Higher Risk Of Readmission Research Articles

Abstract 4134340: Title: Comorbidities Associated with One Year Mortality and Hospital Readmission After Leadless Pacemaker Implantation

Introduction: Previous studies have noted racial and ethnic disparities in access to leadless pacemaker implantation (LPI), but none have evaluated the socioeconomic disadvantaged (SED). Additionally, few studies have evaluated outcomes of LPI beyond thirty days on a large scale. This study aimed to determine which comorbidities are associated with one-year readmissions and mortality after LPI, including SED via the Social Deprivation Index (SDI). Methods: Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York and Florida from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2018 SDI (1-100, higher scores representing more disadvantage). International Classification of Diseases 10 codes for LPI were used. The risk of readmission and mortality was assessed using Cox proportional hazards first in an unadjusted fashion for each comorbidity in the Charlson Comorbidity Index. In addition to demographic variables, only significant variables from the unadjusted analysis were included in the final adjusted multivariable models. Results: 3,094 patients met inclusion criteria. The readmission and mortality rates at one, three, and twelve months were 17.2%, 31.3%, 50.2% and 5.7%, 7.1%, 10.7%, respectively. The most common diagnoses for readmission were dyspnea/chest pain (9.4%), heart failure (4%), and sepsis (3.8%). Federal insurance, heart failure (CHF), pulmonary disease, diabetes without complications, and renal disease (CKD) were associated with increased risk for twelve-month readmissions. African American race, myocardial infarction, CHF, CKD, and higher SDI were associated with increased risk for twelve-month mortality. Conclusion: CHF and CKD put patients at high risk of readmission and mortality. Sepsis was among the most common causes of readmission at twelve months. Patients of higher SED are at increased risk of mortality within one year after LPI.

Abstract 4124457: Socioeconomic Deprivation is Associated with Readmission Within One Year After Atrial Fibrillation Ablation

Introduction: Gender and race have been shown to impact access and outcomes regarding rhythm control management such as atrial fibrillation (AF) ablation. We aimed to evaluate the role of the Area Deprivation Index (ADI), a validated metric that represents the social disadvantage of communities, to determine if socioeconomic disadvantage (SED) increases the risk of readmission within one year after AF ablation. Methods: Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Ambulatory Surgery and Services Databases in New York and Florida from 2016-2019 with follow-up into 2020 into the inpatient setting. These states were chosen due to availability for linkage of the 2020 ADI. International Classification of Diseases 10 and Current Procedural Terminology codes for AF and AF ablation were used. The risk of readmission was assessed using multivariable Cox proportional hazards with covariates age, sex, race, insurance, Charlson Comorbidity Index (0 vs ≥ 1 comorbidity), and ADI quartiles. ADI is scored 1-100 with higher scores representing more disadvantage. Results: 14,078 patients met inclusion criteria. The readmission rate at one, three, and twelve months was 6.1%, 9.9%, and 20.9% respectively. The most common readmission diagnoses at twelve months were AF (22.8%), followed by symptoms such as chest pain, dyspnea, palpitations, and syncope (13%). In the adjusted model, older age, female sex, federal insurance, ≥ 1 Charlson comorbidity, and higher ADI had higher one-, three-, and twelve-month risks of readmission. Hispanic ethnicity had a higher risk of one month readmission. Conclusion: Readmission for AF after ablation is common at twelve months. Higher risk of readmission after AF ablation was observed with SED. Enhanced awareness and additional research regarding SED as a risk factor for readmission may help improve post-ablation AF outcomes and equitable access to cardiovascular care.

Evaluate the Differential Effectiveness of the Case Management and Primary Nursing Models in the Implementation of Discharge Planning.

This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival. To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care. Retrospective case-control study. This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results. To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research. The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group. Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home. Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than the primary nursing care model in reducing readmission rates and increasing survival rates. Early consultation with case managers for discharge planning is crucial to ensuring patient care continuity and resource utilization.

