scholarly journals Factors associated with unplanned readmissions in a major Australian health service

2019 ◽  
Vol 43 (1) ◽  
pp. 1 ◽  
Author(s):  
Julie Considine ◽  
Karen Fox ◽  
David Plunkett ◽  
Melissa Mecner ◽  
Mary O'Reilly ◽  
...  
Keyword(s):  
Health Service ◽  
Hospital Admission ◽  
Acute Care ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Factors Associated ◽  
Australian Health ◽  
Increased Risk ◽  
Patient Groups ◽  
Comorbidity Index

Objective The aim of the present study was to gain an understanding of the factors associated with unplanned hospital readmission within 28 days of acute care discharge from a major Australian health service. Methods A retrospective study of 20575 acute care discharges from 1 August to 31 December 2015 was conducted using administrative databases. Patient, index admission and readmission characteristics were evaluated for their association with unplanned readmission in ≤28 days. Results The unplanned readmission rate was 7.4% (n=1528) and 11.1% of readmitted patients were returned within 1 day. The factors associated with increased risk of unplanned readmission in ≤28 days for all patients were age ≥65 years (odds ratio (OR) 1.3), emergency index admission (OR 1.6), Charlson comorbidity index >1 (OR 1.1–1.9), the presence of chronic disease (OR 1.4) or complications (OR 1.8) during the index admission, index admission length of stay (LOS) >2 days (OR 1.4–1.8), hospital admission(s) (OR 1.7–10.86) or emergency department (ED) attendance(s) (OR 1.8–5.2) in the 6 months preceding the index admission and health service site (OR 1.2–1.6). However, the factors associated with increased risk of unplanned readmission ≤28 days changed with each patient group (adult medical, adult surgical, obstetric and paediatric). Conclusions There were specific patient and index admission characteristics associated with increased risk of unplanned readmission in ≤28 days; however, these characteristics varied between patient groups, highlighting the need for tailored interventions. What is known about the topic? Unplanned hospital readmissions within 28 days of hospital discharge are considered an indicator of quality and safety of health care. What does this paper add? The factors associated with increased risk of unplanned readmission in ≤28 days varied between patient groups, so a ‘one size fits all approach’ to reducing unplanned readmissions may not be effective. Older adult medical patients had the highest rate of unplanned readmissions and those with Charlson comorbidity index ≥4, an index admission LOS >2 days, left against advice and hospital admission(s) or ED attendance(s) in the 6 months preceding index admission and discharge from larger sites within the health service were at highest risk of unplanned readmission. What are the implications for practitioners? One in seven discharges resulted in an unplanned readmission in ≤28 days and one in 10 unplanned readmissions occurred within 1 day of discharge. Although some patient and hospital characteristics were associated with increased risk of unplanned readmission in ≤28 days, statistical modelling shows there are other factors affecting the risk of readmission that remain unknown and need further investigation. Future work related to preventing unplanned readmissions in ≤28 days should consider inclusion of health professional, system and social factors in risk assessments.

scholarly journals One-year Versus Five-year Hospital Readmission after Ischemic Stroke and TIA

2018 ◽  
Author(s):  
Anna Therese Bjerkreim ◽  
Halvor Naess ◽  
Andrej Netland Khanevski ◽  
Lars Thomassen ◽  
Ulrike Waje-Andreassen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Cardiovascular Comorbidity ◽  
Factors Associated ◽  
Artery Disease ◽  
One Year

