TY - JOUR
T1 - A Novel Approach to Characterizing Readmission Patterns Following Hospitalization for Ambulatory Care-Sensitive Conditions
AU - Agana, Denny Fe G.
AU - Striley, Catherine W.
AU - Cook, Robert L.
AU - Cruz-Almeida, Yenisel
AU - Carek, Peter J.
AU - Salemi, Jason L.
N1 - Funding Information:
This research was supported by the H. James Free Center for Primary Care Education and Innovation and the Department of Community Health and Family Medicine of University of Florida (Denny Fe G. Agana’s PhD funding). The funding sources had no role in the writing of this manuscript or in the decision to submit the manuscript for publication. This research was also supported by the Health Resources and Services Administration, an agency of the US Department of Health and Human Services, grant number T32 HP10031 (Denny Fe G. Agana’s postdoctoral funding). The funding source/study sponsor had no role in the writing of this manuscript or in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Little is known about the frequency, patterns, and determinants of readmissions among patients initially hospitalized for an ambulatory care-sensitive condition (ACSC). The degree to which hospitalizations in close temporal proximity cluster has also not been studied. Readmission patterns involving clustering likely reflect different underlying determinants than the same number of readmissions more evenly spaced. Objective: To characterize readmission rates, patterns, and predictors among patients initially hospitalized with an ACSC. Design: Retrospective analysis of the 2010–2014 Nationwide Readmissions Database. Participants: Non-pregnant patients aged 18–64 years old during initial ACSC hospitalization and who were discharged alive (N = 5,007,820). Main Measures: Frequency and pattern of 30-day all-cause readmissions, grouped as 0, 1, 2+ non-clustered, and 2+ clustered readmissions. Key Results: Approximately 14% of patients had 1 readmission, 2.4% had 2+ non-clustered readmissions, and 3.3% patients had 2+ clustered readmissions during the 270-day follow-up. A higher Elixhauser Comorbidity Index was associated with increased risk for all readmission groups, namely with adjusted odds ratios (AORs) ranging from 1.12 to 3.34. Compared to patients aged 80 years and older, those in younger age groups had increased risk of 2+ non-clustered and 2+ clustered readmissions (AOR range 1.27–2.49). Patients with chronic versus acute ACSCs had an increased odds ratio of all readmission groups compared to those with 0 readmissions (AOR range 1.37–2.69). Conclusions: Among patients with 2+ 30-day readmissions, factors were differentially distributed between clustered and non-clustered readmissions. Identifying factors that could predict future readmission patterns can inform primary care in the prevention of readmissions following ACSC-related hospitalizations.
AB - Background: Little is known about the frequency, patterns, and determinants of readmissions among patients initially hospitalized for an ambulatory care-sensitive condition (ACSC). The degree to which hospitalizations in close temporal proximity cluster has also not been studied. Readmission patterns involving clustering likely reflect different underlying determinants than the same number of readmissions more evenly spaced. Objective: To characterize readmission rates, patterns, and predictors among patients initially hospitalized with an ACSC. Design: Retrospective analysis of the 2010–2014 Nationwide Readmissions Database. Participants: Non-pregnant patients aged 18–64 years old during initial ACSC hospitalization and who were discharged alive (N = 5,007,820). Main Measures: Frequency and pattern of 30-day all-cause readmissions, grouped as 0, 1, 2+ non-clustered, and 2+ clustered readmissions. Key Results: Approximately 14% of patients had 1 readmission, 2.4% had 2+ non-clustered readmissions, and 3.3% patients had 2+ clustered readmissions during the 270-day follow-up. A higher Elixhauser Comorbidity Index was associated with increased risk for all readmission groups, namely with adjusted odds ratios (AORs) ranging from 1.12 to 3.34. Compared to patients aged 80 years and older, those in younger age groups had increased risk of 2+ non-clustered and 2+ clustered readmissions (AOR range 1.27–2.49). Patients with chronic versus acute ACSCs had an increased odds ratio of all readmission groups compared to those with 0 readmissions (AOR range 1.37–2.69). Conclusions: Among patients with 2+ 30-day readmissions, factors were differentially distributed between clustered and non-clustered readmissions. Identifying factors that could predict future readmission patterns can inform primary care in the prevention of readmissions following ACSC-related hospitalizations.
KW - ambulatory care-sensitive conditions
KW - hospitalization
KW - readmissions
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U2 - 10.1007/s11606-020-05643-2
DO - 10.1007/s11606-020-05643-2
M3 - Article
C2 - 31993948
AN - SCOPUS:85078439004
SN - 0884-8734
VL - 35
SP - 1060
EP - 1068
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 4
ER -