Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

Calvillo-King, Linda; Arnold, Danielle; Eubank, Kathryn J.; Lo, Matthew; Yunyongying, Pete; Stieglitz, Heather; Halm, Ethan A.

doi:10.1007/s11606-012-2235-x

Cited by 364 publications

(322 citation statements)

References 73 publications

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“…We had hypothesized that disability limitations measured as ADL limitations would be significant predictors of readmission for all the cohorts, supported by literature data. [10][11][12][13][14][15][16][17][18][19][39][40][41][42] Although ADL limitations were significant predictors of readmission for pneumonia using the HRS-CMS and ACS-HCUP data sets, this was not demonstrated for the heart failure or acute myocardial infarction cohorts. Cognitive impairment did not predict readmission in any cohort for either data set, perhaps because the diagnosis of dementia is part of the standard CMS risk adjustment already applied.…”

Section: Discussionmentioning

confidence: 99%

“…7 However, an increasing body of literature reveals that patient disability and social determinants of health impact readmission risk and vary across hospital populations, contributing to higher readmission penalties for safety-net hospitals-and generating increasing interest in studying risk adjustment for sociodemographic factors. 1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] To provide a better understanding of the extent to which the addition of patient disability and social determinants of health would impact the current risk adjustment models used by CMS, the objective of our study was to assess how measures of disability and social determinants of health were associated Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3869-x) contains supplementary material, which is available to authorized users.…”

Section: T He Centers For Medicare and Medicaid Services (Cms)mentioning

confidence: 99%

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The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

et al. 2016

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BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. OBJECTIVE: To assess the impact of disability and social d e t e r m i n an t s o f h ea l t h o n c o n d i t i o n-s p e c i f i c readmissions beyond current risk adjustment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. M A I N M E A S U R E S : O u t c o m e s m e a s u r e d w e r e readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Codepercentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. KEY RESULTS: For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66,) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292)

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Section: Discussionmentioning

confidence: 99%

Section: T He Centers For Medicare and Medicaid Services (Cms)mentioning

confidence: 99%

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

et al. 2016

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“…Third, there was inconsistent reporting of patient characteristics such as socioeconomic status, level of social support, and comorbidities, all of which have been linked with rehospitalization rates (33)(34)(35). Establishing standards for measuring and reporting patient characteristics and outcomes will help readers determine whether study results are applicable to their clinical populations and can therefore be used to develop local quality-improvement programs.…”

Section: Systematic Reviewmentioning

confidence: 99%

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Prieto-Centurion¹,

Markos

Ramey³

et al. 2014

Annals ATS

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Rationale: Approximately 20% of patients hospitalized for COPD exacerbations in the United States will be readmitted within 30 days. The Centers for Medicare and Medicaid Services has recently proposed to revise the Hospital Readmissions Reduction Program to financially penalize hospitals with high all-cause 30-day rehospitalization rates after a hospitalization for COPD exacerbation on or after October 1, 2014.Objectives: To report the results of a systematic review of randomized clinical trials evaluating interventions to reduce the rehospitalizations after COPD exacerbations.Methods: Multiple electronic databases were systematically searched to identify relevant studies published between January 1966 and June 2013. Titles, abstracts, and, subsequently, full-text articles were assessed for eligibility. Each study was appraised using predefined criteria.Measurements and Main Results: Among 913 titles and abstracts screened, 5 studies (1,393 participants) met eligibility criteria. All studies had a primary outcome of rehospitalization at 6 or 12 months. No study examined 30-day rehospitalization as the primary outcome. Each study tested a different set of interventions. Two studies (one conducted in Canada and one conducted in Spain and Belgium) showed a decrease in all-cause rehospitalization over 12 months in the intervention group versus comparator group (mean number of hospitalizations per patient, 1.0 vs. 1.8; P = 0.01; percent hospitalized, 45 vs. 67%; P = 0.028; respectively). The only study conducted in the United States found a greater than twofold higher risk of mortality in the intervention group (17 vs. 7%, P = 0.003) but no significant difference in rehospitalizations. It was unclear which set of interventions was effective or harmful. Conclusions:The evidence base is inadequate to recommend specific interventions to reduce rehospitalizations in this population and does not justify penalizing hospitals for high 30-day rehospitalization rates after COPD exacerbations.

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“…A group of studies suggested that low social-economic status be associated with high risk of readmissions of AMI, CHF or pneumonia hospitalizations (Gu et al 2014, Noori et al 2014, Calvillo-King et al 2013, Amarasingham et al 2010, Arbaje et al 2008, Rathore et al 2006. Arbaje et al (2008) also suggested that postdischarge environmental factors such as being unmarried, living along, lacking self-management skills, or having no helpers with activities of daily living be associated with high readmission risks.…”

Section: Literature Reviewmentioning

confidence: 99%

Once A Cure; Second A Waste: Examining Hospital Readmission Rates of the Commercially Insured Under 65 Population

Fu¹

2016

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Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

Cited by 364 publications

References 73 publications

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Once A Cure; Second A Waste: Examining Hospital Readmission Rates of the Commercially Insured Under 65 Population

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