Impact of Hospital Population Case-Mix, Including Poverty, on Hospital All-Cause and Infection-Related 30-Day Readmission Rates.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE
    • Publication Information:
      Publication: Jan. 2011- : Oxford : Oxford University Press
      Original Publication: Chicago, IL : The University of Chicago Press, c1992-
    • Subject Terms:
      Poverty*/statistics & numerical data; Hospitalization/*statistics & numerical data ; Patient Readmission/*statistics & numerical data; California/epidemiology ; Cohort Studies ; Communicable Diseases/epidemiology ; Comorbidity ; Diagnosis-Related Groups ; Hospitalization/economics ; Humans ; Length of Stay/economics ; Length of Stay/statistics & numerical data ; Odds Ratio ; Patient Discharge/statistics & numerical data ; Patient Readmission/economics ; Retrospective Studies ; Risk Factors ; Skilled Nursing Facilities/standards ; Skilled Nursing Facilities/statistics & numerical data ; Socioeconomic Factors
    • 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 hospital risk factors for readmissions and infection-related readmissions 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, prolonged length of stay, and populations living 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 (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions.
      Conclusions: Infection-related readmissions accounted for nearly 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.
      (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].)
    • References:
      Am J Epidemiol. 2002 Sep 1;156(5):471-82. (PMID: 12196317)
      J Gen Intern Med. 2004 May;19(5 Pt 1):444-50. (PMID: 15109342)
      Am J Med Qual. 2004 May-Jun;19(3):121-7. (PMID: 15212317)
      Med Care. 1998 Jan;36(1):8-27. (PMID: 9431328)
      Ann Thorac Surg. 2005 Dec;80(6):2106-13. (PMID: 16305853)
      Circulation. 2006 Jan 24;113(3):456-62. (PMID: 16365198)
      Circulation. 2006 Apr 4;113(13):1683-92. (PMID: 16549637)
      Public Health Rep. 2007 Mar-Apr;122(2):160-6. (PMID: 17357358)
      Infect Dis Clin North Am. 2007 Sep;21(3):761-72, ix. (PMID: 17826622)
      Ann Intern Med. 2008 Jan 15;148(2):111-23. (PMID: 18195336)
      N Engl J Med. 2009 Apr 2;360(14):1418-28. (PMID: 19339721)
      Ann N Y Acad Sci. 2010 Feb;1186:5-23. (PMID: 20201865)
      JAMA. 2010 Jun 2;303(21):2141-7. (PMID: 20516414)
      CMAJ. 2011 Oct 4;183(14):E1067-72. (PMID: 21859870)
      Infect Control Hosp Epidemiol. 2012 Jan;33(1):20-8. (PMID: 22173518)
      Infect Control Hosp Epidemiol. 2012 Feb;33(2):202-4. (PMID: 22227993)
      BMJ Qual Saf. 2012 Apr;21(4):325-36. (PMID: 22389022)
      N Engl J Med. 2012 Apr 12;366(15):1364-6. (PMID: 22455754)
      Infect Control Hosp Epidemiol. 2012 Jun;33(6):539-44. (PMID: 22561707)
      Acad Med. 2012 Jun;87(6):701-8. (PMID: 22534588)
      JAMA. 2013 Jan 23;309(4):342-3. (PMID: 23340629)
      J Gen Intern Med. 2013 Feb;28(2):269-82. (PMID: 23054925)
      Antimicrob Agents Chemother. 2013 Mar;57(3):1169-72. (PMID: 23254427)
      Malawi Med J. 2013 Jun;25(2):50-2. (PMID: 24098831)
      Clin Infect Dis. 2013 Nov;57(9):1282-8. (PMID: 23912846)
      JAMA Intern Med. 2014 Apr;174(4):535-43. (PMID: 24515422)
    • Grant Information:
      KL2 TR000147 United States TR NCATS NIH HHS; KL2 TR001416 United States TR NCATS NIH HHS; T32 GM007309 United States GM NIGMS NIH HHS
    • Contributed Indexing:
      Keywords: healthcare associated infections; hospital infections; poverty; readmissions
    • Publication Date:
      Date Created: 20150702 Date Completed: 20160711 Latest Revision: 20211102
    • Publication Date:
      20221213
    • Accession Number:
      PMC4583583
    • Accession Number:
      10.1093/cid/civ539
    • Accession Number:
      26129752