Sreenivas P. Veeranki|Kanika Sharma|Michael U. Ohabughiro|Hemalkumar B. Mehta|Deepak Adhikari|Yong Fang Kuo|William J. Calhoun
30-Day Readmissions in Hospitalized Adults With Asthma Exacerbations
The University of Texas Medical Branch at Galveston|Louisiana State University Health Sciences Center Shreveport|The University of Texas Medical Branch at Galveston|The University of Texas Medical Branch at Galveston|The University of Texas Medical Branch at Galveston|The University of Texas Medical Branch at Galveston|The University of Texas Medical Branch at Galveston
using state inpatient databases california florida nebraska hasegawa et al1hasegawa k gibo k tsugawa et alagerelated differences rate timing diagnosis 30day readmissions hospitalized adults asthma exacerbationchest 2016 149 10211029abstract full text full text pdf pubmed scopus 35 google scholar april 2016 investigated 30day anycause readmissions adults across stratified age groups although commend authors meticulous efforts analysis based limited states several years 20052011 may contribute potential bias relating generalizability addition data used analysis current address issues conducted similar analysis based authors work using 2013 national readmission database2hcup nationwide readmission database nrd healthcare cost utilization project hcup 2013 agency healthcare research quality rockville md httpswwwhcupusahrqgovnrdoverviewjsp accessed september 22 2016google scholar unique cohort offers data cumulative 21 state inpatient databases include 14 million discharges accounting 491 hospitalizations united states 153892 adult patients registered index hospitalization asthma exacerbation 142 noted 30day anycause readmission compared without readmissions patients relatively older mean age 645 vs 606 years p 001 largely funded via public insurance medicare 65 vs 53 p 001 medicaid 17 vs 16 p 002 higher number comorbidities mean 70 vs 44 p 001 longer length stay mean 66 vs 50 days p 001 table 1 multivariable regression model fitted generalized estimating equation3panageas ks schrag riedel e et althe effect clustering outcomes association procedure volume surgical outcomesann intern med 2003 139 658665crossref pubmed scopus 276 google scholar limit clustering similar outcomes within hospitals showed elderly 130 95 ci 122140 p 001 middleaged 145 95 ci 136154 p 001 patients higher likelihood readmission younger age groups findings similar reported hasegawa et al1hasegawa k gibo k tsugawa et alagerelated differences rate timing diagnosis 30day readmissions hospitalized adults asthma exacerbationchest 2016 149 10211029abstract full text full text pdf pubmed scopus 35 google scholar albeit lower point estimates fig 1a sensitivity analysis modelbased multiple imputation approach missing values several covariates yielded similar results however unlike study found differences daily percentages readmissions three defined age groups highest rate readmissions adults 2 3 days postdischarge fig 1b overall findings consistent part reported hasegawa et al1hasegawa k gibo k tsugawa et alagerelated differences rate timing diagnosis 30day readmissions hospitalized adults asthma exacerbationchest 2016 149 10211029abstract full text full text pdf pubmed scopus 35 google scholartable 1characteristics patients registered national readmission database 2013 index hospitalization asthma exacerbation based 30day anycause readmissioncharacteristicno readmission n 132105readmissions n 21787overall n 153892p valueage mean age sd6060 17346446 15636115 1716 001 young adults 183916785 1271501 6918286 119 001 middle aged 406457791 4378978 41266769 434 001 elderly 6557529 43511308 51968837 447 001female sex 46456 3528584 39455040 358 001primary payer afrequencies proportions reported excluding patients missing values income 158 payer 012 discharge disposition 010 los 002 medicare69221 52514044 64583265 542 001 medicaid21216 1613680 16924896 162002 private24928 1892470 11327398 178 001 selfpay10390 79888 4111278 73 001 others6182 47696 366878 45 001income quartiles based median household income afrequencies proportions reported excluding patients missing values income 158 payer 012 discharge disposition 010 los 002 144293 3417545 35151838 342003 234455 2655686 26540141 265875 329375 2264811 22434186 226487 421842 1683447 16025289 167005utilization emergency services 