Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization

Horwitz, Leora I.; Wang, Yongfei; Altaf, Faseeha; Wang, Changqin; Lin, Zhenqiu; Liu, Shu-Ling; Grady, Jacqueline N.; Bernheim, Susannah M.; Desai, Nihar R.; Venkatesh, Arjun K.; Herrin, Jeph

doi:10.1097/mlr.0000000000000882

Cited by 21 publications

(22 citation statements)

References 24 publications

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“…This could be explained by the fact that patients treated in the tertiary hospitals tended to be more severe and treatment-resistant, and such severity was not fully adjusted for using the existing variables in the multi-variate model. Previous studies using data from the Centre of Medicare and Medicaid Services (CMS) in United States had identified that larger, urban, academic facilities tended to have slightly higher riskstandardized readmission rates [48,49]. In this study, tertiary hospitals in China normally had more hospital beds and higher service volumes so that the finding of this research was in line with the results of previous studies.…”

Section: Hospital Characteristicssupporting

confidence: 87%

Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis

et al. 2020

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Background: Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. Methods: Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics. Results: The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04-1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56-0.91) and frequent readmissions (OR 0.60, 95%CI 0.40-0.91). Conclusion: More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

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Section: Hospital Characteristicssupporting

confidence: 87%

Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis

et al. 2020

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“…Despite its low incidence, given the potentially lethal outcome of hospital discharge after T&A in patients with various risk factors, including clinical signs of OSA/SDB, overnight admission or prolonged postoperative monitoring is suggested in these patients. Furthermore, alterations in postoperative pain management practices with avoidance or limited use of opioids are suggested given the increased sensitivity of this patient population to the respiratory depressant effects of opioids 23,24. While there were no postoperative deaths reported in the database used for our study, the literature, and closed claims data clearly outline the risk in this patient population.…”

Section: Discussionmentioning

confidence: 85%

<p>Overnight inpatient admission and revisit rates after pediatric adenotonsillectomy</p>

Alsuhebani¹,

Walia²,

Miller³

et al. 2019

TCRM

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Objective: Overnight admission may be necessary following adenotonsillectomy (T&A) in pediatric patients. This practice may reduce unplanned revisits following hospital discharge. Study design: Retrospective cohort study. Subjects: Children from the PHIS database. Methods: T&A performed in children during the years 2007–2015 were identified in the Pediatric Health Information System. The primary outcome was 7-day, all-cause readmission or emergency department (ED) revisit. Secondary analysis examined specific revisit types and 30-day revisits. The primary exposure was each institution’s annual rate of overnight stay after T&A. Results: The analysis included 411,876 procedures at 48 hospitals. Hospitals’ annual rates of overnight stay following T&A ranged from 3% to 100%, and 7-day revisit rates varied from 0% to 15%. The percentage or rate of 7-day revisits did not differ based on the use of overnight stay following T&A. At hospitals with higher overnight admission rates after T&A, 7-day revisits were more likely to take the form of inpatient admission rather than an ED visit. Conclusions: The current study confirms that pediatric hospitals vary widely in inpatient admission practices following T&A. This variation is not associated with differences in revisit rates at 7 and 30 days related to any cause. Although no mortality was noted in the current study, caution is suggested when deciding on the disposition of patients with comorbid conditions as risks related to various patients, anesthetic, and surgical-related issues exist. Risk stratification with appropriate identification of patients requiring overnight stay may be the most important for preventing acute care revisits after T&A.

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“…This study suggests the need to better understand and account for the involvement of the ED in quality measurement for care coordination and population health management strategies within communities and health systems, 47 particularly those involving hospital readmissions. Policy makers may wish to adopt proposals 48,49 to incorporate ED utilization and observation stays into the HRRP to improve its reliability by better accounting for statistical outliers and reducing possible unintended consequences. Another possibility is to develop an explicit ED revisit measure that assesses readmissions, mortality, and morbidity after ED revisits.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hospital Readmissions From the Emergency Department After Implementation of Medicare’s Hospital Readmissions Reduction Program

et al. 2020

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IMPORTANCE The Medicare Hospital Readmissions Reduction Program (HRRP) is associated with reduced readmission rates, but it is unknown how this decrease occurred. OBJECTIVE To examine whether the HRRP was associated with changes in the probability of readmission at emergency department (ED) visits after hospital discharge (ED revisits) overall and depending on whether admission is typically indicated for the patient's condition at the ED revisit.

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Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization

Cited by 21 publications

References 24 publications

Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis

Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis

<p>Overnight inpatient admission and revisit rates after pediatric adenotonsillectomy</p>

Assessment of Hospital Readmissions From the Emergency Department After Implementation of Medicare’s Hospital Readmissions Reduction Program

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