Associação entre peptídeos natriuréticos e gravidade clínica em pacientes internados por insuficiência cardíaca descompensada

This study aims to associate the values of natriuretic peptides (NP), BNP, and NT-proBNP, with the severity of clinical presentation in patients hospitalized with decompensated heart failure (HF). METHODS: This is a historical cohort study where data was collected from the medical records of patients admitted to a private hospital with decompensated heart failure between 2016 and 2023. RESULTS: The most common comorbidities included systemic arterial hypertension in 79 out of 96 patients (82.2%), previous HF in 46 (47.9%), dyslipidemia in 41 (42.7%), and diabetes mellitus in 38 (39.5%). The data revealed that patients who died of cardiac causes during hospitalization had higher NP values compared to those who did not experience the same outcome. Among these deaths, 57.14% of patients exhibited hemodynamic instability on hospital admission (p=0.017). Additionally, two patients were readmitted within 6 months of discharge due to a new episode of decompensated HF, both presenting hemodynamic instability on admission (p=0.03), and eventually progressed to cardiac death. Cardiac and non-cardiac deaths were associated with higher NT-proBNP values (p=0.043). CONCLUSION: The findings indicate that higher NP levels in patients hospitalized with decompensated HF correlate with greater initial severity and long-term, including an increased likelihood of hemodynamic instability and a higher risk of readmission, respectively. Elevated NT-proBNP values are also linked to a higher mortality rate.

Association of postoperative opioid type with mortality and readmission rates: multicentre retrospective cohort study.

Opioid treatment in postoperative pain management is crucial, but the impact of administration practices on outcomes is unclear. The hypothesis was that prescription trends remained stable over recent years, and that no difference in mortality and readmission risks is associated with prescription strategies. Electronic health records of surgical episodes in the Capital and Zealand Regions of Denmark from 2017 to 2021 were analysed. All opioids administered during postoperative admission were converted to oral morphine equivalents (OMEQs) and an average daily dose per patient was calculated. The opioid administered in the highest OMEQ dosages is considered the primary opioid strategy for the surgical case. Administration trends were analysed through linear regression, and Cox regression was used to calculate hazard ratios to assess dominant opioid strategies' association with 90-day mortality and readmission rates while controlling for confounders. A total of 183 317 patients met the inclusion criteria. Prescription trends remained steady during the study period. Multivariable analysis revealed increased readmission risk (HR 1.18, P < 0.001) of tramadol and tapentadol compared to morphine. They exhibited decreased 90-day mortality risk (HR 0.63, P < 0.001). Oxycodone had similar readmission risk (HR 1.009, P = 0.24) but lower 90-day mortality risk (HR 0.68, P < 0.001). Postoperative in-hospital opioid administration remained stable from 2017 to 2021. Tramadol/tapentadol had a higher risk of readmission but lower mortality risk. Oxycodone had comparable readmission but reduced mortality risk. This study provides a framework for future clinical trials assessing this potential impact of opioids in a targeted manner.

Prediction of Hospital Readmission Using the CORE and CORE+ Scores in Persons With COPD.

Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored. A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV1/FVC (<0.70) and FEV1 (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05. Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], P < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], P < .001). Participants who used in-hospital NIV had higher median CORE+ scores (P = < .001). CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.

Healthcare utilization following acute myocardial infarction findings from RECORD MI registry

Abstract Background As therapeutic options and epidemiology have evolved rapidly, the contemporary healthcare utilization following acute myocardial infarction (MI) is not well known. Methods All patients admitted with MI between 01/2015 and 12/2021 in the Baylor Scott &amp; White health system were studied. Patient characteristics and outcomes including hospital readmissions, cardiovascular (CV)-related hospital readmissions, emergency department (ED) encounters, and outpatient visits were studied. Results Of 6804 patients, 6556 were discharged alive. Median age was 69 years, 60% were male, and 77% had non-ST elevation MI (NSTEMI); 1172 (22%) had an LVEF &amp;lt;40%, 493 (7.5%) were revascularized within 3 months of discharge, and 1090 (17%) had multivessel disease. The number of unique patients with first hospital readmission within 30-days, 3-months, and 12-months were 844 (13%), 1372 (21%) and 2306 (35%), respectively, with a higher risk in patients with NSTEMI, prior heart failure (HF), new HF, and LVEF &amp;lt;40%. ED visits at 12 months for any cause were 2401 (37%) and for CV cause were 1321 (20%), with a higher risk in patients with prior HF. Patients with at least 1 primary care visit within 12 months of discharge were captured for 4102 (63%), CV specialty visits for 5009 (76%), and non-CV visits for 3860 patients (59%), with similar distribution across subgroups (Table). Conclusions Post-MI patients had a high risk of readmissions, and ED and outpatient visits, especially amongst those with a prior or new HF diagnosis.

