TY - JOUR
T1 - Association between interhospital care fragmentation, readmission diagnosis, and outcomes
AU - Turbow, Sara
AU - Sudharsanan, Nikkil
AU - Rask, Kimberly J.
AU - Ali, Mohammed K.
N1 - Publisher Copyright:
© 2021 Ascend Media. All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - OBJECTIVES: To assess in-hospital mortality, length of stay, and costs associated with interhospital fragmentation in 30-day readmissions and to determine whether these associations were more or less pronounced for patients with specific high-prevalence conditions. STUDY DESIGN: Cross-sectional analysis using the Agency for Healthcare Research and Quality's National Readmissions Database for 2013 and 2014. METHODS: All patients 18 years and older with a 30-day readmission in 2014 were included. We assessed if readmission to a hospital different from that of the index admission was associated with in-hospital mortality, length of stay, and costs of readmission, separately by whether the readmission occurred for the same or different major diagnostic category. Patients with 1 of 3 common diagnoses (congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], or myocardial infarction) were studied for disease-specific trends. The same analyses were performed on 2013 data as a sensitivity analysis. RESULTS: In 2014, among 792,596 patients with a 30-day readmission, 22.2% experienced fragmentation. Compared with patients whose readmission occurred at the index hospital, patients readmitted to a different hospital experienced 20% higher odds of dying in hospital (P=.02 for same diagnosis readmission; P=.03 for different diagnosis readmission), a half-a-day longer length of stay (P<.001 for both same and different diagnosis readmissions), and more than $1000 higher costs (P<.001 for both same and different diagnosis readmissions). For patients with a CHF or COPD index admission, mortality was consistently higher for fragmented readmissions for a different condition. CONCLUSIONS: Fragmented readmissions were associated with higher in-hospital mortality and cost. Clinical variation across conditions warrants further investigation to optimize pre- A nd postdischarge operations and policy.
AB - OBJECTIVES: To assess in-hospital mortality, length of stay, and costs associated with interhospital fragmentation in 30-day readmissions and to determine whether these associations were more or less pronounced for patients with specific high-prevalence conditions. STUDY DESIGN: Cross-sectional analysis using the Agency for Healthcare Research and Quality's National Readmissions Database for 2013 and 2014. METHODS: All patients 18 years and older with a 30-day readmission in 2014 were included. We assessed if readmission to a hospital different from that of the index admission was associated with in-hospital mortality, length of stay, and costs of readmission, separately by whether the readmission occurred for the same or different major diagnostic category. Patients with 1 of 3 common diagnoses (congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], or myocardial infarction) were studied for disease-specific trends. The same analyses were performed on 2013 data as a sensitivity analysis. RESULTS: In 2014, among 792,596 patients with a 30-day readmission, 22.2% experienced fragmentation. Compared with patients whose readmission occurred at the index hospital, patients readmitted to a different hospital experienced 20% higher odds of dying in hospital (P=.02 for same diagnosis readmission; P=.03 for different diagnosis readmission), a half-a-day longer length of stay (P<.001 for both same and different diagnosis readmissions), and more than $1000 higher costs (P<.001 for both same and different diagnosis readmissions). For patients with a CHF or COPD index admission, mortality was consistently higher for fragmented readmissions for a different condition. CONCLUSIONS: Fragmented readmissions were associated with higher in-hospital mortality and cost. Clinical variation across conditions warrants further investigation to optimize pre- A nd postdischarge operations and policy.
UR - http://www.scopus.com/inward/record.url?scp=85106152902&partnerID=8YFLogxK
U2 - 10.37765/ajmc.2021.88639
DO - 10.37765/ajmc.2021.88639
M3 - Article
C2 - 34002968
AN - SCOPUS:85106152902
SN - 1088-0224
VL - 27
SP - E164-E170
JO - American Journal of Managed Care
JF - American Journal of Managed Care
IS - 5
ER -