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Thirty-day hospital readmission rate among adults living with HIV
Stephen A Berry1, John A Fleishman, Baligh R Yehia
1aJohns Hopkins University, Baltimore bAgency for Healthcare Research and Quality, Rockville, Maryland cUniversity of Pennsylvania, Philadelphia, Pennsylvania dOregon Health and Science University, Portland, Oregon, USA.
Objective:
Thirty-day hospital readmission rate is receiving increasing attention as a quality-of-care indicator. The objective of this study was to determine readmission rates and to identify factors associated with readmission among persons living with HIV.
Design:
Prospective multicenter observational cohort.
Setting:
Nine US HIV clinics affiliated through the HIV Research Network.
Participants:
Patients engaged in HIV care during 2005-2010.
Main Outcome Measure(S):
Readmission rate was defined as the proportion of hospitalizations followed by a readmission within 30 days. Factors in multivariate analyses included diagnostic categories, patient demographic and clinical characteristics, and having an outpatient follow-up visit.
Results:
Among 11,651 total index hospitalizations, the 30-day readmission rate was 19.3%. AIDS-defining illnesses (ADIs, 9.6% of index hospitalizations) and non-AIDS-defining infections (26.4% of index hospitalizations) had readmission rates of 26.2 and 16.6%, respectively. Factors independently associated with readmission included lower CD4 cell count [adjusted odds ratio 1.80 (1.53-2.11) for CD4 cell count <50 vs. ≥351 cells/μl], longer length of stay [1.77 (1.53-2.04) for ≥9 days vs. 1-3 days], and several diagnostic categories including ADI. Having an outpatient follow-up clinic visit was not associated with lower readmission risk [adjusted hazard ratio 0.98 (0.88-1.08)].
Conclusion:
The 19.3% readmission rate exceeds the 13.3% rate reported for the general population of 18-64-year-olds. HIV providers may use the 19.3% rate as a basis of comparison. Policymakers may consider the impact of HIV when estimating expected readmissions for a hospital or region. Preventing or recovering from severe immune dysfunction may be the most important factor to reducing readmissions.
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