Sex-specific clinical outcomes and healthcare resource utilization in the 5 years following hospitalization for heart failure

Abstract Background Heart failure (HF) a leading cause of hospitalization, and sex differences in care have been described. Purpose We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. Methods This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals enrolled in the Patient-Centred Care Transitions in HF pragmatic cluster-randomized trial. Primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Results The 4441 patients (50.7% female) had high event rates. At 5 years of follow-up, 63.6% male and 65.5% of male and female patients, respectively, had died (p=0.19); 85.4% and 84.4% of male and female patients, respectively, were readmitted with no sex differences in mean [SD] all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p=0.54) or HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p=0.80) per person. The mean (SD) annual total healthcare costs per patient was $80334 (116762) for males and $81010 (112625) for females, with no sex difference (p=0.90); however, there were sex differences in cost breakdown: males incurred greater costs from specialist, hemodialysis, and day surgical care, and females incurred greater costs from home visits and long-term care. Conclusions Males and females were at similarly high risk of mortality and readmissions, and had similar total healthcare costs following hospitalized for HF. Notwithstanding similar risks, males received relatively more specialist and invasive care, and females received relatively more supportive care.

Elevated levels of PDGF-BB and VEGF are associated with a decreased risk of readmission or death in children with severe malarial anemia.

Children with severe malarial anemia (SMA) typically have low in-hospital mortality but have a high risk of post-discharge readmission or death. We hypothesized that the dysregulation of hematopoiesis, vascular growth factors, and endothelial function that occurs in SMA might affect risk of readmission or death. Plasma was obtained from children 18 months to 12 years old with SMA (N=145) in Kampala, Uganda on admission, and outcomes were assessed over 12-month follow-up. Admission plasma levels of ten biomarkers of vascular growth, hematopoiesis, and endothelial function were compared to risk of readmission or death over 12-month follow-up. Over 12-month follow-up, 19 of 145 children with SMA were either readmitted or died: 15 children were readmitted (13 with malaria) and 4 children died. In multivariable analyses adjusted for age and sex, elevated plasma levels of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) on admission were independently associated with a decreased risk of all-cause readmission or death (adjusted hazard ratios [95% confidence intervals], 0.28 [0.16-0.51] and 0.19 [0.08-0.48], respectively) and a decreased risk of readmission due to severe malaria (0.27 [0.15, 0.51] and 0.16 [0.05, 0.47]) but not with risk of uncomplicated malaria (1.01 [0.53, 1.95] and 2.07 [0.93-4.64]). In children with severe malarial anemia, elevated plasma levels of PDGF-BB and VEGF, two factors that promote angiogenesis, are associated with a decreased risk of readmission or death in the year following admission, primarily driven by a decrease in the risk of recurrent severe malaria.

Bias in Prediction Models to Identify Patients With Colorectal Cancer at High Risk for Readmission After Resection

PURPOSE Machine learning (ML) algorithms are used for predictive modeling in medicine, but studies often do not evaluate or report on the potential biases of the models. Our purpose was to develop clinical prediction models for readmission after surgery in patients with colorectal cancer (CRC) and to examine their potential for racial bias. METHODS We used the 2012-2020 American College of Surgeons' National Surgical Quality Improvement Program Participant Use File and Targeted Colectomy File. Patients were categorized into four race groups—White, Black or African American, other, and unknown/not reported. Potential predictive features were identified from studies of risk factors of 30-day readmission in patients with CRC. We compared four ML-based methods—logistic regression, multilayer perceptron, random forest, and XGBoost (XGB). Model bias was assessed using false-negative rate (FNR) difference, false-positive rate (FPR) difference, and disparate impact (DI). RESULTS In all, 112,077 patients were included, 67.2% of whom were White, 9.2% Black, 5.6% other race, and 18% with race not recorded. There were significant differences in the area under the receiver operating characteristics curve, FPR, and FNR between race groups across all models. Notably, patients in the other race category had higher FNR compared with Black patients in all but the XGB model, while Black patients had higher FPR than White patients in some models. Patients in the other category consistently had the lowest FPR. Applying the 80% rule for DI, the models consistently met the threshold for unfairness for the other race category. CONCLUSION Predictive models for 30-day readmission after colorectal surgery may perform unequally for different race groups, potentially propagating to inequalities in delivery of care and patient outcomes if the predictions from these models are used to direct care.

Risk factors for early readmission to hospital in patients with malignancy-related ascites: a retrospective cohort study.

