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Differences between early and late readmissions among patients: a cohort study.

ABSTRACT: Early and late readmissions may have different causal factors, requiring different prevention strategies.To determine whether predictors of readmission change within 30 days after discharge.Retrospective cohort study.Academic medical center.Patients admitted between 1 January 2009 and 31 December 2010.Factors related to the index hospitalization (acute illness burden, inpatient care process factors, and clinical indicators of instability at discharge) and unrelated factors (chronic illness burden and social determinants of health) and how they affect early readmissions (0 to 7 days after discharge) and late readmissions (8 to 30 days after discharge).13 334 admissions, representing 8078 patients, were included in the analysis. Early readmissions were associated with markers of acute illness burden, including length of hospital stay (odds ratio [OR], 1.02 [95% CI, 1.00 to 1.03]) and whether a rapid response team was called for assessment (OR, 1.48 [CI, 1.15 to 1.89]); markers of chronic illness burden, including receiving a medication indicating organ failure (OR, 1.19 [CI, 1.02 to 1.40]); and social determinants of health, including barriers to learning (OR, 1.18 [CI, 1.01 to 1.38]). Early readmissions were less likely if a patient was discharged between 8:00 a.m. and 12:59 p.m. (OR, 0.76 [CI, 0.58 to 0.99]). Late readmissions were associated with markers of chronic illness burden, including receiving a medication indicating organ failure (OR, 1.24 [CI, 1.08 to 1.41]) or hemodialysis (OR, 1.61 [CI, 1.12 to 2.17]), and social determinants of health, including barriers to learning (OR, 1.24 [CI, 1.09 to 1.42]) and having unsupplemented Medicare or Medicaid (OR, 1.16 [CI, 1.01 to 1.33]).Readmissions were ascertained at 1 institution.The time frame of 30 days after hospital discharge may not be homogeneous. Causal factors and readmission prevention strategies may differ for the early versus late periods.Health Resources and Services Administration, National Institute on Aging, National Institutes of Health, Harvard Catalyst, and Harvard University.

SUBMITTER: Graham KL

PROVIDER: S-EPMC4747330 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Differences between early and late readmissions among patients: a cohort study.

Graham Kelly L KL Wilker Elissa H EH Howell Michael D MD Davis Roger B RB Marcantonio Edward R ER

Annals of internal medicine 20150601 11

<h4>Background</h4>Early and late readmissions may have different causal factors, requiring different prevention strategies.<h4>Objective</h4>To determine whether predictors of readmission change within 30 days after discharge.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Academic medical center.<h4>Participants</h4>Patients admitted between 1 January 2009 and 31 December 2010.<h4>Measurements</h4>Factors related to the index hospitalization (acute illness burden, inpatient care proc ...[more]

PMID: 26030632

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Project description:ObjectivesLimited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions.DesignA retrospective cohort study.SettingTwo tertiary-level hospitals in Australia.ParticipantsAll medical admissions ≥18 years over a period of 1 year.OutcomesPrimary objective was to determine predictors of early (0-7 days) and late (8-180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions.ResultsThere were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions.ConclusionsMalnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.Trial registrationANZCTRN 12617001362381; Results.

