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Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the
Harshil Shah1, Uvesh Mansuri2, Sukrut Pagad3
1Internal Medicine, Independent Researcher, Sayre, USA.
Insights
The 30-day readmission rate for Acute Respiratory Distress Syndrome (ARDS) patients in the US is 18%. Key predictors for readmission include insurance status, socioeconomic factors, and hospital type.
Area of Science:
- Pulmonology
- Healthcare Quality Improvement
- Health Services Research
Background:
- 30-day readmission rates are a key quality metric for Centers for Medicare and Medicaid Services (CMS).
- Acute Respiratory Distress Syndrome (ARDS) significantly contributes to morbidity and mortality in the US.
- Understanding ARDS patient readmission predictors is crucial for improving care.
Purpose of the Study:
- To determine 30-day readmission rates in US ARDS patients.
- To identify characteristics and predictors associated with 30-day readmissions for ARDS.
- To utilize the largest available nationwide database for comprehensive analysis.
Main Methods:
- Extracted ARDS patients from the National Readmission Database (2013) using ICD-9-CM codes.
- Calculated all-cause unplanned 30-day readmission rates for January-November 2013 admissions.
- Employed survey logistic regression to identify independent predictors of readmission.
Main Results:
- The all-cause unplanned 30-day readmission rate for ARDS patients was 18%.
- Patients readmitted within 30 days had a higher burden of comorbidities (Charlson Comorbidity Index ≥1).
- Significant predictors of readmission included self-pay/no charge/other insurance, higher income class, private insurance, and teaching metropolitan hospitals.
Conclusions:
- Unplanned 30-day readmission rates are notably high for ARDS patients in the US.
- Modifiable factors like insurance type, socioeconomic status, and hospital characteristics influence ARDS readmissions.
- These findings highlight opportunities for targeted interventions to reduce readmission rates.
Abstract:
Background The 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study. Objective The aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database. Methods We used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression. Results After excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; p = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; p = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; p = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; p = 0.01). Conclusion The unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients.
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