Malignancy-related ascites (MRA) is a common serious complication of many advanced malignant tumors with high morbidity and mortality. The high hospital expenditures induced by unplanned readmission in patients with MRA have become an urgent issue to the public. We aimed to overall assess the unplanned early readmission rate of patients with MRA and explore the potential risk factors for such readmission. A retrospective cohort study based on 2018 Nationwide Readmissions Database was performed and patients with MRA were recruited into the analysis. The primary outcome was unplanned 30-day readmission rate and inpatient outcomes. The multivariate logistic regression analysis was performed to evaluate the potential risk factors for such early readmission. Data obtained from 32,457 patients with MRA were analyzed, and of these 7,799 individuals (24.03%) were unplanned readmitted within 30-day follow-up. The mortality rate in the readmitted population was 15.15%. Patients at younger age were at a higher risk of readmission. The morbidities including hypertension (OR=1.117, 95%CI: 1.054-1.184), hyperlipemia (OR=1.075, 95%CI: 1.009-1.146) and diabetes (OR=1.118, 95%CI: 1.053-1.188), gastrointestinal malignancies and peritoneal procedure significantly increased the risk of 30-day readmission in patients with MRA. More than one in five patients with MRA was unplanned readmitted within 30-day follow-up. The above risk factors should be timely intervened and the corresponding medical care should be strengthened in patients with MRA to lessen the unplanned readmission and improve the readmission outcomes.

Enhancing care coordination through transitional care management.

232 Background: West Cancer Center and Research Institute (WCCRI) serves Memphis and the Arkansas, Mississippi, and Tennessee tri-state region as the comprehensive care leader in adult cancer care and research, amounting to over 260,000 visits across 57,000 unique patients in 2023. Cancer patients are predisposed for higher risk of hospital admissions, making uniform care coordination between the discharging hospital and their outpatient oncology care home essential to care continuity. While WCCRI attempted to mitigate readmissions, there was no formalized managed care approach for capturing and responding to unplanned patient hospital visits to prevent readmission. Auditing of claims data suggested nearly 500 patient care opportunities within a four-month period. Methods: To improve continuity of care and decrease preventable readmissions, WCCRI implemented a care transitions process based on the Centers for Medicare and Medicaid's Transitional Care Management (TCM). This required a repeatable approach of proactive outreach to patient upon discharge, a clinical assessment of patient need, and an office visit within fourteen days of discharge. To maximize impact, this project was scoped to patients with unplanned hospital admissions who are at moderate to high risk for readmission. Results: Twelve months after implementation, WCCRI has proactively identified 974 patients qualifying for TCM and successfully scheduled 91.48% for a hospital follow-up appointment with their oncologist. Proactive outreach to patients has led to a 35% increase in office visits within fourteen days of discharge, a key measure of care continuity. Conclusions: Learnings from this implementation project have been spread to formalize hospital follow-up approaches across WCCRI. By aligning policies, engaging stakeholders, and fostering a culture of collaboration and accountability, WCCRI has delivered high-quality, coordinated care, and achieved better patient outcomes.

Impact of wearable device data and multi-scale entropy analysis on improving hospital readmission prediction.

Unplanned readmissions following a hospitalization remain common despite significant efforts to curtail these. Wearable devices may offer help identify patients at high risk for an unplanned readmission. We conducted a multi-center retrospective cohort study using data from the All of Us data repository. We included subjects with wearable data and developed a baseline Feedforward Neural Network (FNN) model and a Long Short-Term Memory (LSTM) time-series deep learning model to predict daily, unplanned rehospitalizations up to 90 days from discharge. In addition to demographic and laboratory data from subjects, post-discharge data input features include wearable data and multiscale entropy features based on intraday wearable time series. The most significant features in the LSTM model were determined by permutation feature importance testing. In sum, 612 patients met inclusion criteria. The complete LSTM model had a higher area under the receiver operating characteristic curve than the FNN model (0.83 vs 0.795). The 5 most important input features included variables from multiscale entropy (steps) and number of active steps per day. Data available from wearable devices can improve ability to predict readmissions. Prior work has focused on predictors available up to discharge or on additional data abstracted from wearable devices. Our results from 35 institutions highlight how multiscale entropy can improve readmission prediction and may impact future work in this domain. Wearable data and multiscale entropy can improve prediction of a deep-learning model to predict unplanned 90-day readmissions. Prospective studies are needed to validate these findings.