Project description:BackgroundLimited information exists about the nature of late-onset asthma (LOA) without medication intervention when compared to early-onset asthma (EOA). Our goal was to understand how EOA and LOA affect clinical and pathophysiological features.MethodsA population-based cross-sectional study was carried out in Zhongshan Hospital (Shanghai, China). EOA and LOA were based on age of diagnosis (before and after age 40 years, respectively). Clinical variables were collected with an emphasis on allergic features, analyzed, related, and compared using one-way ANOVA or Kruskal-Wallis test. Correlations between blood basophils and clinical data were evaluated by Spearman's rank test. Statistical analyses were conducted with SPSS v24.0.ResultsOf a total of 12,760 adults with cough, sputum, or chest tightness, 90 subjects with EOA (mean age ± standard deviation (SD):28.73 ± 5.89), 111 with LOA (mean age ± SD: 60.25 ± 9.85), and 106 with chronic obstructive pulmonary disease (COPD) (mean age ± SD: 61.58 ± 10.95) were selected. FEV1/FVC (%), FEV1% predicted, and FVC% predicted were all significantly lower in LOA compared to EOA (p < 0.01). The values of post-bronchodilator FEV1 in bronchodilator reversibility testing were higher in the LOA and EOA groups compared to subjects with COPD (p < 0.01). Among allergic features, mite sensitization was most common in EOA patients, followed by LOA and COPD, whereas mold sensitization was more prevalent in LOA than EOA. Moreover, blood eosinophils were a typical feature of asthma in both EOA and LOA compared to COPD and controls (p < 0.01), and there were no differences in blood neutrophils in LOA compared to controls. Interestingly, blood basophils were increased in both EOA (p < 0.01) and LOA (p < 0.05) compared to COPD and controls. This variable correlated with eosinophils in EOA (r = 0.549, p=0.002) but not in LOA.ConclusionLOA is a distinct clinical entity from EOA. In LOA, atopy was less frequent and spirometry values were lower when compared to EOA. In EOA, blood basophils and eosinophils were significantly correlated owing to pathophysiological differences between the two forms of the disease.

Project description:BackgroundThe clinical characteristics of early-onset type 2 diabetes (T2D) patients are not fully understood. To address this gap, we conducted a cohort study to evaluate clinical characteristics and disease burden in the new-onset T2D population, especially regarding the progression of diseases.MethodsThis cohort study was conducted using a population-based database. Patients who were diagnosed with T2D were identified from the database and were classified into early- (age < 40) and late-onset (age ≥ 40) groups. A descriptive analysis was performed to compare clinical characteristics and disease burden between early- and late-onset T2D patients. The progression of disease was compared using Kaplan‒Meier analysis.ResultsA total of 652,290 type 2 diabetic patients were included. Of those, 21,347 were early-onset patients, and 300,676 were late-onset patients. Early-onset T2D patients had poorer glycemic control than late-onset T2D patients, especially at the onset of T2D (HbA1c: 9.3 [7.5, 10.9] for early-onset vs. 7.7 [6.8, 9.2] for late-onset, P < 0.001; random blood glucose: 10.9 [8.0, 14.3] for early-onset vs. 8.8 [6.9, 11.8] for late-onset, P < 0.001). Insulin was more often prescribed for early-onset patients (15.2%) than for late-onset patients (14.8%). Hypertension (163.0 [28.0, 611.0] days) and hyperlipidemia (114.0 [19.0, 537.0] days) progressed more rapidly among early-onset patients, while more late-onset patients developed hypertension (72.7% vs. 60.1%, P < 0.001), hyperlipidemia (65.4% vs. 51.0%, P < 0.001), cardiovascular diseases (66.0% vs. 26.7%, P < 0.001) and chronic kidney diseases (5.5% vs. 2.1%, P < 0.001) than early-onset patients.ConclusionsOur study results indicate that patients with newly diagnosed early-onset T2D had earlier comorbidities of hypertension and hyperlipidemia. Both clinical characteristics and treatment patterns suggest that the degree of metabolic disturbance is more severe in patients with early-onset type 2 diabetes. This highlights the importance of promoting healthy diets or lifestyles to prevent T2D onset in young adults.

