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Individual and health system variation in rehospitalizations the year after pneumonia.

ABSTRACT: Little is known about variation in patterns of recovery among patients discharged alive from hospitalizations for pneumonia.The aim of the is observational cohort study was to characterize the variation in patterns of hospital readmission and survival in the year after discharge for pneumonia in 3 different health systems.The 3 cohorts consisted of (1) the Health and Retirement Study participants enrolled in Fee-for-service Medicare (FFS), (2) Veterans Administration (VA) Healthcare system, and (3) Kaiser Permanente of Northern California (KPNC). The 365-day survival and re-hospitalizations were determined for each cohort. Multinomial logistic regression was used to identify potential contributors to the different patterns.We identified 2731, 23,536, and 39,147 hospitalizations for pneumonia in FFS Medicare, VA, and KPNC, respectively, of whom 88.1%, 92.8%, and 89.7% survived to hospital discharge. The median patient survived to 1 year and was rehospitalized twice in FFS (9.0%), once in VA (14.1%) and KPNC (9.1%). Of the patients who survived the hospitalization, 33.3% (FFS), 30.2% (VA), and 26.8% (KPNC) died during the subsequent year. Of those who survived, 29.8% (FFS), 35.9% (VA), and 46.1% (KPNC) were never rehospitalized. 11.9% (FFS), 11.9% (VA), and 11.7% (KPNC) had greater than 3 hospitalizations. Age, race, gender, comorbidity, ICU use, and hospital length stay collectively explained little (5-7%) of the variation in the recovery pattern.There is significant variation in the year after the hospitalization for pneumonia across individuals, but less so across health systems. There may be important opportunities to better classify these heterogeneous individual-level pathways.

SUBMITTER: Viglianti EM

PROVIDER: S-EPMC5626157 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Individual and health system variation in rehospitalizations the year after pneumonia.

Viglianti Elizabeth M EM Prescott Hallie C HC Liu Vincent V Escobar Gabriel J GJ Iwashyna Theodore J TJ

Medicine 20170801 31

Little is known about variation in patterns of recovery among patients discharged alive from hospitalizations for pneumonia.The aim of the is observational cohort study was to characterize the variation in patterns of hospital readmission and survival in the year after discharge for pneumonia in 3 different health systems.The 3 cohorts consisted of (1) the Health and Retirement Study participants enrolled in Fee-for-service Medicare (FFS), (2) Veterans Administration (VA) Healthcare system, and ...[more]

PMID: 28767603

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Project description:BackgroundReducing unplanned rehospitalizations is one of the priorities of health care policies in France and other Western countries. An easy-to-use algorithm for identifying patients at higher risk of rehospitalizations would help clinicians prioritize actions and care concerning discharge transitions. Our objective was to develop a predictive unplanned 30-day all-cause rehospitalization risk score based on the French hospital medico-administrative database.MethodsThis was a retrospective cohort study of all 2015 discharges from acute-care inpatient hospitalizations in a tertiary-care university center comprising four hospitals. The study endpoint was unplanned 30-day all-cause rehospitalization via emergency departments, and we collected sociodemographic, clinical, and hospital characteristics based on hospitalization database computed for reimbursement of fees. We derived a predictive rehospitalization risk score using a split-sample design and multivariate logistic regression, and we compared the discriminative properties with the LACE index risk-score.ResultOur analysis included 118,650 hospitalizations, of which 4,127 (3.5%) led to rehospitalizations via emergency departments. Variables independently associated with rehospitalization were age, gender, state-funded medical assistance, as well as disease category and severity, Charlson comorbidity index, hospitalization via emergency departments, length of stay (LOS), and previous hospitalizations 6 months before. The predictive rehospitalization risk score yielded satisfactory discriminant properties (C statistic: 0.74) exceeding the LACE index (0.66).ConclusionOur findings indicate that the possibility of unplanned rehospitalization remains high for some patient characteristics, indicating that targeted interventions could be beneficial for patients at the greatest risk. We developed an easy-to-use predictive rehospitalization risk-score of unplanned 30-day all-cause rehospitalizations with satisfactory discriminant properties. Future works should, however, explore if other data from electronic medical records and other databases could improve the accuracy of our predictive rehospitalization risk score based on medico-administrative data.

Project description:ObjectiveAlthough recent studies have shown that 30-day readmissions following sepsis are common, the overall fiscal impact of these rehospitalizations and their variability between hospitals relative to other high-risk conditions, such as congestive heart failure and acute myocardial infarction, are unknown. The objectives of this study were to characterize the frequency, cost, patient-level risk factors, and hospital-level variation in 30-day readmissions following sepsis compared with congestive heart failure and acute myocardial infarction.DesignA retrospective cohort analysis of hospitalizations from 2009 to 2011.SettingAll acute care, nonfederal hospitals in California.PatientsHospitalizations for sepsis (n = 240,198), congestive heart failure (n = 193,153), and acute myocardial infarction (n = 105,684) identified by administrative discharge codes.InterventionsNone.Measurements and main resultsThe primary outcomes were the frequency and cost of all-cause 30-day readmissions following hospitalization for sepsis compared with congestive heart failure and acute myocardial infarction. Variability in predicted readmission rates between hospitals was calculated using mixed-effects logistic regression analysis. The all-cause 30-day readmission rates were 20.4%, 23.6%, and 17.7% for sepsis, congestive heart failure, and acute myocardial infarction, respectively. The estimated annual costs of 30-day readmissions in the state of California during the study period were $500 million/yr for sepsis, $229 million/yr for congestive heart failure, and $142 million/yr for acute myocardial infarction. The risk- and reliability-adjusted readmission rates across hospitals ranged from 11.0% to 39.8% (median, 19.9%; interquartile range, 16.1-26.0%) for sepsis, 11.3% to 38.4% (median, 22.9%; interquartile range, 19.2-26.6%) for congestive heart failure, and 3.6% to 40.8% (median, 17.0%; interquartile range, 12.2-20.0%) for acute myocardial infarction. Patient-level factors associated with higher odds of 30-day readmission following sepsis included younger age, male gender, Black or Native American race, a higher burden of medical comorbidities, urban residence, and lower income.ConclusionSepsis is a leading contributor to excess healthcare costs due to hospital readmissions. Interventions at clinical and policy levels should prioritize identifying effective strategies to reduce sepsis readmissions.

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Individual and health system variation in rehospitalizations the year after pneumonia.

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Individual and health system variation in rehospitalizations the year after pneumonia.

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