Application of the Self-Assembling Peptide Hydrogel RADA16 for Hemostasis during Tonsillectomy: A Feasibility Study.

Tonsillectomy is a common surgical procedure but carries a high risk of readmission for secondary bleeding and pain. This study evaluated the feasibility and effectiveness of using the hemostatic self-assembling peptide hydrogel RADA16 (PuraBond, 3-D Matrix SAS; Caluire et Cuire, France) to control bleeding from the tonsillectomy wound bed. Readmission/re-operation rates were compared between a prospective case series of 21 primarily adult tonsillectomy patients treated with topical RADA16 and an untreated historical Control group of 164 patients who underwent tonsillectomy by 10 surgeons at a single tertiary hospital in the UK between March 2019 and June 2022. Cumulative readmission rates for any reason were 2-fold elevated in Control subjects (18.9%; n = 31/164 subjects) compared to patients treated intra-operatively with RADA16 hemostatic hydrogel (9.5%; n = 2/21) (p = 0.378). Readmission rates for postoperative bleeding were 3-fold higher in Controls (14.6%; n = 24/164 subjects) than in the RADA16-treated group (4.8%; n = 1/21) (p = 0.317). A similar rate of retreatment for pain was recorded in the Control (4.3%; n = 7/164) and RADA16 (4.8%; n = 1/21) groups (p = 0.999). Two Control subjects (1.2%) required re-operation for recalcitrant bleeding; no RADA16 subject (0.0%) required re-operation for any reason. No device-related adverse events occurred in the RADA16 group. Surgeons were pleased with the easy learning curve and technical feasibility associated with intra-operatively administering RADA16 hemostatic hydrogel. Intra-operative hemostasis using RADA16 peptide hydrogel was straightforward and was associated with a trend of 3-fold lower rates of readmission for postoperative bleeding events than untreated Control subjects.

Outcomes in clinical subgroups of patients with alcohol-related hospitalizations: a population-based retrospective cohort study

ObjectiveIndividuals who experience alcohol-related hospitalizations are at a high risk of recurrent harm and premature mortality. This project characterized the clinical subgroups of individuals who experience alcohol-related hospitalizations to understand who is at the highest risk of recurrent harm following discharge. ApproachPopulation-based retrospective cohort study of individuals with an alcohol-related hospitalization between 2017-2018 in two Canadian provinces (Ontario and Manitoba) using linked provincial health administrative databases. Clinical subgroups were identified with latent class analysis based on the type and frequency of alcohol-related health service use in the two-years preceding the index hospitalization. Associations between subgroup membership, readmission, and mortality in the year following discharge were evaluated using multivariable time-to-event regression. ResultsIn cohorts of 4,753 (Manitoba) and 29,290 (Ontario) individuals, seven subgroups were identified. These followed a severity gradient from low-frequency service use for acute intoxication to high-frequency service use for alcoholic liver disease. Individuals in the ‘liver disease’ subgroup had the highest risk of 1-year mortality relative to the rest of the cohort (adjusted hazard ratio [aHR]: 3.83, 95% confidence interval (CI): 2.80-5.24). A small subgroup of individuals with a history of high-frequency alcohol-related health service had the highest hazard of readmission (aHR: 5.09, 95% CI: 4.11-6.31). Conclusions and ImplicationsThere are distinct clinical subgroups of individuals who experience alcohol related hospitalizations and individuals with high-frequency health service use and alcohol-related liver disease are at the highest risk of readmission and mortality. These subgroups merit consideration in strategies aimed at reducing the risk of post-discharge harm.

Health Care Resource Utilization Following Acute Myocardial Infarction: Findings from the RECORD-MI Registry

The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis.

Readmissions in Sepsis Survivors: Discharge Setting Risks.

Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors. To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged. The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting. A χ2 contingency analysis was used with each factor and presence/absence of readmission. The Kruskal-Wallis test was used to compare readmissions across discharge settings. From our sample (N = 7107; mean age 66.5 years; 46.2% women), 23.6% (n = 1674) were readmitted within 30 days and of those readmitted, 30% were readmitted between 1 and 3 times. Discharge setting (P < .001) and age (P = .02) were significantly associated with readmission, but sex, ethnicity, and insurance type were not. High numbers of readmissions were seen in patients discharged to skilled nursing facilities (29.6%), home health care (26.9%), and home (15.0%). Similar high comorbidity burden and acuteness of illness were seen in patients discharged to these settings. Sepsis survivors discharged to skilled nursing facilities, home health care, and home are at high risk for 30-day readmission. The rates of readmission from home health care and home settings were alarming. Often patients are discharged to inappropriate settings, placing them at risk for residual sepsis and readmission. Future research should focus on appropriate timing of hospital discharge and transition to the most appropriate discharge setting.

