Dataset Information

Risk Factors for Emergency Department Short Time Readmission in Stratified Population.

ABSTRACT: Emergency department (ED) readmissions are considered an indicator of healthcare quality that is particularly relevant in older adults. The primary objective of this study was to identify key factors for predicting patients returning to the ED within 30 days of being discharged.We analysed patients who attended our ED in June 2014, stratified into four groups based on the Kaiser pyramid. We collected data on more than 100 variables per case including demographic and clinical characteristics and drug treatments. We identified the variables with the highest discriminating power to predict ED readmission and constructed classifiers using machine learning methods to provide predictions.Classifier performance distinguishing between patients who were and were not readmitted (within 30 days), in terms of average accuracy (AC). The variables with the greatest discriminating power were age, comorbidity, reasons for consultation, social factors, and drug treatments.It is possible to predict readmissions in stratified groups with high accuracy and to identify the most important factors influencing the event. Therefore, it will be possible to develop interventions to improve the quality of care provided to ED patients.

SUBMITTER: Besga A

PROVIDER: S-EPMC4664798 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Risk Factors for Emergency Department Short Time Readmission in Stratified Population.

Besga Ariadna A Ayerdi Borja B Alcalde Guillermo G Manzano Alberto A Lopetegui Pedro P Graña Manuel M González-Pinto Ana A

BioMed research international 20151117

<h4>Background</h4>Emergency department (ED) readmissions are considered an indicator of healthcare quality that is particularly relevant in older adults. The primary objective of this study was to identify key factors for predicting patients returning to the ED within 30 days of being discharged.<h4>Methods</h4>We analysed patients who attended our ED in June 2014, stratified into four groups based on the Kaiser pyramid. We collected data on more than 100 variables per case including demographi ...[more]

PMID: 26682222

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Project description:Preventing death is the most important outcome pursued in the Emergency Department. Prompt accurate assessment, followed by competent and efficient investigation and treatment is the recipe sought. Abnormal physiological measurements are common antecedents to deterioration and therefore a cornerstone in many risk stratification tools. Some risk factors have their impact during the first few days after admittance, others have higher impact on 30 day mortality. Understanding the variance in impact of risk factors is relevant for future composition of risk stratification models.We included patients aged 18 years or older, registered at the Emergency Department at Odense University Hospital from April 1st 2012 to September 30th 2014. We performed multivariate logistic regressions, adjusted for age, gender and comorbidity, to describe the relationship between potential risk factors and measures of short term mortality.A total of 43,178 were eligible for analysis. Median age was 56 (IQR 36-72) and 48.3% were males. The over-all 30-day-mortality was 4%. One third of deaths occurred within the first 2 days. Higher age, male gender and comorbidity are all associated with immediate, 0-2 day, 3-7 day and 8-30 day mortality. The degree of acuteness at arrival defined by urgency-level, physician-assisted transfer to the Emergency Department and abnormal vital parameters are associated with 0-2 day mortality. High temperature at arrival shows no association in either mortality-group. Missing values are associated with immediate and 0-2 day mortality, but no association with mortality after 7 days.Abnormal vital parameters and degree of acuity at admission were strongly associated with mortality in the first hours and days after admission, where after the association decreased. The effect of other risk factors such as male gender, comorbidity and high age were time stable or even increasing over time..The over-all 30-day mortality was 4%. Physiology-related risk factors varied in strength of association throughout different mortality outcome measures.

Project description:ObjectiveTo quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance.DesignTime stratified case crossover analyses with distributed lag non-linear models.SettingUS nationwide administrative healthcare claims database.ParticipantsAll commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019.Main outcome measuresDaily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes.Results21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100 000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate.ConclusionsAmong both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.

Project description:BACKGROUND:Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. DESIGN:Cross-sectional analysis. SUBJECTS:Nonfederal United States acute care hospitals. MEASURES:Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0). RESULTS:We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0-1.5 versus 21.7% of hospitals with ratios >2.0. CONCLUSIONS:Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform disproportionately poorly versus nonteaching or public hospitals. However, it enables identification of more outliers and a more granular assessment of the association of hospital factors and outcomes.

Dataset Information

Risk Factors for Emergency Department Short Time Readmission in Stratified Population.

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Risk Factors for Emergency Department Short Time Readmission in Stratified Population.

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