TY - JOUR
T1 - Heart failure
T2 - Same-hospital vs. different-hospital readmission outcomes
AU - Lahewala, Sopan
AU - Arora, Shilpkumar
AU - Tripathi, Byomesh
AU - Panaich, Sidakpal
AU - Kumar, Varun
AU - Patel, Nirali
AU - Savani, Sejal
AU - Dave, Mihir
AU - Varma, Yash
AU - Badheka, Apurva
AU - Deshmukh, Abhishek
AU - Gidwani, Umesh
AU - Gopalan, Radha
AU - Briasoulis, Alexandros
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - 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.
AB - 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.
KW - Cost
KW - Heart failure
KW - Length of stay
KW - Mortality
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=85058775520&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2018.12.043
DO - 10.1016/j.ijcard.2018.12.043
M3 - Article
C2 - 30579719
AN - SCOPUS:85058775520
SN - 0167-5273
VL - 278
SP - 186
EP - 191
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -