Impact of functional status and biomarkers on hospital costs and readmission rates in geriatric patients: An observational study with comprehensive geriatric assessment

Irene Simonetti; Stefano Landi; Chiara Leardini; Anna Giani; Arianna Bortolani; Francesco Fantin

doi:10.1371/journal.pone.0324465

Peer Review History

Original SubmissionDecember 4, 2024
4 Dec 2024 Author Response https://doi.org/10.1371/journal.pone.0324465.r001
31 Jan 2025 Decision Letter - Pedro Kallas Curiati, Editor PONE-D-24-48156Impact of Functional Status and Biomarkers on Hospital Costs and Readmission Rates in Geriatric Patients: An Observational Study with Comprehensive Geriatric AssessmentPLOS ONE Dear Dr. Simonetti, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 17 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: General Evaluation: This study provides a comprehensive and insightful analysis of the factors influencing hospitalization costs and readmissions in elderly patients, focusing strongly on functional status, comorbidities, and biomarkers. Using administrative data combined with clinical variables strengthens the study's findings, and the long follow-up period adds valuable depth to the research. Strengths: The study effectively integrates clinical, functional, and laboratory data to predict hospital costs and readmissions, highlighting the significant role of comorbidities, length of stay (LOS), and functional status (Barthel Index). Identifying low systolic blood pressure as a predictor of readmission is a novel and valuable contribution to the field. A long-term follow-up period (6 months) and a large cohort enhance the generalizability of the findings. The discussion thoroughly compares results with existing literature and clearly explains the study's implications. Areas for Improvement: Clarity and Structure: To improve readability, the discussion section could benefit from clearer separation between key findings, strengths, and limitations. Specificity in Findings: More detailed clinical examples or scenarios would enhance understanding of how these findings could be applied in real-world settings. Comparative Analysis: This study's uniqueness could be emphasized more, particularly its long follow-up period and integration of multiple data sources. Conciseness: Some sections could be more concise. For instance, simplifying repeated concepts or overly complex sentences could improve clarity without sacrificing detail. Limitations: The lack of specific data on the primary diagnosis of readmissions is a notable limitation, as it prevents a deeper understanding of whether readmissions were related to the original condition or new health issues. Future studies could address this gap. Conclusion: Overall, this study contributes to understanding the determinants of hospital costs and readmissions in elderly patients. With minor revisions for clarity and structure, it would be an excellent addition to the literature. Reviewer #2: Thanks for the opportunity, I believe that studies that focus on cost reduction associated with detailed knowledge of the population of each country, city, state becomes a facilitator for the development of more accurate public policies and more accurate interventions by health teams. Congratulations on the article. Update yours reference 36 and adapt the text to the 2024 version: 36. United Nations Department of Economic and Social Affairs, Population Division. (2019). World population ageing 2019. Highlights. See: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPo pulationAgeing2019-Highlights.pdf The delay in publishing this data, which was collected in 2018/2019, should be explained in the text to justify the reason. I believe this could be a detrimental factor in the context of the relevance of the data to the present day. Cordialment, GMA ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . 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Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0324465.r002
Revision 1
14 Apr 2025 Author Response Response Reviewer 1: We thank Reviewer 1 for the valuable comments. In response to the reviewer’s thoughtful feedback, we have revised and restructured the Discussion section to enhance clarity and coherence by simplifying complex sentences and removing redundant concepts, ensuring that key points remain clear without losing detail. First, to enhance readability, we have reorganized the Discussion section to clearly separate key findings, strengths, and limitations. The section now begins with a concise discussion of the univariate analysis results, followed by a more detailed explanation of the multivariate analysis findings. This facilitates comparisons with previous studies and reinforces how our work builds upon existing literature. After presenting our main findings, we have included an extended discussion that incorporates more clinical examples and real-world scenarios. Specifically, we address how demographic shifts and an aging population are placing increasing pressure on healthcare expenditures, making cost-effective interventions in geriatric care more critical than ever. We highlight the role of transition care (TC) programs in reducing unplanned readmissions and generating cost savings by improving outpatient management. Additionally, we discuss how the Value-Based Healthcare (VBHC) framework offers a more patient-centered approach to cost analysis, incorporating disease characteristics and functional assessments to better tailor interventions. These additions provide a broader perspective on how our findings can inform policymakers and hospital managers in optimizing resource allocation and improving healthcare outcomes. In the final part of the Discussion, we have expanded on the strengths of our study. Specifically, we emphasize the integration of diverse data sources, combining administrative records, laboratory findings, and functional assessments to offer a more comprehensive evaluation of patient risk factors. Additionally, we now clearly highlight the significance of our longer follow-up period, which allows for a more thorough assessment of both early and medium-term readmission risks. Unlike previous studies that either included larger samples with a short follow-up or smaller samples with an extended follow-up, our study balances these aspects, providing a broader perspective on hospital readmissions in geriatric care. Finally, we conclude the Discussion by outlining the main limitations of the study. These include the lack of specific data on the primary diagnosis for readmissions and the time lag between data collection and publication. This delay stemmed from constraints related to the COVID-19 pandemic as well as the time required for data preprocessing. Response Reviewer 2: We thank Reviewer 2 for the valuable comments. First, the opening paragraph of the introduction has been revised to include more recent statistics and references. The reference list has been updated accordingly. Second, we acknowledge the time lag between data collection (2018/2019) and publication as a limitation of this study. Data collection started in 2018, continued through 2019, and was only partially completed in 2020 due to challenges posed by COVID-19. Originally, the data was intended for an observational study on transitional care programs. However, due to the incompleteness of the dataset in 2020, unfortunately, we decided to abandon that study and take advantage of the more complete data from 2018 and 2019 to examine the determinants of hospital costs and readmission. Furthermore, the preprocessing and integration of data into a unified dataset required additional time. This limitation has been acknowledged in the final paragraph of the Discussion Section. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0324465.r003
25 Apr 2025 Decision Letter - Pedro Kallas Curiati, Editor Impact of Functional Status and Biomarkers on Hospital Costs and Readmission Rates in Geriatric Patients: An Observational Study with Comprehensive Geriatric Assessment PONE-D-24-48156R1 Dear Dr. Simonetti, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Pedro Kallas Curiati, M.D., Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0324465.r004
Formally Accepted
Acceptance Letter - Pedro Kallas Curiati, Editor PONE-D-24-48156R1 PLOS ONE Dear Dr. Simonetti, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Pedro Kallas Curiati Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0324465.r005

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