Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach

2019 ◽  
Vol 77 (6) ◽  
pp. 574-583 ◽  
Author(s):  
Peter May ◽  
Melissa M. Garrido ◽  
Egidio Del Fabbro ◽  
Danielle Noreika ◽  
Charles Normand ◽  
...  
Keyword(s):  
Competing Risks ◽  
High Mortality ◽  
Hospital Readmission ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hospital Readmission Rate ◽  
Diagnosis Of Cancer

Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Eligible participants were adult inpatients admitted to an academic, safety-net medical center (2009-2015) with at least one diagnosis of cancer, heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure, AIDS/HIV, and selected neurodegenerative conditions. PC was associated with reduced 30-, 60-, and 90-day readmissions (subhazard ratios = 0.57, 0.53, and 0.52, respectively [all p < .001]). Hospital PC is associated with a reduction in readmissions, and this is not explained by higher mortality among PC patients. Performance measures only counting those alive at a given end point may underestimate systematically the effects of treatments with a high-mortality rate.

Hospital Readmissions: Patient, Carer and Clinician Views

2006 ◽  
Vol 5 (3) ◽  
pp. 104-107
Author(s):  
Elinor Kirk ◽  
◽  
M K Prasad ◽  
Ahmed H Abdelhafiz ◽  
◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Medical Condition ◽  
Hospital Readmissions ◽  
Chronic Obstructive ◽  
Medical Patients ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome

Aim: To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission. Methods: A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles. Results: Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged ≥75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients ≥ 75 years was noted (7.2% vs 5.1%, p=0.1). Conclusion: Although the majority of discharges are appropriate, up to a third of readmissions may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.

scholarly journals Contributing Factors to Hospital Readmissions

2013 ◽  
Author(s):  
Susan Amalfitano
Keyword(s):  
Elderly Patients ◽  
Hospital Readmission ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
The Elderly ◽  
High Rate ◽  
Chronic Obstructive ◽  
Contributing Factors ◽  
Obstructive Pulmonary Disease ◽  
Care Of Elderly

Aims and objectives. To investigate the elderly patient’s perspective about the reasons for discharge to home being unsuccessful, resulting in rehospitalization. Background. Elderly patients have a high rate of readmission to the hospital within 30 days of discharge. Starting in October of 2013, hospitals having a high rate of readmission of patients with heart failure (HF), myocardial infarction (MI), and pneumonia (PNA) will face financial penalties. Evidence indicated that by utilizing risk prediction tools and incorporating transition interventions the risk of a hospital readmission may be reduced. Design. A qualitative, descriptive design was used. Methods. In 2013, a student investigator interviewed elderly patients over the age of 65 who were readmitted to the hospital with the diagnosis of HF, MI, PNA or chronic obstructive pulmonary disease (COPD) within 30 days of discharge. A total of six (N=6) patients and/or surrogates participated in the interviews. Data were collected using semistructured interviews and subjected to thematic content analysis. Results. Three major themes emerged: discharge readiness, communication, and education. Implications for the advanced practice registered nurse (APRN). Practicing in an APRN role provides the opportunity for the nurse to facilitate the appropriate transitional care of elderly patients placing them at less risk for hospital readmission within 30 days.

scholarly journals COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258243
Author(s):  
Jacquelyn Jacobs ◽  
Amy K. Johnson ◽  
Arianna Boshara ◽  
Bijou Hunt ◽  
Christina Khouri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Minority Population ◽  
Obstructive Pulmonary Disease ◽  
Ethnic Minority Population ◽  
Prolonged Length

Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18–24, the odds of testing positive were statistically significantly higher for every age group except 25–34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.

scholarly journals Together in Care: An Enhanced Meals on Wheels Intervention Designed to Reduce Rehospitalizations among Older Adults with Cardiopulmonary Disease—Preliminary Findings

2022 ◽  
Vol 19 (1) ◽  
pp. 458
Author(s):  
Panagis Galiatsatos ◽  
Adejoke Ajayi ◽  
Joyce Maygers ◽  
Stephanie Archer Smith ◽  
Lucy Theilheimer ◽  
...  
Keyword(s):  
Social Engagement ◽  
Medical Center ◽  
Food Delivery ◽  
Chronic Obstructive ◽  
Socioeconomically Disadvantaged ◽  
Obstructive Pulmonary Disease ◽  
Meals On Wheels ◽  
Hospital Expenditures ◽  
Access To Food ◽  
The Impact

Rehospitalizations in the Medicare population may be influenced by many diverse social factors, such as, but not limited to, access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12 months, and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3 months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital expenditure. In regard to the results, 84 participants were included in the pilot cohort, with the majority (54) having COPD. Mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p < 0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as its generalizability across diverse geographic regions.

