TY - JOUR
T1 - Risk of readmission for injury in patients with epilepsy in the United States – A population-based study
AU - Kwon, Churl Su
AU - Agrawal, Parul
AU - Goldstein, Jonathan
AU - Dhamoon, Mandip
AU - Mazumdar, Madhu
AU - Jetté, Nathalie
N1 - Funding Information:
We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database (NRD) for the year 2014 that is sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NRD contains information of approximately 17 million hospital discharges across 22 geographically dispersed states in the US. The database accounts for almost half of the total US population and hospital admissions. It excludes hospital admissions of rehabilitation and long-term hospitals. The longitudinal feature of the database allows conducting studies related to readmissions. One of the major strength of the database is that it includes information of all payers and of uninsured. When discharge weights are used in the analysis of the NRD, the results are generalizable nationally. Discharge weights are provided to the researchers along with the database and are calculated by dividing the number of hospital discharges nationally by the number of hospital discharges in the sampling frame. The sampling frame includes discharges in community hospitals that were poststratified by patient (gender, age) and hospital (census region, urban/rural location, teaching status, size of the hospital defined by the number of beds, and hospital control) characteristics [ 13 ]. The NRD allows analysis of readmissions with the use of an anonymized, verified linkage identifier for each patient. The study was approved by the Mount Sinai program for the protection of human subjects under IRB-IF2356842 and all analyses comply with the HCUP data use agreement. 2.3
Funding Information:
Churl-Su Kwon, Parul Agarwal, Jonathan Goldstein, Mandip Dhamoon, and Madhu Mazumdar report no disclosures. N. Jette receives grant funding paid to her institution for grants unrelated to this work from NINDS (NIH U24NS107201, NIH IU54NS100064), PCORI, and Alberta Health. She also receives an honorarium for her work as an associate editor of Epilepsia. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/1
Y1 - 2020/1
N2 - Objective: The objective of this study was to determine the 30-day injury readmission risk among persons with epilepsy vs. without epilepsy using a nationally representative US database. Secondary objectives were to examine the factors associated with injury-related readmissions among those with epilepsy and identify specific causes of readmissions within 30 days of index admission. Methods: Hospitalized individuals of all ages with epilepsy as the primary diagnosis were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in the 2014 Nationwide Readmission Database (NRD). Primary outcome was 30-day readmission for an injury defined by ICD-9-CM diagnosis codes following discharge from index hospitalization. Subgroup differences in the groups with epilepsy and without epilepsy were estimated using standardized mean difference scores that are calculated with means and variances of the covariates. Multinomial logistic regressions were conducted to determine the 30-day injury readmission risk and examine the factors associated with injury-related readmissions. Results: There were 60,074 unique persons with epilepsy (mean age: 42.53 years, female: 49.32%) and 9,282,952 without epilepsy (mean age: 44.46 years, female: 59.43%). A higher proportion of persons with epilepsy (n = 215, 0.34%) vs. without epilepsy (n = 22,783, 0.22%) had a 30-day readmission due to an injury. After adjusting for covariates, persons with epilepsy had higher odds of 30-day readmission due to an injury (adjusted OR: 1.40, 95% CI: 1.20–1.62, p < 0.0001). Factors associated with an injury-related readmission in persons with epilepsy include the following: increasing age (OR: 1.01, 95% CI: 1.00–1.02, p = 0.02), transfer to short term hospital/other facility (OR: 1.50, 95% CI: 1.00–2.27, p = 0.05), discharged against medical advice/discharge destination unknown (OR: 2.26, 95% CI: 1.40–4.45, p = 0.02), and higher Elixhauser comorbidity index (OR: 1.02, 95% CI: 1.01–1.03, p < 0.0001). Conclusions: Higher odds of 30-day injury readmissions were observed in persons with epilepsy vs. without epilepsy. Optimizing the management of comorbid conditions during the patient's index admission for epilepsy, minimizing discharges against medical advice, and fostering outreach programs to those who have been transferred to short-term hospitals or facilities may reduce 30-day readmissions due to an injury.
AB - Objective: The objective of this study was to determine the 30-day injury readmission risk among persons with epilepsy vs. without epilepsy using a nationally representative US database. Secondary objectives were to examine the factors associated with injury-related readmissions among those with epilepsy and identify specific causes of readmissions within 30 days of index admission. Methods: Hospitalized individuals of all ages with epilepsy as the primary diagnosis were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in the 2014 Nationwide Readmission Database (NRD). Primary outcome was 30-day readmission for an injury defined by ICD-9-CM diagnosis codes following discharge from index hospitalization. Subgroup differences in the groups with epilepsy and without epilepsy were estimated using standardized mean difference scores that are calculated with means and variances of the covariates. Multinomial logistic regressions were conducted to determine the 30-day injury readmission risk and examine the factors associated with injury-related readmissions. Results: There were 60,074 unique persons with epilepsy (mean age: 42.53 years, female: 49.32%) and 9,282,952 without epilepsy (mean age: 44.46 years, female: 59.43%). A higher proportion of persons with epilepsy (n = 215, 0.34%) vs. without epilepsy (n = 22,783, 0.22%) had a 30-day readmission due to an injury. After adjusting for covariates, persons with epilepsy had higher odds of 30-day readmission due to an injury (adjusted OR: 1.40, 95% CI: 1.20–1.62, p < 0.0001). Factors associated with an injury-related readmission in persons with epilepsy include the following: increasing age (OR: 1.01, 95% CI: 1.00–1.02, p = 0.02), transfer to short term hospital/other facility (OR: 1.50, 95% CI: 1.00–2.27, p = 0.05), discharged against medical advice/discharge destination unknown (OR: 2.26, 95% CI: 1.40–4.45, p = 0.02), and higher Elixhauser comorbidity index (OR: 1.02, 95% CI: 1.01–1.03, p < 0.0001). Conclusions: Higher odds of 30-day injury readmissions were observed in persons with epilepsy vs. without epilepsy. Optimizing the management of comorbid conditions during the patient's index admission for epilepsy, minimizing discharges against medical advice, and fostering outreach programs to those who have been transferred to short-term hospitals or facilities may reduce 30-day readmissions due to an injury.
KW - Epilepsy
KW - Injury
KW - National readmission database
KW - Population-based
UR - http://www.scopus.com/inward/record.url?scp=85075414695&partnerID=8YFLogxK
U2 - 10.1016/j.yebeh.2019.106651
DO - 10.1016/j.yebeh.2019.106651
M3 - Article
C2 - 31778877
AN - SCOPUS:85075414695
SN - 1525-5050
VL - 102
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 106651
ER -