Abstract Background: The burden of readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke. In a cohort composing patients with ischemic stroke and transient ischemic attack (TIA), we examined and compared factors associated with readmission within 1 year and first readmission during year 2-5. Methods: Patients with ischemic stroke or TIA who were discharged alive between July 2007 and October 2012, were followed for five years by review of medical charts. Timing and cause of the first unplanned readmission were registered. Cox regression was used to identify independent risk factors for readmission within 1 year and first readmission during year 2-5 after discharge. Results: The cohort included 1453 patients, of whom 568 (39.1%) were readmitted within 1 year. Of the 830 patients that were alive and without readmission 1 year after discharge, 439 (52.9%) were readmitted within 5 years. Patients readmitted within 1 year were older, had more severe strokes, poorer functional outcome, and a higher occurrence of complications during index admission than patients readmitted during years 2-5. Cardiovascular comorbidity did not differ between the two groups of readmitted patients. Higher age, poorer functional outcome, coronary artery disease and hypertension were independently associated with first readmission within both 1 year and during year 2-5. Peripheral artery disease was independently associated with readmission within 1 year, and atrial fibrillation was associated with first readmission during year 2-5. Conclusions: More than half of all patients who survived the first year after stroke without any readmissions were readmitted within 5 years. Patients readmitted within 1 year and between years 2-5 shared many risk factors for readmission, but they differed in age, functional outcome and occurrence of complications during the index admission.

scholarly journals Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243373
Author(s):  
Pei-Fang Huang ◽  
Pei-Tseng Kung ◽  
Wen-Yu Chou ◽  
Wen-Chen Tsai
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Payment System ◽  
Hospital Ownership ◽  
Related Factors ◽  
Factors Associated ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Ed Visits ◽  
Monthly Salary

Objectives Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC). Methods We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System. Results In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69–9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32–31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals. Conclusion The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.

Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

2014 ◽  
Vol 35 (4) ◽  
pp. 398-405 ◽  
Author(s):  
Ashish Bhargava ◽  
Kayoko Hayakawa ◽  
Ethan Silverman ◽  
Samran Haider ◽  
Krishna Chaitanya Alluri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Acute Care ◽  
Entire Cohort ◽  
Carbapenem Resistant ◽  
Increased Risk ◽  
Surveillance Programs ◽  
Acute Care Facilities ◽  
Carbapenem Resistant Enterobacteriaceae

Background.This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission.Methods.A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3:1 ratio to cases) were patients with negative screening cultures.Results.Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64–14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08–1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09–2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71–21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar.Conclusions.These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

scholarly journals A Systematic Literature Review and Meta-Analysis of Factors Associated with Methicillin-ResistantStaphylococcus aureusColonization at Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (10) ◽  
pp. 1077-1086 ◽  
Author(s):  
James A. McKinnell ◽  
Loren G. Miller ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Susan S. Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Hospital Admission ◽  
Systematic Evaluation ◽  
Factors Associated ◽  
Icu Admission ◽  
Increased Risk ◽  
Healthcare Associated ◽  
Mrsa Colonization

Objective.Screening for methicillin-resistantStaphylococcus aureus(MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission.Design.We searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization.Results.We reviewed 4,381 abstracts; 29 articles met inclusion criteria (n= 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3–4.7];P<.01), nursing home exposure (OR, 3.8 [95% CI, 2.3–6.3];P< .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2–15.1];Clostridium difficileinfection: OR, 3.4 [95% CI, 2.2–5.3]; vancomycin-resistantEnterococcicarriage: OR, 3.1 [95% CI, 2.5–4.0];P< .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure;P< .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6–1.8];P= .87).Conclusions.MRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention programs utilizing targeted MRSA screening may consider our results to define patients likely to have MRSA colonization.

scholarly journals Mental health and substance use associated with hospitalization among people with laboratory confirmed diagnosis of COVID-19 in British Columbia: a population-based cohort study

2021 ◽  
Author(s):  
Héctor Alexander Velásquez García ◽  
James Wilton ◽  
Kate Smolina ◽  
Mei Chong ◽  
Drona Rasali ◽  
...  
Keyword(s):  
British Columbia ◽  
Substance Use ◽  
Hospital Admission ◽  
Prescription Drugs ◽  
Older Age ◽  
Reproductive Age ◽  
Adjusted Risk ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Sex

