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Infections responsible for 28% of hospital readmissions
Infection-related hospital readmissions, including avoidable health care-associated infections, accounted for 28% of all-cause readmissions, according to recent findings.
Susan S. Huang, MD, MPH, division of infectious diseases at the University of California, Irvine School of Medicine, and colleagues examined 30-day, all-cause and infection-related readmission rates among adult patients admitted to 323 acute care hospitals in California from January 2009 through November 2011. Readmissions were classified as infection-related by identifying the subset of readmissions with infection codes as the primary or secondary diagnosis.
The California mandatory hospitalization dataset was used to compile information on patient demographics, admission and discharge dates and locations, insurance type, and multiple procedural and medical diagnostic codes. Using this, the researchers created a hierarchical generalized linear mixed model to predict all-cause and infection-related readmissions.
After analyzing 213,879,194 person-days of follow-up after discharge, the researchers found that 28% of all readmissions were attributable to infection. Hospitals with higher rates of all-cause readmission had higher percentages of patients who were male, not Caucasian, not commercially insured, had longer hospital stays, had prior residence at or discharge to a skilled nursing facility and lived in impoverished areas. Those hospitals also had higher comorbidity scores.
Higher all-cause readmission rates (OR = 1.24) and infection-related readmission rates (OR = 1.15) were seen in academic hospitals. When comparing adjusted and crude hospital rankings regarding infection-related readmission, the adjusted ranking showed that 12% of the hospitals were incorrectly classified as deviating from the norm, while 10.5% were misclassified as average.
According to the researchers, these data demonstrate a need for hospitals to make increased infection control efforts and to collaborate with skilled nursing facilities and insurance companies.
“Strategies to affect change in post-discharge health outcomes, including the risk for readmissions, necessitate consideration of both patient and community-level impacts on health,” the researchers wrote. “Fair benchmarking and allocation of hospital readmission reimbursement penalties should account for socioeconomic status factors such as neighborhood poverty and provide resources and investments to help hospitals meet the challenges such patients face in obtaining quality care.” – by Jen Byrne
Disclosure s : Gohil reports no relevant financial disclosures. Huang reports conducting a clinical trial for which participating hospitals are receiving contributed product from Sage Products and Molnlycke.