Patterns of Readmissions for Three Common Conditions Among Younger US Adults - 17/09/17
, Shashank S. Sinha, MD, MSc a, b, c, d, Andrew M. Ryan, PhD d, e, Michael W. Sjoding, MD, MSc b, c, d, f, Scott L. Hummel, MD, MS a, g, Brahmajee K. Nallamothu, MD, MPH a, b, c, d, gAbstract |
Background |
Thirty-day readmissions among elderly Medicare patients are an important hospital quality measure. Although plans for using 30-day readmission measures are under consideration for younger patients, little is known about readmission in younger patients or the relationship between readmissions in younger and elderly patients at the same hospital.
Methods |
By using the 2014 Nationwide Readmissions Database, we examined readmission patterns in younger patients (18-64 years) using hierarchical models to evaluate associations between hospital 30-day, risk-standardized readmission rates in elderly Medicare patients and readmission risk in younger patients with acute myocardial infarction, heart failure, or pneumonia.
Results |
There were 87,818, 98,315, and 103,251 admissions in younger patients for acute myocardial infarction, heart failure, and pneumonia, respectively, with overall 30-day unplanned readmission rates of 8.5%, 21.4%, and 13.7%, respectively. Readmission risk in younger patients was significantly associated with hospital 30-day risk-standardized readmission rates for elderly Medicare patients for all 3 conditions. A decrease in an average hospital's 30-day, risk-standardized readmission rates from the 75th percentile to the 25th percentile was associated with reduction in younger patients' risk of readmission from 8.8% to 8.0% (difference: 0.7%; 95% confidence interval, 0.5-0.9) for acute myocardial infarction; 21.8% to 20.0% (difference: 1.8%; 95% confidence interval, 1.4-2.2) for heart failure; and 13.9% to 13.1% (difference: 0.8%; 95% confidence interval, 0.5-1.0) for pneumonia.
Conclusions |
Among younger patients, readmission risk was moderately associated with hospital 30-day, risk-standardized readmission rates in elderly Medicare beneficiaries. Efforts to reduce readmissions among older patients may have important areas of overlap with younger patients, although further research may be necessary to identify specific mechanisms to tailor initiatives to younger patients.
Le texte complet de cet article est disponible en PDF.Keywords : Acute myocardial infarction, Heart failure, Patient readmission, Pneumonia
Plan
| Funding: DS and SSS and are supported by the National Institutes of Health (National Heart, Lung, and Blood Institute) T32 postdoctoral research training grant (5T32HL007853). AMR receives grant funding from the National Institute on Aging (R01-AG-047932). MWS is supported by a National Heart, Lung, and Blood Institute T32 postdoctoral training grant (T32HL007749). SLH is supported by the National Institute on Aging (R21-AG-047939). BKN is paid for editorial work through the American Heart Association as Editor of Circulation: Cardiovascular Quality and Outcomes. Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent those of the US Department of Veterans Affairs. |
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| Conflict of Interest: None. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
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| DS and SSS are co-first authors. |
Vol 130 - N° 10
P. 1220.e1-1220.e16 - octobre 2017 Retour au numéro
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