Dataset Information

Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study.

ABSTRACT:

Background

There is a persistently high incidence of adverse events during hospitalization among Medicare beneficiaries. Attributes of vulnerability are prevalent, readily apparent, and therefore potentially useful for recognizing those at greatest risk for hospital adverse events who may benefit most from preventive measures. We sought to identify patient characteristics associated with adverse events that are present early in a hospital stay.

Methods

An interprofessional panel selected characteristics thought to confer risk of hospital adverse events and measurable within the setting of acute illness. A convenience sample of 214 Medicare beneficiaries admitted to a large, academic medical center were included in a quality improvement project to develop risk assessment protocols. The data were subsequently analyzed as a prospective cohort study to test the association of risk factors, assessed within 24 hours of hospital admission, with falls, hospital-acquired pressure ulcers (HAPU) and infections (HAI), adverse drug reactions (ADE) and 30-day readmissions.

Results

Mean age?=?75(±13.4) years. Risk factors with highest prevalence included >4 active comorbidities (73.8%), polypharmacy (51.7%), and anemia (48.1%). One or more adverse hospital outcomes occurred in 46 patients (21.5%); 56 patients (26.2%) were readmitted within 30 days. Cluster analysis described three adverse outcomes: 30-day readmission, and two groups of in-hospital outcomes. Distinct regression models were identified: Weight loss (OR?=?3.83; 95% CI?=?1.46, 10.08) and potentially inappropriate medications (OR?=?3.05; 95% CI?=?1.19, 7.83) were associated with falls, HAPU, procedural complications, or transfer to intensive care; cognitive impairment (OR?=?2.32; 95% CI?=?1.24, 4.37), anemia (OR?=?1.87; 95% CI?=?1.00, 3.51) and weight loss (OR?=?2.89; 95% CI?=?1.38, 6.07) were associated with HAI, ADE, or length of stay >7 days; hyponatremia (OR?=?3.49; 95% CI?=?1.30, 9.35), prior hospitalization within 30 days (OR?=?2.66; 95% CI?=?1.31, 5.43) and functional impairment (OR?=?2.05; 95% CI?=?1.02, 4.13) were associated with 30-day readmission.

Conclusions

Patient characteristics recognizable within 24 hours of admission can be used to identify increased risk for adverse events and 30-day readmission.

SUBMITTER: Borenstein J

PROVIDER: S-EPMC3710470 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Publications

Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study.

Borenstein Jeff J Aronow Harriet Udin HU Bolton Linda Burnes LB Choi Jua J Bresee Catherine C Braunstein Glenn D GD

BMC geriatrics 20130708

<h4>Background</h4>There is a persistently high incidence of adverse events during hospitalization among Medicare beneficiaries. Attributes of vulnerability are prevalent, readily apparent, and therefore potentially useful for recognizing those at greatest risk for hospital adverse events who may benefit most from preventive measures. We sought to identify patient characteristics associated with adverse events that are present early in a hospital stay.<h4>Methods</h4>An interprofessional panel s ...[more]

PMID: 23834816

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Project description:ObjectivesRecent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.DesignWe analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.SettingPatients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.ParticipantsAdmitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.Primary and secondary outcomes measuresThe primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.ResultsWe included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).ConclusionsThe accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

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Dataset Information

Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study.

Background

Methods

Results

Conclusions

Publications

Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study.

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