Sopan Lahewala1, Shilpkumar Arora2, Byomesh Tripathi3, Sidakpal Panaich4, Varun Kumar3, Nirali Patel5, Sejal Savani3, Mihir Dave6, Yash Varma7, Apurva Badheka8, Abhishek Deshmukh9, Umesh Gidwani6, Radha Gopalan10, Alexandros Briasoulis4. 1. Department of Medicine, Robert Wood Johnson - Barnabas Health, Jersey City, NJ, United States of America. 2. Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital, New York, NY, United States of America. Electronic address: dr.shilparora@yahoo.com. 3. Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital, New York, NY, United States of America. 4. Department of Interventional Cardiology/Structural Heart Disease, University of Iowa, United States of America. 5. Department of Cardiology, University of Southern California, California, LA, United States of America. 6. Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America. 7. Department of Medicine, Guthrie Hospital, Sayre, PA, United States of America. 8. Department of Cardiology, The Everett Clinic, Everett, WA, United States of America. 9. Department of Cardiology, Mayo Clinic, Rochester, MN, United States of America. 10. Department of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, United States of America.
Abstract
BACKGROUND: Heart Failure (HF) is a major driver of the readmissions/penalties in the US. Although extensive literature on rehospitalization attributed to HF, studies to compare outcomes for same-hospital vs. different-hospital readmissions are sparse. METHODS: Nationwide Readmission Database from 2010 to 14 utilized for HF-related hospitalization using appropriate ICD-9-CM diagnostic codes. 30-day readmissions were classified into two groups: same-hospital and different-hospital. A comparative analysis was conducted focusing on: in-hospital mortality, length of stay (LOS) and hospitalization cost. Hierarchical two-level modeling and propensity score matching utilized to adjust confounders. RESULTS: 715,993 HF readmissions were identified, of which 21.3% were readmitted to different-hospital. Elderly, females, patients with higher co-morbidities and higher median household income were less likely to be readmitted to different-hospital. Index hospitalizations in a teaching hospital and/or larger hospital were associated with reduced different-hospital readmissions. Readmissions to the different hospital were associated with higher in-hospital mortality (7.7% vs. 6.6%, p < 0.001), higher resource utilization (LOS:7.5 days vs. 6.1 days, p < 0.001 and Cost: $22,602 vs. $13,740, p < 0.001) after adjusting for propensity score match. Similar results were observed with propensity score matching of multiple high-risk subgroups. CONCLUSION: Resources should be directed towards minimizing different-hospital HF readmissions to improve patient outcomes by identifying the vulnerable subgroup and further tailoring in-hospital and post-discharge care.
BACKGROUND:Heart Failure (HF) is a major driver of the readmissions/penalties in the US. Although extensive literature on rehospitalization attributed to HF, studies to compare outcomes for same-hospital vs. different-hospital readmissions are sparse. METHODS: Nationwide Readmission Database from 2010 to 14 utilized for HF-related hospitalization using appropriate ICD-9-CM diagnostic codes. 30-day readmissions were classified into two groups: same-hospital and different-hospital. A comparative analysis was conducted focusing on: in-hospital mortality, length of stay (LOS) and hospitalization cost. Hierarchical two-level modeling and propensity score matching utilized to adjust confounders. RESULTS: 715,993 HF readmissions were identified, of which 21.3% were readmitted to different-hospital. Elderly, females, patients with higher co-morbidities and higher median household income were less likely to be readmitted to different-hospital. Index hospitalizations in a teaching hospital and/or larger hospital were associated with reduced different-hospital readmissions. Readmissions to the different hospital were associated with higher in-hospital mortality (7.7% vs. 6.6%, p < 0.001), higher resource utilization (LOS:7.5 days vs. 6.1 days, p < 0.001 and Cost: $22,602 vs. $13,740, p < 0.001) after adjusting for propensity score match. Similar results were observed with propensity score matching of multiple high-risk subgroups. CONCLUSION: Resources should be directed towards minimizing different-hospital HF readmissions to improve patient outcomes by identifying the vulnerable subgroup and further tailoring in-hospital and post-discharge care.
Authors: Wei Ning Chi; Courtney Reamer; Robert Gordon; Nitasha Sarswat; Charu Gupta; Emily White VanGompel; Julie Dayiantis; Melissa Morton-Jost; Urmila Ravichandran; Karen Larimer; David Victorson; John Erwin; Lakshmi Halasyamani; Anthony Solomonides; Rema Padman; Nirav S Shah Journal: Appl Clin Inform Date: 2021-12-29 Impact factor: 2.342
Authors: Michael Urbich; Gary Globe; Krystallia Pantiri; Marieke Heisen; Craig Bennison; Heidi S Wirtz; Gian Luca Di Tanna Journal: Pharmacoeconomics Date: 2020-11 Impact factor: 4.981