Impact of time from discharge to readmission on outcomes: an observational study from the US National Readmission Database.
Humans
Patient Readmission
/ statistics & numerical data
Male
Female
United States
/ epidemiology
Retrospective Studies
Aged
Middle Aged
Patient Discharge
/ statistics & numerical data
Length of Stay
/ statistics & numerical data
Databases, Factual
Time Factors
Arthroplasty, Replacement, Hip
Pulmonary Disease, Chronic Obstructive
/ mortality
Myocardial Infarction
/ mortality
Pneumonia
/ mortality
Coronary Artery Bypass
/ statistics & numerical data
Heart Failure
/ mortality
Adult
Hospitals
Medicine
Mortality
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
28 Aug 2024
28 Aug 2024
Historique:
medline:
31
8
2024
pubmed:
31
8
2024
entrez:
29
8
2024
Statut:
epublish
Résumé
The Hospital Readmission Reduction Programme (HRRP) was created to decrease the number of hospital readmissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia (PNA), coronary artery bypass graft (CABG), elective total hip arthroplasty (THA) and total knee arthroplasty. To analyse the impact of the HRRP on readmission rates from 2010 to 2019 and how time to readmission impacted outcomes. Population-based retrospective study. All patients included in the US National Readmission database from 2010 to 2019. We recorded demographic and clinical variables. Using linear regression models, we analysed the association between readmission status and timing with death and length of stay (LOS) outcomes. We transformed LOS and charges into log-LOS and log-charges to normalise the data. There were 31 553 363 records included in the study. Of those, 4 593 228 (14.55%) were readmitted within 30 days. From 2010 to 2019, readmission rates for COPD (20.8%-19.8%), HF (24.9%-21.9%), PNA (16.4%-15.1%), AMI (15.6%-12.9%) and TKR (4.1%-3.4%) decreased whereas CABG (10.2%-10.6%) and THA (4.2%-5.8%) increased. Readmitted patients were at higher risk of mortality (6% vs 2.8%) and had higher LOS (3 (2-5) vs 4 (3-7)). Patients readmitted within 10 days had a mortality 6.4% higher than those readmitted in 11-20 days (5.4%) and 21-30 days (4.6%). Increased time from discharge to readmission was associated with a lower likelihood of mortality, like LOS. Over the last 10 years, readmission rates decreased for most conditions included in the HRRP except CABG and THA. Patients readmitted shortly after discharge were at higher risk of death.
Sections du résumé
BACKGROUND
BACKGROUND
The Hospital Readmission Reduction Programme (HRRP) was created to decrease the number of hospital readmissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia (PNA), coronary artery bypass graft (CABG), elective total hip arthroplasty (THA) and total knee arthroplasty.
OBJECTIVES
OBJECTIVE
To analyse the impact of the HRRP on readmission rates from 2010 to 2019 and how time to readmission impacted outcomes.
DESIGN
METHODS
Population-based retrospective study.
SETTING
METHODS
All patients included in the US National Readmission database from 2010 to 2019.
PATIENTS
METHODS
We recorded demographic and clinical variables.
MEASUREMENTS
METHODS
Using linear regression models, we analysed the association between readmission status and timing with death and length of stay (LOS) outcomes. We transformed LOS and charges into log-LOS and log-charges to normalise the data.
RESULTS
RESULTS
There were 31 553 363 records included in the study. Of those, 4 593 228 (14.55%) were readmitted within 30 days. From 2010 to 2019, readmission rates for COPD (20.8%-19.8%), HF (24.9%-21.9%), PNA (16.4%-15.1%), AMI (15.6%-12.9%) and TKR (4.1%-3.4%) decreased whereas CABG (10.2%-10.6%) and THA (4.2%-5.8%) increased. Readmitted patients were at higher risk of mortality (6% vs 2.8%) and had higher LOS (3 (2-5) vs 4 (3-7)). Patients readmitted within 10 days had a mortality 6.4% higher than those readmitted in 11-20 days (5.4%) and 21-30 days (4.6%). Increased time from discharge to readmission was associated with a lower likelihood of mortality, like LOS.
CONCLUSION
CONCLUSIONS
Over the last 10 years, readmission rates decreased for most conditions included in the HRRP except CABG and THA. Patients readmitted shortly after discharge were at higher risk of death.
Identifiants
pubmed: 39209489
pii: bmjopen-2024-085466
doi: 10.1136/bmjopen-2024-085466
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e085466Informations de copyright
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.