Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention

Khawaja, Farhan J.; Shah, Nilay D.; Lennon, Ryan J.; Slusser, Joshua P.; Al-Katib, Ayad; Rihal, Charanjit S.; Gersh, Bernard J.; Montori, Víctor M.; Holmes, David R.; Bell, Malcolm R.; Curtis, Jeptha P.; Krumholz, Harlan M.; Ting, Henry H.

doi:10.1001/archinternmed.2011.569

Cited by 105 publications

(99 citation statements)

References 16 publications

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“…9 Two recent analyses, the first among residents of New York State and the second among patients at a single center in Minnesota, also described high rates of 30-day readmission after PCI and identified a number of important predictors of readmission. 21,22 These included female sex, lung disease, renal failure, and long length of stay, among other factors, similar to what was found in multivariable analysis in our population. However, whether variation in hospital crude short-term readmission rates after PCI was due to differences in patient case mix or hospital quality has not been previously examined.…”

Section: Discussionsupporting

confidence: 79%

Sources of Hospital Variation in Short-Term Readmission Rates After Percutaneous Coronary Intervention

Yeh

Rosenfield

Zelevinsky

et al. 2012

Circ: Cardiovascular Interventions

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Background-Risk-standardized all-cause 30-day readmission rates (RSRRs) after percutaneous coronary intervention (PCI) have been endorsed as a national measure of hospital quality. Little is known about variation in the performance of hospitals on this measure, and whether high hospital rates of readmission after PCI are due to modifiable deficiencies in quality of care has not been assessed. Methods and Results-We estimated 30-day, all-cause RSRRs for all nonfederal PCI-performing hospitals in Massachusetts, adjusted for clinical and angiographic variables, between 2005 and 2008. We assessed if differences in race, insurance type, and PCI and post-PCI characteristics, including procedural complications and discharge characteristics, could explain variation between hospitals using nested hierarchical logistic regression models. Of 36 060 patients undergoing PCI at 24 hospitals and surviving to discharge, 4469 (12.4%) were readmitted within 30 days of discharge. Hospital RSRRs ranged from 9.5% to 17.9%, with 8 of 24 hospitals being identified as outliers (4 lower than expected and 4 higher than expected). Differences in race, insurance, PCI, and post-PCI factors accounted for 10.4% of the between-hospital variance in RSRRs. Conclusions-We observed wide variation in hospital 30-day all-cause RSRRs after PCI, most of which could not be explained by identifiable differences in procedural and postprocedural factors. A better understanding of etiologies of hospital variation is necessary to determine whether this measure is an actionable assessment of hospital quality, and, if so, how hospitals might improve their performance. (Circ Cardiovasc Interv. 2012;5:227-236.)

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Section: Discussionsupporting

confidence: 79%

Sources of Hospital Variation in Short-Term Readmission Rates After Percutaneous Coronary Intervention

Yeh

Rosenfield

Zelevinsky

et al. 2012

Circ: Cardiovascular Interventions

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“…Thresholds of Ն10 discharge medications, Ͼ3-day hospital stay, and one or more prior hospitalizations were chosen after reviewing the distributions as shown in Figure 2 and consulting published literature using similar cutoff values. 1,17,23,24,29 This was done to enable the computation of an easily interpretable odds ratio for all independent variables. We kept prior hospitalizations and age as primary independent variables because of our hypothesis.…”

Section: Resultsmentioning

confidence: 99%

“…Many disease-specific models fail to account for the multiple comorbidity often witnessed in hospitalized general medical patients. [13][14][15][16][17][18][19][20][21] It is fortunate that increased hospitalization and lengthy hospital stays are useful proxies for disease severity and multiple comorbidities, which are more difficult to quantify.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies looking at hospital readmissions are disease specific. [13][14][15][16][17][18][19][20][21] There are relatively few studies examining the risk factors for readmission among all primary care patients, and many of these were performed outside the United States or in hospitalist practices. 10,[22][23][24][25] It is well known that a small proportion of patients account for a disproportionate number of hospital admissions and health care costs.…”

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confidence: 99%

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Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

Garrison

Mansukhani

Bohn

2013

The Journal of the American Board of Family Medicine

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Purpose: Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days.Methods: A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor.Results: Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect.Conclusions: This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission. (J Am Board Fam Med 2013;26:71-77.)

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“…This is particularly applicable with radial access (or post-procedural deployment of a femoral closure device), and, in a US registry study, 1339 patients discharged on the same day as their procedure had similar 30-day readmission rates to 105 679 patients who stayed overnight (14). This is important because it is now recognised that readmission within 30 days after PCI is associated with a significant increase in 1-year mortality (15).…”

Section: Pci Versus Coronary Bypass Surgerymentioning

confidence: 98%

Almanac 2012: interventional cardiology

Meier¹

2012

Anadolu Kardiyol Derg

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Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention

Cited by 105 publications

References 16 publications

Sources of Hospital Variation in Short-Term Readmission Rates After Percutaneous Coronary Intervention

Sources of Hospital Variation in Short-Term Readmission Rates After Percutaneous Coronary Intervention

Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

Almanac 2012: interventional cardiology

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