Health information exchange systems and length of stay in readmissions to a different hospital

Flaks‐Manov, Natalie; Shadmi, Efrat; Hoshen, Moshe; Balicer, Ran D.

doi:10.1002/jhm.2535

Cited by 22 publications

(9 citation statements)

References 38 publications

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“…27,28 Characteristics Similar to other studies, 2,3 the present study found no difference in age and sex between the two groups, but a higher number of previous admissions in patients who had a non-index hospital readmission. Unlike other studies, 29,30 CCI was significantly lower in the non-index readmission group, indicating that these patients had fewer comorbidities and possibly had a less complicated illness explaining the shorter LOS during their index admission. Recurrence of the illness provoking the index admission and the occurrence of complications during the index admission affected the likelihood of the patient being readmitted to the index hospital rather than to a non-index hospital.…”

Section: Discussioncontrasting

confidence: 84%

Characteristics and clinical outcomes of index versus non-index hospital readmissions in Australian hospitals: a cohort study

Sharma

Horwood

Hakendorf

et al. 2020

Aust. Health Review

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Objective Risk factors and clinical outcomes of non-index hospital readmissions (readmissions to a hospital different from the previous admission) have not been studied in Australia. The present study compared characteristics and clinical outcomes between index and non-index hospital readmissions in the Australian healthcare setting. Methods This retrospective cohort study included medical admissions from 2012 to 2016 across all major public hospitals in South Australia. Readmissions within 30 day to all public hospitals were captured using electronic health information system. In-hospital mortality and readmission length of hospital stay (LOS) were compared, along with 30-day mortality and subsequent readmissions among patients readmitted to index or non-index hospitals. Results Of 114105 index admissions, there were 20539 (18.0%) readmissions. Of these, 17519 (85.3%) were index readmissions and 3020 (14.7%) were non-index readmissions. Compared with index readmissions, patients in the non-index readmissions group had a lower Charlson comorbidity index, shorter LOS and fewer complications during the index admission and were more likely to be readmitted with a different diagnosis to the index admission. No difference in in-hospital mortality was observed, but readmission LOS was shorter and 30-day mortality was higher among patients with non-index readmissions. Conclusion A substantial proportion of patients experienced non-index hospital readmissions. Non-index hospital readmitted patients had no immediate adverse outcomes, but experienced worse 30-day outcomes. What is known about the topic? A significant proportion of unplanned hospital readmissions occur to non-index hospitals. North American studies suggest that non-index hospital readmissions are associated with worse outcomes for patients due to discontinuity of care, medical reconciliation and delayed treatment. Limited studies have determined factors associated with non-index hospital readmissions in Australia, but whether such readmissions lead to adverse clinical outcomes is unknown. What does this paper add? In the Australian healthcare setting, 14.7% of patients were readmitted to non-index hospitals. Compared with index hospital readmissions, patients admitted to non-index hospitals had a lower Charlson comorbidity index, a shorter index LOS and fewer complications during the index admission. At the time of readmission there was no differences in discharge summary completion rates between the two groups. Unlike other studies, the present study found no immediate adverse outcomes for patients readmitted to non-index hospitals, but 30-day outcomes were worse than for patients who had an index hospital readmission. What are the implications for practitioners? Non-index hospital readmissions may not be totally preventable due to factors such as ambulance diversions stemming from emergency department overcrowding and prolonged emergency department waiting times. Patients should be advised to re-present to hospital in case they experience recurrence or relapse of a medical condition, and preferably should be readmitted to the same hospital to prevent discontinuity of care.