Project description:BackgroundWhile life-long impacts exist for infants born one or two weeks early little evidence exists for those infants born after their due date. However interventions could be used to expedite birth if the risks of continuing the pregnancy are higher than intervening. It is known that the risk of epilepsy in childhood is higher in infants exposed to perinatal compromise and therefore may be useful as a proxy for intrapartum compromise. The aim of this work is to quantify the likelihood of children developing epilepsy based on their gestational age at birth (37-39 weeks or ?41 weeks).MethodsThe work is based on term infants born in Sweden between 1983 and 1993 (n = 1,030,168), linked to data on disability pension, child mortality and in-patient epilepsy care. The reference group was defined as infants born at 39 or 40 completed weeks of gestation; compared with infants born at early term (37/38 weeks) or late/post term (41 weeks or more). Primary outcome was defined a-priori as a diagnosis of epilepsy before 20 years of age. Secondary outcomes were childhood mortality (before five years of age), and registered for disability pension before 20 years of age. Logistic regression models were used to assess any association of the outcomes with gestational age at birth.FindingsIn the unadjusted results, infants born 7 or more days after their due date had higher risks of epilepsy and disability pension than the reference group, but similar risks of child death. Early term infants showed higher risks of epilepsy, disability pension and child death. After adjustment for confounders, there remained a higher risk of epilepsy for both early term (OR 1·19 (1·11-1·29)) and late/post term infants (OR 1·13 (1·06-1·22)).InterpretationInfants born at 37/38 week or 41 weeks and above, when compared to those born at 39 or 40 weeks gestation, have an increased risk of developing epilepsy. This data could be useful in helping women and care givers make decisions with regard to the timing of induction of labour.

Project description:BackgroundSkin-to-skin contact (SSC) is an important factor to consider in the care of late preterm infants (born between 34 0/7 and 36 6/7 completed weeks of gestation). The literature suggests that SSC between preterm infants and their mothers facilitates breastfeeding. However, more studies are needed to explore potential dose-response effects between SSC and breastfeeding as well as studies that explicitly investigate SSC by fathers among late preterm infants. The aim was to investigate the duration of healthy late preterm infants' SSC with the mother and father, respectively, during the first 48 h after birth and the associations with breastfeeding (exclusive/partial at discharged), clinical and demographic variables.MethodsThis was an observational cohort study in which parents to healthy late preterm infants, born between 34 5/7 and 36 6/7 completed weeks of gestation, recorded duration of SSC provided by mother and father, respectively. Demographic and clinical variables were retrieved from the medical records and were used as predictors. Multiple linear regression analysis was used to assess the association between the predictors and the outcome, SSC (hours), separately for mothers and fathers.ResultsThe mean (standard deviation [SD]) time per day spent with SSC with mothers (n = 64) and fathers (n = 64), was 14.7 (5.6) and 4.4 (3.3) hours during the first day (24 h) after birth and 9.2 (7.1) and 3.1 (3.3) hours during the second day (24 h), respectively. Regarding SSC with mothers, no variable was significantly associated with SSC during the first day, while the mean (95% confidence interval [CI]) time of SSC during the second day was 6.9 (1.4-12.4) hours shorter for each additional kg of birthweight (p = 0.014). Concerning SSC with fathers, the mean (95% CI) time of SSC during the first day was 2.1 (0.4-3.7) hours longer for infants born at night (p = 0.015), 1.7 (0.1-3.2) hours longer for boys (p = 0.033), 3.2 (1.2-5.2) hours longer for infants born by caesarean section (p = 0.003), and 1.6 (0.1-3.1) hours longer for infants exclusively breastfed at discharge (p = 0.040). During the second day, the mean (95% CI) time of SSC with fathers was 3.0 (0.6-5.4) hours shorter for each additional kg of birthweight (p = 0.014), 2.0 (0.5-3.6) hours longer for infants born during night-time (p = 0.011), 2.9 (1.4-4.4) hours longer if the mother was primipara (p < 0.001), and 1.9 (0.3-3.5) hours shorter if supplementary artificial milk feeds were given. None of the other predictors, i.e., mother's age, gestational age, or induction of labor were significantly associated with infants' SSC with mothers or fathers during any of the first two days after birth.ConclusionFuture studies are warranted that investigate duration of SSC between late preterm infants and their parents separately and the associations with breastfeeding and other variables of clinical importance.

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Differences between early and late readmissions among patients: a cohort study.

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Differences between early and late readmissions among patients: a cohort study.

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