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Thirty-day unplanned readmission in hospitalised asthma patients in the USA
  1. Neel Patel1,
  2. Sandeep Singh2,
  3. Rupak Desai3,
  4. Aakash Desai4,
  5. Mohammed Nabeel5,
  6. Neil Parikh6,
  7. Gagandeep Singh7,
  8. Smit Patel8,
  9. Radhika Parikh9,
  10. Supriya Mahajan10
  1. 1Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
  3. 3Department of Cardiology, Atlanta VA Health Care System, Decatur, Georgia, USA
  4. 4Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
  5. 5Department of Critical Care Medicine, University of Maryland Medical System, Baltimore, Maryland, USA
  6. 6Department of Medicine, University at Buffalo, Buffalo, New York, USA
  7. 7Department of Medicine, Saint Francis Hospital, Tulsa, Oklahoma, USA
  8. 8Department of Internal Medicine, UCONN Health, Farmington, Connecticut, USA
  9. 9Department of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, Vermont, USA
  10. 10Department of Allergy and Immunology, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Supriya Mahajan, Department of Allergy and Immunology, University at Buffalo, Buffalo, NY 14260, USA; smahajan{at}buffalo.edu

Abstract

Introduction Hospital quality improvement and hospital performance are commonly evaluated using parameters such as average length of stay (LOS), patient safety measures and rates of hospital readmission. Thirty-day readmission (30-DR) rates are widely used as a quality indicator and a quantifiable metric for hospitals since patients are often readmitted for the exacerbation of conditions from index admission. The quality of patient education and postdischarge care can influence readmission rates. We report the 30-DR rates of patients with asthma using a national dataset for the year 2013.

Objectives The aim of our study was to assess the 30- day readmission (30-DR) rate as well as, the causes and predictors of readmissions.

Study designs/methods Using the Nationwide Readmission Database (NRD) (2013), we identified primary discharge diagnoses of asthma by using International Classification of Diseases, Ninth Revision, Clinical Modification code ‘493’. Categorical and continuous variables were assessed by a χ2 test and a Student’s t-test, respectively. The independent predictors of unplanned 30-DR were detected by multivariate analysis. We used sampling weights, which are provided in the NRD, to generate the national estimates.

Results There were 130 490 (weighted N=311 173) inpatient asthma admissions during 2013. The overall 30-DR for asthma was 11.9%. The associated factors for 30-DR were age 45–84 years (40.32% vs 29.05%; p<0.001), enrolment in Medicare (49.33% vs 30.61% p<0.001), extended LOS (mean, 4.40±0.06 vs 3.25±0.04 days; p<0.001), higher mean cost (US$8593.91 vs US$6741.31; p<0.001) and higher disposition against medical advice (DAMA) (4.14% vs 1.51%; p<0.001). The factors that increased the chance of 30-DR were advanced age (≥45–64 vs ≤17 years; OR 4.61, 95% CI 4.04 to 5.27, p<0.0001), male sex (OR 1.19, 95% CI 1.13 to 1.26, p<0.0001), a higher Charlson Comorbidity Index (CCI) (OR 1.16, 95% CI 1.14 to 1.18, p<0.0001), DAMA (OR 2.32, 95% CI 2.08 to 2.59, p<0.0001), non-compliance with medication (OR 1.34, 95% CI 1.24 to 1.46, p<0.0001), post-traumatic stress disorder (OR 1.48, 95% CI 1.22 to 1.79, p<0.0001), alcohol use (OR 1.45, 95% CI 1.27 to 1.65, p<0.0001), gastro-oesophageal reflux disease (OR 1.20, 95% CI 1.14 to 1.27, p<0.0001), obstructive sleep apnoea (OR 1.11, 95% CI 1.03 to 1.18, p<0.0042) and hypertension (OR 1.11, 95% CI 1.06 to 1.17, p<0.0001).

Conclusions We found that the overall 30-DR rate for asthma was 11.9% all-cause readmission. Major causes of 30-DR were asthma exacerbation (36.74%), chronic obstructive pulmonary disease (11.47%), respiratory failure (6.46%), non-specific pneumonia (6.19%), septicaemia (3.61%) and congestive heart failure (3.32%). One-fourth of the revisits occurred in the first week, while half of the revisits took place in the first 2 weeks. Education regarding illness and the importance of medicine compliance could play a significant role in preventing asthma-related readmission.

  • asthma
  • allergy
  • general medicine
  • respiratory medicine
  • chronic airways disease

Data availability statement

Data are available in a public, open access repository. Nationwide Readmissions Database (NRD) is a set of unidentified inpatient participants databases in the HCUP (Healthcare cost and utilisation project) family designed for readmission analyses. AHRQ creates these HCUP databases through a Federal-State-Industry partnership.

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Data availability statement

Data are available in a public, open access repository. Nationwide Readmissions Database (NRD) is a set of unidentified inpatient participants databases in the HCUP (Healthcare cost and utilisation project) family designed for readmission analyses. AHRQ creates these HCUP databases through a Federal-State-Industry partnership.

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Footnotes

  • Twitter @neel4ahm

  • Contributors NP and SM had full access to all of the study data and took responsibility for the integrity and accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis and interpretation of data: all authors. Drafting of the manuscript: all authors. Critical revision of the manuscript for valuable intellectual content: all authors. Statistical analysis: SP. Administrative, technical or material support: all authors; Study supervision: SM and RP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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