Hospital Readmissions After Laboratory-Confirmed Influenza Hospitalization

2020 ◽  
Vol 222 (4) ◽  
pp. 583-589
Author(s):  
David M Dobrzynski ◽  
Danielle N Ndi ◽  
Yuwei Zhu ◽  
Tiffanie Markus ◽  
William Schaffner ◽  
...  
Keyword(s):  
Influenza Infection ◽  
Hospital Readmissions ◽  
Influenza Surveillance ◽  
Chronic Obstructive ◽  
Emerging Infections ◽  
Obstructive Pulmonary Disease ◽  
Discharge Data ◽  
Increased Risk ◽  
Common Causes ◽  
Substantial Morbidity

Abstract Background Influenza infection causes substantial morbidity and mortality. However, little is known about hospital readmissions after an influenza hospitalization. The aim of our study was to characterize frequency of hospital readmissions among patients hospitalized with laboratory-confirmed influenza. Methods We conducted a retrospective study using Tennessee Emerging Infections Program Influenza Surveillance data from 2006 to 2016 and the concurrent Tennessee Hospital Discharge Data System. We analyzed demographic characteristics and outcomes to better understand frequency and factors associated with hospital readmissions. Results Of the 2897 patients with a laboratory-confirmed influenza hospitalization, 409 (14%) and 1364 (47%) had at least 1 hospital readmission within 30 days and 1 year of the influenza hospitalization, respectively. Multiple readmissions occurred in 739 patients (54%). The readmission group was older, female predominant, and had more comorbidities than patients not hospitalized. Pneumonia, acute chronic obstructive pulmonary disease/asthma exacerbation, septicemia, acute respiratory failure, and acute renal failure were the most common causes for readmission at 30 days. Underlying cardiovascular disease, lung disease, kidney disease, diabetes, immunosuppression, and liver disease were associated with increased risk of readmission during the subsequent year. Conclusions After an admission with laboratory-confirmed influenza, there is a high likelihood of readmission within 30 days and 1 year adding to the morbidity of influenza.

scholarly journals Ability of the LACE index to predict 30-day hospital readmissions in patients with community-acquired pneumonia

2020 ◽  
Vol 6 (2) ◽  
pp. 00301-2019
Author(s):  
Claudia C. Dobler ◽  
Maryam Hakim ◽  
Sidhartha Singh ◽  
Matthew Jennings ◽  
Grant Waterer ◽  
...  
Keyword(s):  
Prediction Models ◽  
Hospital Readmissions ◽  
Predictive Ability ◽  
Tertiary Hospital ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Day Hospital ◽  
Discriminative Ability ◽  
Obstructive Pulmonary Disease ◽  
C Statistic

Background and objectiveHospital readmissions within 30 days are used as an indicator of quality of hospital care. We aimed to evaluate the ability of the LACE (Length of stay, Acuity of admission, Comorbidities based on Charlson comorbidity score and number of Emergency visits in the last 6 months) index to predict the risk of 30-day readmissions in patients hospitalised for community-acquired pneumonia (CAP).MethodsIn this retrospective cohort study a LACE index score was calculated for patients with a principal diagnosis of CAP admitted to a tertiary hospital in Sydney, Australia. The predictive ability of the LACE score for 30-day readmissions was assessed using receiver operator characteristic curves with C-statistic.ResultsOf 3996 patients admitted to hospital for CAP at least once, 8.0% (n=327) died in hospital and 14.6% (n=584) were readmitted within 30 days. 17.8% (113 of 636) of all 30-day readmissions were again due to CAP, followed by readmissions for chronic obstructive pulmonary disease, heart failure and chest pain. The LACE index had moderate discriminative ability to predict 30-day readmission (C-statistic=0.6395) but performed poorly for the prediction of 30-day readmissions due to CAP (C-statistic=0.5760).ConclusionsThe ability of the LACE index to predict all-cause 30-day hospital readmissions is comparable to more complex pneumonia-specific indices with moderate discrimination. For the prediction of 30-day readmissions due to CAP, the performance of the LACE index and modified risk prediction models using readily available variables (sex, age, specific comorbidities, after-hours, weekend, winter or summer admission) is insufficient.

Sign in / Sign up

Export Citation Format

Share Document