Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach.
Autor: May, Peter; Garrido, Melissa M.; Del Fabbro, Egidio; Noreika, Danielle; Normand, Charles; Skoro, Nevena; Cassel, J. Brian
Publication year: 2020
Medical care research and review : MCRR
issn:1552-6801 1077-5587
doi: 10.1177/1077558718823919
Abstract:
Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Eligible participants were adult inpatients admitted to an academic, safety-net medical center (2009-2015) with at least one diagnosis of cancer, heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure, AIDS/HIV, and selected neurodegenerative conditions. PC was associated with reduced 30-, 60-, and 90-day readmissions (subhazard ratios = 0.57, 0.53, and 0.52, respectively [all p < .001]). Hospital PC is associated with a reduction in readmissions, and this is not explained by higher mortality among PC patients. Performance measures only counting those alive at a given end point may underestimate systematically the effects of treatments with a high-mortality rate. Language: eng Rights: Pmid: 30658539 Tags: Humans; Retrospective Studies; Patient Discharge; *Patient Readmission; palliative care; mortality; Aftercare; Heart Failure; hospital readmissions; retrospective studies Link: https://pubmed.ncbi.nlm.nih.gov/30658539/