Background: This study identified factors associated with hospital admission among people with laboratory-diagnosed COVID-19 cases in British Columbia. Methods: This study was performed using the BC COVID-19 Cohort, which integrates data on all COVID-19 cases, hospitalizations, medical visits, emergency room visits, prescription drugs, chronic conditions and deaths. The analysis included all laboratory-diagnosed COVID-19 cases in British Columbia as of January 15th, 2021. We evaluated factors associated with hospital admission using multivariable Poisson regression analysis with robust error variance. Findings: From 56,874 COVID-19 cases included in the analyses, 2,298 were hospitalized. Models showed significant association of the following factors with increased hospitalization risk: male sex (adjusted risk ratio (aRR)=1.27; 95%CI=1.17-1.37), older age (p-trend <0.0001 across age groups with a graded increase in hospitalization risk with increasing age [aRR 30-39 years=3.06; 95%CI=2.32-4.03, to aRR 80+years=43.68; 95%CI=33.41-57.10 compared to 20-29 years-old]), asthma (aRR=1.15; 95%CI=1.04-1.26), cancer (aRR=1.19; 95%CI=1.09-1.29), chronic kidney disease (aRR=1.32; 95%CI=1.19-1.47), diabetes (treated without insulin aRR=1.13; 95%CI=1.03-1.25, requiring insulin aRR=5.05; 95%CI=4.43-5.76), hypertension (aRR=1.19; 95%CI=1.08-1.31), injection drug use (aRR=2.51; 95%CI=2.14-2.95), intellectual and developmental disabilities (aRR=1.67; 95%CI=1.05-2.66), problematic alcohol use (aRR=1.63; 95%CI=1.43-1.85), immunosuppression (aRR=1.29; 95%CI=1.09-1.53), and schizophrenia and psychotic disorders (aRR=1.49; 95%CI=1.23-1.82). Among women of reproductive age, in addition to age and comorbidities, pregnancy (aRR=2.69; 95%CI=1.42-5.07) was associated with increased risk of hospital admission. Interpretation: Older age, male sex, substance use, intellectual and developmental disability, chronic comorbidities, and pregnancy increase the risk of COVID-19-related hospitalization. Funding: BC Centre for Disease Control, Canadian Institutes of Health Research.

scholarly journals Comparison of clinical characteristics and disease outcome of COVID-19 and seasonal influenza

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thomas Theo Brehm ◽  
Marc van der Meirschen ◽  
Annette Hennigs ◽  
Kevin Roedl ◽  
Dominik Jarczak ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Seasonal Influenza ◽  
Clinical Course ◽  
Severe Illness ◽  
Group 13 ◽  
Course Of Disease ◽  
Increased Risk ◽  
Duration Of Hospitalization ◽  
Patient Groups ◽  
Comorbidity Index

AbstractWhile several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017–18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45–71] vs 66 [52–77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.

73 High Cost and Resource Utilization of Frostbite Readmissions

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S50-S51
Author(s):  
Frederick W Endorf ◽  
Rachel M Nygaard
Keyword(s):  
Alcohol Abuse ◽  
Urban Areas ◽  
National Level ◽  
Unplanned Readmission ◽  
High Morbidity ◽  
Burden Of Care ◽  
Total Cost ◽  
Factors Associated ◽  
Comorbidity Index ◽  
Nationwide Readmission Database

Abstract Introduction Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people. Methods Index hospitalizations and readmissions were identified in the 2016 and 2017 Nationwide Readmission Database. Weighted incidence and characteristics of readmissions associated with frostbite injury were calculated and adjusted for by using survey weight, sampling clusters, and stratum. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index. Results The unplanned readmission rate following frostbite injury was 35.4% (95% CI 32.2 – 38.6%). In the two-year cohort, 1,065 index hospitalizations resulted in 1,907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total LOS of readmissions was $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare Insurance, but not drug or alcohol abuse or homelessness. Conclusions This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions.

