Risk of Readmission Among HIV Patients in Public Portuguese Hospitals: Longitudinal Multilevel Population-Based Study

Abstract

Background: Thirty-day hospital readmission is receiving growing attention as an indicator of the quality of hospital care. Understanding factors associated with 30-day hospital readmission among HIV patients in Portugal is essential given the high burden cost of HIV hospitalizations in Portugal, a country suffering from financial constrains for almost 10 years. Objectives: We aimed to estimate the 30-day hospital readmission rates among HIV patients in Portugal and to identify its determinants using population-based data for Portuguese public hospitals.

COVID-19: What Is Next for Portugal?

“…On the contrary, it will allow the health system to absorb an abrupt or unexpected increase in demand for medical resources, as in the case of COVID-19. As regards hospitals, hospitalizations or additional in-patient stays that consume a considerable amount of resources could be avoided with efficient treatment and management of chronic diseases, knowing that chronic diseases in Portugal consume a considerable amount of the health budget (29)(30)(31)(32)(33)(34). We pointed out, in previous contributions (30,34), possible approaches to reduce the costs of healthcare in Portugal through integrating quality measures of hospitals' performance, namely thirty-day readmission rate and length of stay (LOS).…”

“…On the contrary, it will allow the health system to absorb an abrupt or unexpected increase in demand for medical resources, as in the case of COVID-19. As regards hospitals, hospitalizations or additional in-patient stays that consume a considerable amount of resources could be avoided with efficient treatment and management of chronic diseases, knowing that chronic diseases in Portugal consume a considerable amount of the health budget ( 29 – 34 ).…”

“…We pointed out, in previous contributions ( 30 , 34 ), possible approaches to reduce the costs of healthcare in Portugal through integrating quality measures of hospitals' performance, namely thirty-day readmission rate and length of stay (LOS). Thirty-day hospital readmission is defined as an episode in which a patient is readmitted within 30 days from the last discharge.…”

“…These findings are especially worrisome when considering how the apparent aspects of health inequalities can aggravate the COVID-19 distribution in Portugal. It is important to mention that socioeconomic characteristics are important indicators for health inequalities in Portugal ( 34 , 56 , 57 ). Portugal has a high proportion of elderly population, which is among the most affected by COVID-19, with those aged 65 years or more accounting for almost 20% of the total population ( 58 ).…”

Statistical models for analyzing count data: predictors of length of stay among HIV patients in Portugal using a multilevel model

“…Additionally, ignoring the existence of within-hospital clustering, as in-patient level analysis with no hospital random effect terms generates serious technical problems [ 20 ]. Disregarding this clustering will lead to an increase in the number of independent observations at the hospital level, thus underestimating the standard errors of regression coefficients at the hospital’s level [ 20 , 25 , 26 ]. Therefore, the random-effects model is more relevant to analyze the impact of a set of predictors on LOS while controlling for variations in hospitilizations and hospital characteristics [ 25 – 27 ].…”