HIV and early hospital readmission: evaluation of a tertiary medical facility in Lilongwe, Malawi

Abstract

BackgroundDelivery of quality healthcare in resource-limited settings is an important, understudied public health priority. Thirty-day (early) hospital readmission is often avoidable and an important indicator of healthcare quality.MethodsWe investigated the prevalence of all-cause early readmission and its associated factors using age and sex adjusted risk ratios (RR) and 95% confidence intervals (CI). A retrospective review of the medical ward database at Kamuzu Central Hospital in Lilongwe, Malawi was conducted between February and December 2013.ResultsThere were 3547 patients with an index admission of which 2776 (74.4%) survived and were eligible for readmission. Among these patients: 49.7% were male, mean age was 39.7 years, 36.1% were HIV-positive, 34.6% were HIV-negative, and 29.3% were HIV-unknown. The prevalence of early hospital readmission was 5.5%. Diagnoses associated with 30-day readmission were HIV-positive status (RR = 2.41; 95% CI: 1.64–3.53) and malaria (RR = 0.45; 95% CI: 0.22–0.91). Other factors associated with readmission were multiple diagnoses (excluding HIV) (RR = 1.52; 95% CI: 1.11–2.06), and prolonged length of stay (≥ 16 days) at the index hospitalization (RR = 3.63; 95% CI: 1.72–7.67).ConclusionTargeting HIV-infected inpatients with multiple diagnoses and longer index hospitalizations may prevent early readmission and improve quality of care.

Outcomes of people living with HIV after hospital discharge: a systematic review and meta-analysis

“…48 The 29 studies provided information about post-discharge outcomes for 92 781 patients. Most studies were from North America; [11][12][13][14]20,21,24,25,[29][30][31]33,34,40,44 nine studies were from Africa, including five from South Africa, 5,23,27,38,43 one from Malawi, 26 one from Mozambique, 36,37 one from Tanzania, 41 and one from Zambia; 32 two studies were from southeast Asia; 22,35 one study was from Latin America; 28 and two studies were from Europe (table ). 39,42 The study from Mozambique reported outcomes in children; 36,37 all other studies were done in adults.…”

“…11 studies reported the proportion of patients with advanced HIV disease (CD4 count <200 cells per µL), 5,[11][12][13]28,29,32,[35][36][37]41 which ranged from 16% to 91%. 11 studies reported length of hospital stay, 5,[11][12][13]23,26,28,29,32,43,44 which ranged from 4 days to 12 days.…”

“…20 studies (91451 admissions) reported the number of patients readmitted to care after hospital dis charge, 5,[11][12][13][14][22][23][24][25][26][27][28][31][32][33][34]38,40,42,44 of which, 14 studies reported readmission within 30 days of discharge. The proportion of patients readmitted post-discharge ranged from 3•4% (1•0-7•2) to 52•9% (44•0-61•6), with an overall pooled proportion of 18•8% (15•3-22•3; figure 2).…”

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

“…Recent hospitalization may suggest clinical failure in this subgroup of non-suppressed women. Hospital readmissions are frequent among HIV positive adults when compared to their HIV negative counterparts [25]. Persistent viremia above 200 copies/ml has been found to predispose one to higher morbidity, virologic failure and mortality especially among cases of delayed ART switch to 2nd line therapy [15,26].…”

Lessons learned from the development and implementation of an electronic paediatric emergency and acute care database in Lilongwe, Malawi

“…These are described elsewhere and have provided useful information about targeted prevention measures. [42][43][44] Through meetings with key personnel responsible for these databases, we learnt their implementation logistics and ongoing processes. We assessed data collection forms, which influenced the production of our database forms.…”