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Impact of Hospital Population Case-Mix, IncludingPoverty,on HospitalAll-Cause and Infection-Related 30-Day Readmission Rates.
Clin Infect Dis. 2015 Jun 30;
Authors: Gohil SK, Datta R, Cao C, Phelan MJ, Nguyen V, Rowther AA, Huang SS
Abstract
BACKGROUND: Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospitalrisk factorsfor readmissions and infection-related-readmission may help optimize interventions to prevent readmissions.
METHODS: Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011.Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen's kappa.
RESULTS: We assessed 30-day readmission rates from 323 hospitals, accounting for 213,879,194 post-discharge person-days of follow up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolongedlength-of-stay, and populationsliving in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (OR 1.24 and 1.15, respectively).When comparing adjusted versus crude hospital rankings for infection-related readmission rates, adjustment revealed 39 (12%) of hospitals misclassified in outlier categories and 3 (10.5%) misclassified as average.
CONCLUSIONS: Infection-related readmissions accounted fornearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths-of-stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.
PMID: 26129752 [PubMed - as supplied by publisher]