Introduction Risk adjusted thirty-day hospital readmission rate is a commonly used benchmark for hospital quality of care and for Medicare reimbursement. Persons living with HIV (PLWH) may have high readmission rates. This study compared 30-day readmission rates by HIV status in a multi-state sample with planned subgroup comparisons by insurance and diagnostic categories. Methods Data for all acute care, non-military hospitalizations in 9 states in 2011 were obtained from the Healthcare Costs and Utilization Project. The primary outcome was readmission for any cause within 30 days of hospital discharge. Factors associated with readmission were evaluated using multivariate logistic regression. Results 5,484,245 persons, including 33,556 (0.6%) PLWH, had a total of 6,441,695 index hospitalizations, including 45,382 (0.7%) among PLWH. Unadjusted readmission rates for hospitalizations of HIV-uninfected persons and PLWH were 11.2% (95% CI: 11.2, 11.2) and 19.7% (19.3, 20.0), respectively. After adjustment for age, gender, race, insurance, and diagnostic category, HIV was associated with 1.50 (1.46, 1.54) times higher odds of readmission. Predicted, adjusted readmission rates were higher for PLWH within every insurance category, including Medicaid (12.9% [12.8, 13.0] and 19.1% [18.4, 19.7] for HIV-uninfected persons and PLWH, respectively) and Medicare (13.2% [13.1, 13.3] and 18.0% [17.4, 18.7], respectively) and within every diagnostic category. Discussion HIV is associated with significantly increased readmission risk independent of demographics, insurance, and diagnostic category. The 19.7% 30-day readmission rate may serve as a preliminary benchmark for assessing quality of care of PLWH. Policymakers may consider adjusting for HIV when calculating a hospital’s expected readmission rate.

In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage.

ObjectivesWhile highly active antiretroviral therapy (HAART) decreases long-term morbidity and mortality, its short-term effect on hospitalization rates is unknown. The primary objective of this study was to determine hospitalization rates over time in the year after HAART initiation for virological responders and nonresponders. MethodsHospitalizations among 1327 HAART-naïve subjects in an urban HIV clinic in 1997-2007 were examined before and after HAART initiation. Hospitalization rates were stratified by virological responders ( ! 1 log 10 decrease in HIV-1 RNA within 6 months after HAART initiation) and nonresponders. Causes were determined through International Classification of Diseases, 9th Revision (ICD-9) codes and chart review. Multivariate negative binomial regression was used to assess factors associated with hospitalization. ResultsDuring the first 45 days after HAART initiation, the hospitalization rate of responders was similar to their pre-HAART baseline rate [75.1 vs. 78.8/100 person-years (PY)] and to the hospitalization rate of nonresponders during the first 45 days (79.4/100 PY). The hospitalization rate of responders fell significantly between 45 and 90 days after HAART initiation and reached a plateau at approximately 45/100 PY from 91 to 365 days after HAART initiation. Significant decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. ConclusionsThe first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time.Keywords: AIDS-defining illness, antiretroviral therapy, healthcare utilization, hospitalization, immune reconstitution Accepted 7 August 2009 IntroductionIn the short term after starting highly active antiretroviral therapy (HAART), HIV-infected patients may have an increased risk of serious illness as a result of an immune reconstitution inflammatory syndrome (IRIS), a traditional opportunistic infection (OI), or an adverse drug reaction. While HAART is known to decrease hospitalization rates and mortality in the long term [1][2][3][4][5][6][7], the time at which hospitalization risk declines during the weeks to months immediately following HAART initiation is not clear.In studies in high-income countries conducted since the advent of HAART in 1996, AIDS-defining illnesses (ADIs) and non-ADI infections have been the most frequent reasons for hospital admission [1,4,6,[8][9][10][11]. The next most common categories of admitting diagnoses have varied among mental illness, gastrointestinal and hepatic disease, and cardiovascular disease. Studies have compared hospitalization rates for these disease categories in the several years prior to the advent of HAART vs. the several years after its advent among cohorts of patients, not all of whom were prescribed HAART [1,4,5,[12][13][14][15][16][17]. These studies did not determine changes in an individual's risk of serious illness within these disease categories in the weeks to months immediately after initia...