scholarly journals Factors associated with early 14-day unplanned hospital readmission: a matched case–control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu-Tai Lo ◽  
Chia-Ming Chang ◽  
Mei-Hua Chen ◽  
Fang-Wen Hu ◽  
Feng-Hwa Lu
Keyword(s):  
Nasogastric Tube ◽  
Case Control Study ◽  
Case Control ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Increased Risk ◽  
Clinical Instability ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Abstract Background/Purpose Early unplanned hospital readmissions are burdensome health care events and indicate low care quality. Identifying at-risk patients enables timely intervention. This study identified predictors for 14-day unplanned readmission. Methods We conducted a retrospective, matched, case–control study between September 1, 2018, and August 31, 2019, in an 1193-bed university hospital. Adult patients aged ≥ 20 years and readmitted for the same or related diagnosis within 14 days of discharge after initial admission (index admission) were included as cases. Cases were 1:1 matched for the disease-related group at index admission, age, and discharge date to controls. Variables were extracted from the hospital’s electronic health records. Results In total, 300 cases and 300 controls were analyzed. Six factors were independently associated with unplanned readmission within 14 days: previous admissions within 6 months (OR = 3.09; 95 % CI = 1.79–5.34, p < 0.001), number of diagnoses in the past year (OR = 1.07; 95 % CI = 1.01–1.13, p = 0.019), Malnutrition Universal Screening Tool score (OR = 1.46; 95 % CI = 1.04–2.05, p = 0.03), systolic blood pressure (OR = 0.98; 95 % CI = 0.97–0.99, p = 0.01) and ear temperature within 24 h before discharge (OR = 2.49; 95 % CI = 1.34–4.64, p = 0.004), and discharge with a nasogastric tube (OR = 0.13; 95 % CI = 0.03–0.60, p = 0.009). Conclusions Factors presented at admission (frequent prior hospitalizations, multimorbidity, and malnutrition) along with factors presented at discharge (clinical instability and the absence of a nasogastric tube) were associated with increased risk of early 14-day unplanned readmission.

scholarly journals Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma

2015 ◽  
Vol 101 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Christopher A Green ◽  
David Yeates ◽  
Allie Goldacre ◽  
Charles Sande ◽  
Roger C Parslow ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Admission ◽  
Record Linkage ◽  
Geographical Variation ◽  
Hospital Admissions ◽  
Paediatric Intensive Care ◽  
Hospital Admission Rate ◽  
Factors Associated ◽  
Admission Rates ◽  
Increased Risk

BackgroundAdmission of infants to hospital with bronchiolitis consumes considerable healthcare resources each winter. We report an analysis of hospital admissions in England over five decades.MethodsData were analysed from the Hospital In-Patient Enquiry (HIPE, 1968–1985), Hospital Episode Statistics (HES, 1989–2011), Oxford Record Linkage Study (ORLS, 1963–2011) and Paediatric Intensive Care Audit Network (PICANet, 2003–2012). Cases were identified using International Classification of Diseases (ICD) codes in discharge records. Bronchiolitis was given a separate code in ICD9 (used in England from 1979). Geographical variation was analysed using Local Authority area boundaries. Maternal and perinatal risk factors associated with bronchiolitis and subsequent admissions for asthma were analysed using record-linkage.ResultsAll-England HIPE and HES data recorded 468 138 episodes of admission for bronchiolitis in infants aged <1 year between 1979 and 2011. In 2011 the estimated annual hospital admission rate was 46.1 (95% CI 45.6 to 46.6) per 1000 infants aged <1 year. Between 2004 and 2011 the rates rose by an average of 1.8% per year in the all-England HES data, whereas admission rates to paediatric intensive care changed little (1.3 to 1.6 per 1000 infants aged <1 year). A fivefold geographical variation in hospital admission rates was observed. Young maternal age, low social class, low birth weight and maternal smoking were among factors associated with an increased risk of hospital admission with bronchiolitis.ConclusionsHospital admissions for infants with bronchiolitis have increased substantially in recent years. However, cases requiring intensive care have changed little since 2004.

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