity; Continuity of care; Diabetes; Gender differences; Heart failure; Hospitalization; Insulin; Kidney diseases; Meta-analysis; Patients; Risk factors; Systematic review; United States > US
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2020-001227

Adult patients with diabetes mellitus (DM) represent one-fifth of all 30-day unplanned hospital readmissions but some may be preventable through continuity of care with better DM self-management. We aim to synthesize evidence concerning the association between 30-day unplanned hospital readmission and patient-related factors, insurance status, treatment and comorbidities in adult patients with DM. We searched full-text English language articles in three electronic databases (MEDLINE, Embase and CINAHL) without confining to a particular publication period or geographical area. Prospective and retrospective cohort and case–control studies which identified significant risk factors of 30-day unplanned hospital readmission were included, while interventional studies were excluded. The study participants were aged ≥18 years with either type 1 or 2 DM. The random effects model was used to quantify the overall effect of each factor. Twenty-three studies published between 1998 and 2018 met the selection criteria and 18 provided information for the meta-analysis. The data were collected within a period ranging from 1 to 15 years. Although patient-related factors such as age, gender and race were identified, comorbidities such as heart failure (OR=1.81, 95% CI 1.67 to 1.96) and renal disease (OR=1.69, 95% CI 1.34 to 2.12), as well as insulin therapy (OR=1.45, 95% CI 1.24 to 1.71) and insurance status (OR=1.41, 95% CI 1.22 to 1.63) were stronger predictors of 30-day unplanned hospital readmission. The findings may be used to target DM self-management education at vulnerable groups based on comorbidities, insurance type, and insulin therapy.