Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty
Introduction: The 30-day readmission rate for chronic obstructive pulmonary disease (COPD) is a common performance metric but may be confounded by factors unrelated to quality of care. Our aim was to assess how sociodemographic factors, multimorbidity and frailty impact 30-day readmission risk afte...
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Academy of Medicine Singapore
2025-07-01
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| Series: | Annals, Academy of Medicine, Singapore |
| Online Access: | https://annals.edu.sg/chronic-obstructive-pulmonary-disease-30-day-readmission-metric-risk-adjustment-for-multimorbidity-and-frailty/# |
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| author | Anthony Yii Isaac Fong Sean Chee Hong Loh Jansen Meng-Kwang Koh Augustine Tee |
| author_facet | Anthony Yii Isaac Fong Sean Chee Hong Loh Jansen Meng-Kwang Koh Augustine Tee |
| author_sort | Anthony Yii |
| collection | DOAJ |
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Introduction: The 30-day readmission rate for chronic obstructive pulmonary disease (COPD) is a common performance metric but may be confounded by factors unrelated to quality of care. Our aim was to assess how sociodemographic factors, multimorbidity and frailty impact 30-day readmission risk after COPD hospitalisation, and whether risk adjustment alters interpretation of temporal trends. Method: This is a retrospective analysis of administrative data from October 2017 to June 2023 from Changi General Hospital, Singapore. Multivariable mixed-effects logistic regression models were used to estimate unadjusted and risk-adjusted 30-day readmission odds. Covariates included age, sex, race, Charlson Comorbidity Index (CCI), Hospital Frailty Risk Score (HFRS) and year. Temporal trends in readmission risk were compared across unadjusted and adjusted models. Results: Of the 2774 admissions, 749 (27%) resulted in 30-day readmissions. Higher CCI (CCI≥4 versus [vs] CCI=1: adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.33–2.99, P=0.003; CCI 2–3 vs CCI=1: aOR 1.50, 95% CI 1.15–1.96, P=0.001) and higher HFRS (equal or more than 5 vs less than 5: aOR 1.29, 95% CI 1.01–1.65, P=0.04) were independently associated with increased readmission risk. While unadjusted analyses showed no significant temporal trends, the risk-adjusted model revealed a 32–35% reduction in readmission odds in 2021–2023 compared to baseline. Conclusion: Multimorbidity and frailty significantly impact COPD readmissions. Risk adjustment revealed improvements in readmission risk not evident in unadjusted analyses, emphasising the importance of applying risk adjustments to ensure valid performance metrics. |
| format | Article |
| id | doaj-art-24a591a79bcd40d584522e427050b5dd |
| institution | Kabale University |
| issn | 2972-4066 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Academy of Medicine Singapore |
| record_format | Article |
| series | Annals, Academy of Medicine, Singapore |
| spelling | doaj-art-24a591a79bcd40d584522e427050b5dd2025-08-20T03:39:15ZengAcademy of Medicine SingaporeAnnals, Academy of Medicine, Singapore2972-40662025-07-0154741910.47102/annals-acadmedsg.202524Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailtyAnthony YiiIsaac FongSean Chee Hong LohJansen Meng-Kwang KohAugustine Tee Introduction: The 30-day readmission rate for chronic obstructive pulmonary disease (COPD) is a common performance metric but may be confounded by factors unrelated to quality of care. Our aim was to assess how sociodemographic factors, multimorbidity and frailty impact 30-day readmission risk after COPD hospitalisation, and whether risk adjustment alters interpretation of temporal trends. Method: This is a retrospective analysis of administrative data from October 2017 to June 2023 from Changi General Hospital, Singapore. Multivariable mixed-effects logistic regression models were used to estimate unadjusted and risk-adjusted 30-day readmission odds. Covariates included age, sex, race, Charlson Comorbidity Index (CCI), Hospital Frailty Risk Score (HFRS) and year. Temporal trends in readmission risk were compared across unadjusted and adjusted models. Results: Of the 2774 admissions, 749 (27%) resulted in 30-day readmissions. Higher CCI (CCI≥4 versus [vs] CCI=1: adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.33–2.99, P=0.003; CCI 2–3 vs CCI=1: aOR 1.50, 95% CI 1.15–1.96, P=0.001) and higher HFRS (equal or more than 5 vs less than 5: aOR 1.29, 95% CI 1.01–1.65, P=0.04) were independently associated with increased readmission risk. While unadjusted analyses showed no significant temporal trends, the risk-adjusted model revealed a 32–35% reduction in readmission odds in 2021–2023 compared to baseline. Conclusion: Multimorbidity and frailty significantly impact COPD readmissions. Risk adjustment revealed improvements in readmission risk not evident in unadjusted analyses, emphasising the importance of applying risk adjustments to ensure valid performance metrics. https://annals.edu.sg/chronic-obstructive-pulmonary-disease-30-day-readmission-metric-risk-adjustment-for-multimorbidity-and-frailty/# |
| spellingShingle | Anthony Yii Isaac Fong Sean Chee Hong Loh Jansen Meng-Kwang Koh Augustine Tee Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty Annals, Academy of Medicine, Singapore |
| title | Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty |
| title_full | Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty |
| title_fullStr | Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty |
| title_full_unstemmed | Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty |
| title_short | Chronic obstructive pulmonary disease 30-day readmission metric: Risk adjustment for multimorbidity and frailty |
| title_sort | chronic obstructive pulmonary disease 30 day readmission metric risk adjustment for multimorbidity and frailty |
| url | https://annals.edu.sg/chronic-obstructive-pulmonary-disease-30-day-readmission-metric-risk-adjustment-for-multimorbidity-and-frailty/# |
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