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Section: Discussioncontrasting

confidence: 84%

Characteristics and clinical outcomes of index versus non-index hospital readmissions in Australian hospitals: a cohort study

Sharma

Horwood

Hakendorf

et al. 2020

Aust. Health Review

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“…Of the 969 community‐dwelling participants recruited to the HoPE‐FOR study, a subset of 758 (78%) members of Clalit was used for the current study, as data on readmissions to any general hospital were accurately and readily available from Clalit's EHR system . Of those, we excluded 199 due to the following reasons: 13 (2%) died during the hospitalization, 46 (6%) transferred to another ward, 16 (2%) were discharged to a post–acute care facility, and 124 (16%) dropped‐out from the HoPE‐FOR study during the hospitalization (due to unavailability because of intensive tests or procedures) or had missing data on the main variables, leaving a final sample of 559 participants.…”

Section: Methodsmentioning

confidence: 99%

Functional status before and during acute hospitalization and readmission risk identification

Tonkikh

Shadmi

Flaks‐Manov

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Recent efforts to prevent readmissions are increasingly focusing on early identification of high‐risk patients. OBJECTIVE To test whether information on functioning during hospitalization contributes to the ability to accurately identify older adults at high risk of readmission beyond their baseline risk. DESIGN Prospective cohort study. SETTING Internal medicine wards at 2 medical centers. PATIENTS Five hundred fifty‐nine community‐dwelling older adults (aged ≥70 years) discharged to their homes. MEASUREMENTS Data on unplanned 30‐day readmissions were retrieved from electronic health records. Data on at‐admission activities of daily living (ADL) and in‐hospital ADL decline were collected using validated questionnaires. Multivariate logistic regression was used to model the association between functioning and readmission controlling for known risk factors. RESULTS Higher in‐hospital ADL decline was significantly associated with readmission (odds ratio for each 10‐point decrease in ADL = 1.32, 95% confidence interval = 1.02‐1.72) but did not contribute to the overall discrimination of the model, as compared with the at‐admission data (C statistic = 0.81 for each model). Identifying high‐risk (10th highest percentile) patients by the at‐admission model did not detect 7/55 (12.7%) of patients who would have been categorized as high risk if risk identification was postponed to the discharge date and included data on in‐hospital ADL decline. CONCLUSIONS The study highlights the ability to identify patients at high risk for readmission already early in the index hospitalization using data on functioning, nutrition, chronic morbidity, and prior hospitalizations. Nonetheless, at‐discharge functional assessment can detect additional patients whose readmission risk changes during the index hospitalization. Journal of Hospital Medicine 2016;11:636–641. © 2016 Society of Hospital Medicine

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“…16 For adult patients, when readmissions are fragmented across multiple hospitals, the readmission LOS increases, whereas efficient, cost-effective care decreases. 15,17 Likewise, data from health systems reveal that fragmentation of care for adults with chronic conditions results in increased health care costs, worsened outcomes (eg, increases in mortality), and longer intervals between health maintenance visits. 17,18 Although readmissions to different hospitals are associated with longer total LOS among adults, relatively little is known about the effect of fragmentation of care on overall LOS for hospitalized children.…”

mentioning

confidence: 99%

“…17,18 Although readmissions to different hospitals are associated with longer total LOS among adults, relatively little is known about the effect of fragmentation of care on overall LOS for hospitalized children. 15,16 Therefore, our objectives in this study were (1) to assess, nationally, the LOS and cost for 30-day readmissions in children; (2) to compare the LOS and cost between index admissions, readmissions, and for the episode of care (ie, combined index admission and readmission); and (3) to describe the impact on LOS and cost when a readmission occurs to the same versus a different hospital from that of the index admission.…”

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confidence: 99%

Length of Stay and Cost of Pediatric Readmissions

Markham¹,

Hall²,

Gay³

et al. 2018

Pediatrics

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Health information exchange systems and length of stay in readmissions to a different hospital

Abstract: BACKGROUND: Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems.

Cited by 22 publications

References 38 publications

Characteristics and clinical outcomes of index versus non-index hospital readmissions in Australian hospitals: a cohort study

Characteristics and clinical outcomes of index versus non-index hospital readmissions in Australian hospitals: a cohort study

Functional status before and during acute hospitalization and readmission risk identification

Length of Stay and Cost of Pediatric Readmissions

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