117146 88719499 895136645 888 001weekend admission 34381 2605722 26340103 261459mean los median dafrequencies proportions reported excluding patients missing values income 158 payer 012 discharge disposition 010 los 002501 4657 5523 4 001breported p values derived nonparametric mannwhitney u test graphic ie histograms qq plots stemandleaf plots numeric ie shapirowilk test assessments confirming nongaussian distribution covariatesmean median procedures125 0172 1131 0 001breported p values derived nonparametric mannwhitney u test graphic ie histograms qq plots stemandleaf plots numeric ie shapirowilk test assessments confirming nongaussian distribution covariateselixhauser comorbidity score mean median438 6695 6474 3 001breported p values derived nonparametric mannwhitney u test graphic ie histograms qq plots stemandleaf plots numeric ie shapirowilk test assessments confirming nongaussian distribution covariates low 0236783 2783782 17440565 264 001 moderatehigh 395322 72218005 826113327 736 001bed size small15487 1172393 11017880 116002 medium36355 2755902 27142257 275187 large80263 60813492 61993755 609001teaching status rural13755 1042044 9415799 103 001 urban nonteaching61829 46810298 47372127 469204 urban teaching56521 4289445 43465966 429117hospital controlownership government nonfederal public17279 1312734 12520013 130031 private notforprofit89373 67714733 676104106 676930 private investorowned25453 1934320 19829773 193052hospital volumeccomputed based median cutoff value 50 index admissions facility 2013 asthma exacerbation low 50 cases13583 1031970 9015553 101 001 high 50 cases118522 89719817 910138339 899 001discharge dispositionafrequencies proportions reported excluding patients missing values income 158 payer 012 discharge disposition 010 los 002 routine home home health care112392 85216886 775129278 841 001 unfavorable skilled facilities19568 1484983 22524461 159 001values boldface statistically significant determined 005 los length staya frequencies proportions reported excluding patients missing values income 158 payer 012 discharge disposition 010 los 002b reported p values derived nonparametric mannwhitney u test graphic ie histograms qq plots stemandleaf plots numeric ie shapirowilk test assessments confirming nongaussian distribution covariatesc computed based median cutoff value 50 index admissions facility 2013 asthma exacerbation open table new tab values boldface statistically significant determined 005 los length stay beginning october 1 2012 section 3025 patient protection affordable care act 1886q established readmissions reduction program required centers medicare medicaid services reduce payments hospitals excess readmissions4center medicare medicaid services readmissions reduction program 2016 httpswwwcmsgovmedicaremedicarefeeforservicepaymentacuteinpatientppsreadmissionsreductionprogramhtml accessed september 16 2016google scholar therefore 30day readmissions focus national improvement efforts advancing age identified independent predictor readmission hospitalized patients asthma possibly due higher comorbid conditions5gibson pg mcdonald vm marks gb asthma older adultslancet 2010 376 803813abstract full text 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pdf pubmed scopus 35 google scholar propose development strategies aimed reducing readmissions among hospitalized patients asthma agerelated differences rate timing diagnosis 30day readmissions hospitalized adults asthma exacerbationchestvol 149issue 4previewreducing hospital readmissions attracted attention many stakeholders however characteristics 30day readmissions asthmarelated hospital admissions adults known also unclear whether older adults higher risk 30day readmission fulltext pdf responsechestvol 150issue 5previewwe agree veeranki colleagues analysis several healthcare cost utilization project state inpatient databases 2005 2011 could yielded results generalize well entire us population1 conversely three analyzed states california florida nebraska raciallyethnically diverse geographically dispersed together represent approximately 20 us population2 pleased learn main findingthat older adults hospitalized asthma exacerbations higher risk 30day readmission compared younger adultshas replicated analysis 2013 healthcare cost utilization project national readmission database nrd fulltext pdf