Abstract 12392: Rethinking Re-Hospitalization in Heart Failure Care Transitions: Heterogeneity in Utilization Typologies

Abstract

Introduction: Re-hospitalization for patients with heart failure (HF) is a persistent challenge. Person-oriented analysis may highlight heterogeneities and inform strategies to avert acute-care utilization. Purpose: To evaluate how outpatient utilization and sociodemographic, health behavior, and clinical factors are associated with high acute-care utilization using trajectory modeling. Methods: This retrospective cohort study used group-based trajectory modeling to identify latent groups of emergency department (ED), inpatient, and outpatient utilization one year before and after the initial HF hospitalization in adults (n= 1269) who had the index hospitalization between January 2016 and December 2018. Factors associated with high acute-care utilization were assessed by multinomial logistic regression. Results: People with medium or high outpatient utilization (44.9%) versus those with low outpatient utilization (37.7%) were associated with higher acute-care utilization after controlling for other significant factors such as insurance and comorbidities. Patients had six distinct typologies of acute-care utilization (Figure 1). Four typologies (14.3%) with higher acute-care utilization (ED or inpatient or both) accounted for 52% and 33.0% of the total ED and inpatient encounters. However, the association between outpatient and higher acute-care utilization was not significant among people with fluctuating outpatient utilization (17.4%). Conclusions: A person-oriented approach characterizing heterogeneity in acute-care utilization complements the hospital-focused 30-day readmission metric by revealing patients’ unique changes in utilization over time. High-frequency outpatient care may indicate fragmented care. Developing tailored interventions in the outpatient setting to address the small subgroup of patients with consistently high ED or inpatient utilization may improve re-hospitalization for patients with HF.