Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study

Abstract

Background Cardiovascular disease (CVD) is the leading cause of hospitalization in older adults and high readmission rates have attracted considerable attention as actionable targets to promote efficiency in care and to reduce costs. Despite a plethora of research over the past decade, current strategies to predict readmissions have been largely ineffective and efforts to identify novel clinical predictors have been largely unsuccessful. Objective The objective of this study is to examine a wide array of socioeconomic, psychosocial, behavioral, and clinical factors to predict risks of 30-day hospital readmission in cardiovascular patients. Methods The study includes patients (aged 18 years and older) admitted for the treatment of cardiovascular-related illnesses at the Duke Heart Center, which is among the nation’s largest and top-ranked cardiovascular care hospitals. The study uses a novel standardized survey to ascertain data on a comprehensive array of patient characteristics that will be linked to their electronic medical records. A series of univariate and multivariate models will be used to estimate the associations between the patient-level factors and 30-day readmissions. The performance of the risk models will be examined based on 2 components of accuracy—model calibration and discrimination—to determine how closely the predicted outcome agrees with the observed (actual) outcome and how well the model distinguishes patients who were readmitted and those who were not. The purpose of this paper is to present the protocol for the implementation of this study. Results The study was launched in February 2014 and is actively recruiting patients from the Heart Center. Approximately 550 patients have been enrolled to date and the study is expected to continue recruitment until February 2018. Preliminary results show that participants in the study were aged 63.6 years on average (SD 14.0), predominately male (61.2%), and primarily non-Hispanic white (64.6%) or non-Hispanic black (31.7%). The demographic characteristics of study participants were not significantly different from all patients admitted to the Heart Center during this period with an average age of 65.0 years (SD 15.3) and predominately male (58.6%), non-Hispanic white (62.9%) or non-Hispanic black (31.8%) The integration of the interview data with clinical data from the patient electronic medical records is currently underway. The study has received funding and ethical approval. Conclusions Many US hospitals continue to struggle with high readmission rates in patients with cardiovascular disease. The primary objective of this study is to collect and integrate a comprehensive array of patient attributes to develop a powerful yet parsimonious model to stratify risks of rehospitalization in cardiovascular patients. The results of this research also have the potential to identify actionable targets for tailored intervention...

Access to routine care and risks for 30-day readmission in patients with cardiovascular disease

“…Prior research compared patients enrolled in the study with all eligible patients at Duke Heart Center and showed that the two patient groups had similar demographic and clinical profiles. 27 No compensation was provided to patients who participated in the study. Further details on subject selection, recruitment, and survey administration have been documented elsewhere.…”

“…Further details on subject selection, recruitment, and survey administration have been documented elsewhere. 27…”

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

“…Details on subject selection, recruitment and survey administration have been documented elsewhere. 19 The final sample for this study included 520 patients for analysis. All subjects provided informed written consent to participate in the study, and the study was approved by the Institutional Review Board at Duke University Medical Center.…”

Hierarchical analysis of factors associated with hospital readmissions for coronary heart disease: A case–control study

“…Other variables, although representing healthcare indicators that may be present in any system, are nonclinical factors, which are little explored in the models available to predict risk for hospital readmission. Thus, there is still little known of the influence that life habits and the support of the health system exert on this occurrence (Dupre et al, 2017).…”