Abstract
BackgroundAdmitted patients with chronic disease are at high risk of an unplanned hospital readmission, however, little research has examined unplanned readmission among Aboriginal people in Australia. This study aimed to examine whether rates of unplanned 28 day hospital readmission, or death, significantly differ between Aboriginal and non-Aboriginal patients in New South Wales, Australia, over a nine-year period.MethodsA retrospective cohort analysis of a sample of de-identified linked hospital administrative data was conducted. Eligible patients were: 1) aged ≥18 years old, 2) admitted to an acute facility in a NSW public hospital between 30th June 2005 and 1st July 2014, and 3) admitted with either cardiovascular disease, chronic respiratory disease, diabetes or renal disease. The primary composite outcome was unplanned readmission or death within 28 days of discharge. Generalized linear models and a test for trend were used to assess rates of unplanned readmission or death over time in Aboriginal and non-Aboriginal patients with chronic disease, accounting for sociodemographic variables.ResultsThe final study cohort included 122,145 separations corresponding to 48,252 patients (Aboriginal = 57.2%, n = 27,601; non-Aboriginal = 42.8%, n = 20,651). 13.9% (n = 16,999) of all separations experienced an unplanned readmission or death within 28 days of discharge. Death within 28 days of discharge alone accounted for only a small number of separations (1.4%; n = 1767). Over the nine-year period, Aboriginal separations had a significantly higher relative risk of an unplanned readmission or death (Relative risk = 1.34 (1.29, 1.40); p-value < 0.0001) compared with non-Aboriginal separations once adjusted for sociodemographic, disease variables and restricted to < 75 years of age. A test for trend, including an interaction between year and Aboriginal status, showed there was no statistically significant change in proportions over the nine-year period for Aboriginal and non-Aboriginal separations (p-value for trend = 0.176).ConclusionAboriginal people with chronic disease had a significantly higher risk of unplanned readmission or death 28 days post discharge from hospital compared with non-Aboriginal people, and there has been no significant change over the nine year period. It is critical that effective interventions to reduce unplanned readmissions for Aboriginal people are identified.
Highlights
Admitted patients with chronic disease are at high risk of an unplanned hospital readmission, little research has examined unplanned readmission among Aboriginal people in Australia
Admitted patients with chronic disease are known to be at high risk of an unplanned hospital readmission, with readmission highest amongst patients with cardiovascular disease, respiratory disease and diabetes [11, 13, 14]
The purpose of our study was to examine amongst Aboriginal and non-Aboriginal people with chronic disease in New South Wales (NSW) from 2005/6 to 2014/15: 1) whether the proportion of separations with an unplanned 28 day readmission or death significantly differ between Aboriginal and non-Aboriginal patients; 2) the extent to which sociodemographic, disease and separation factors are associated with any differences; and 3) how the proportion of separations with an unplanned 28 day hospital readmission or death changed over the nine-year period
Summary
Admitted patients with chronic disease are at high risk of an unplanned hospital readmission, little research has examined unplanned readmission among Aboriginal people in Australia. On average Aboriginal and Torres Strait Islander people (Aboriginal people hereafter) experience, on average, a 10 year gap in life expectancy compared with non-Aboriginal Australians Two thirds of this gap is accounted for by chronic disease [1]. Most chronic diseases should ideally be managed in the community health setting, admissions to hospital related to chronic disease are common and represent the largest proportion of potentially avoidable hospitalisations [3] Factors such as poor discharge planning, poor community follow up from health care services, and a lack of support for the patient and carer in chronic disease self-management skills mean that many hospital admissions for chronic disease are followed by an unplanned hospital readmission [4,5,6,7,8]. In Australia, unplanned readmissions are considered an indicator relating to “high quality and affordable hospital and hospital related care” in the Australian National Healthcare Agreement, and unplanned readmissions are included in the NSW service performance indicators to provide a mechanism for monitoring and managing the performance of hospitals [9, 15]
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