Associations Between Readmission and Length of Stay in the Acute Admission Unit for Patients with Alcohol-Related Diagnoses-A Cohort Study.

Patients with alcohol-related diagnosis in emergency departments (ED) are at high risk of readmission. Evidence shows an association between alcohol related admissions and a wide range of diseases and disorders. Understanding the risk factors for readmission and the asso-ciation with length of stay in the ED may help identify those who would benefit from targeted interventions. Thus, the hypothesis of this study is that patients with alcohol-related diagnoses and a short length of stay in the ED have a higher risk for readmission. Therefore, this study aimed to investigate the association between length of stay in the ED and 30-day readmission for patients with alcohol-related acute admissions as well as to uncover possible risk factors for 30-day read-mission. The study used a retrospective cohort design and was carried out from March 1, 2019, to January 31, 2020. The inclusion criteria were ≥ 18 years, admitted to an ED, and having an alcohol-related primary or secondary diagnosis (based on ICD-10 codes). Patients were fol-lowed for 30 days after discharge from initial hospitalization to identify associations between length of stay and 30-day readmission. We included 1,174 patients and found that 17% (95% CI: 15-20) of the patients admitted with an alcohol-related primary or secondary diagnosis were readmitted within 30 days. The hazard ratio (HR) for readmission increased with length of stay when compared to admission ≤ 24 hr; admission > 24-48 hr HR 1.50 (95% CI: 1.08-2.08), admission > 48 hr HR 2.08 (95% CI: 1.23-3.52). The study revealed that patients with alcohol-related diagnoses were at a higher risk of ED readmission the longer they stayed in the ED. Furthermore, the risk of readmis-sion increased if patients had a medical or psychiatric diagnosis prior to admission or lived alone.

Disparities in postdischarge follow-up and risk of readmission between Medicaid and privately insured patients.

Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow-up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow-up reduces risk of readmission for patients with Medicaid. To assess whether follow-up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status. This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow-up, and readmission. We analyzed data from 4281 patients aged 21-64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission. Outpatient follow-up within 30 days of discharge and 30-day all-cause readmission were outcomes. Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow-up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow-up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91-1.32) in the overall sample or in analysis stratified by payer. We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow-up. Timely follow-up care alone may not be sufficient as an intervention to reduce readmissions.

Association between new insertion of a long-term enteral feeding tube and mortality in adults admitted to the hospital with aspiration: A retrospective cohort study.

We aimed to describe the association between insertion of a new long-term enteral feeding tube during admission for aspiration and in-hospital mortality. This retrospective cohort study across 28 Canadian hospitals from 2015 to 2022 included consecutive patients who were admitted for aspiration. Patients were categorized based on new long-term enteral feeding tube insertion during hospital stay or not. The primary outcome was the time to death in hospital. Secondary outcomes included time to discharge alive and hospital readmission for aspiration within 90 days. We used propensity score weighting to balance covariates, and a competing risk model to describe in-hospital death and discharge. Of 12,850 patients admitted for aspiration, 852 (6.6%) patients received a long-term enteral feeding tube. In the hospital, 184 (21.6%) and 2489 (20.8%) patients in the enteral feeding tube group and no enteral feeding tube group died, respectively. Within 90 days of discharge, 127 (14.9%) and 1148 (9.6%) patients in the enteral feeding tube and no enteral feeding tube group were readmitted for aspiration, respectively. After balancing covariates, an enteral feeding tube was associated with a similar in-hospital mortality risk (subdistribution hazard ratio [sHR] = 1.05, 95% CI = 0.89-1.23; P = 0.5800), longer time to discharge alive (sHR = 0.58, 95% CI = 0.54-0.63; P < 0.0001), and a higher risk of readmission (risk difference = 5.0%, 95% CI = 2.4%-7.6%; P = 0.0001). Initiation of long-term enteral tube feeding was not uncommon after admission for aspiration and was not associated with an improvement in the probability of being discharged alive from the hospital or readmitted for aspiration.