Risk Factors for Unplanned Readmissions in Older Adult Trauma Patients in Washington State: A Competing Risk Analysis

被引:34
作者
Fawcett, Vanessa J. [1 ,2 ]
Flynn-O'Brien, Katherine T. [1 ,2 ]
Shorter, Zeynep [5 ]
Davidson, Giana H. [2 ]
Bulger, Eileen [1 ,2 ]
Rivara, Frederick P. [1 ,2 ,3 ,4 ]
Arbabi, Saman [1 ,2 ]
机构
[1] Harborview Injury Prevent & Res Ctr, Seattle, WA 98104 USA
[2] Univ Washington, Harborview Med Ctr, Dept Surg, Seattle, WA 98195 USA
[3] Univ Washington, Harborview Med Ctr, Dept Pediat, Seattle, WA 98195 USA
[4] Univ Washington, Harborview Med Ctr, Dept Epidemiol, Seattle, WA 98195 USA
[5] Washington State Dept Hlth, Seattle, WA USA
关键词
HOSPITAL READMISSION; MULTIPLE IMPUTATION; BRAIN-INJURY; MORTALITY; OUTCOMES; 30-DAY; RATES; CARE; EPIDEMIOLOGY; SURVIVAL;
D O I
10.1016/j.jamcollsurg.2014.11.012
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Hospital readmission is a significant contributor to increasing health care use related to caring for older trauma patients. This study was undertaken with the following aims: determine the proportion of older adult trauma patients who experience unplanned readmission, as well as risk factors for these readmissions and identify the most common readmission diagnoses among these patients. STUDY DESIGN: We conducted a retrospective cohort study of trauma patients age 55 years and older who survived their hospitalization at a statewide trauma center between 2009 and 2010. Linking 3 statewide databases, nonelective readmission rates were calculated for 30 days, 6 months, and 1 year after index discharge. Competing risk regression was used to determine risk factors for readmission and account for the competing risk of dying without first being readmitted. Subhazard ratios (SHR) are reported, indicating the relative risk of readmission by 30 days, 6 months, and 1 year. RESULTS: The cumulative readmission rates for the 14,536 participants were 7.9%, 18.9%, and 25.2% at 30 days, 6 months, and 1 year, respectively. In multivariable models, the strongest risk factors for readmission at 1 year (based on magnitude of SHR) were severe head injury (adjusted SHR = 1.47; 95% CI, 1.24-1.73) and disposition to a skilled nursing facility (SHR = 1.54; 95% CI, 1.39-1.71). The diagnoses most commonly associated with readmission were atrial fibrillation, anemia, and congestive heart failure. CONCLUSIONS: In this statewide study, unplanned readmissions after older adult trauma occurred frequently up to 1 year after discharge, particularly for patients who sustained severe head trauma and who could not be discharged home independently. Examining common readmission diagnoses might inform the development of interventions to prevent unplanned readmissions. (C) 2015 by the American College of Surgeons
引用
收藏
页码:330 / 338
页数:9
相关论文
共 38 条
  • [1] [Anonymous], READM RED PROGR
  • [2] [Anonymous], State and County QuickFacts
  • [3] The association between the quality of inpatient care and early readmission - A meta-analysis of the evidence
    Ashton, CM
    DelJunco, DJ
    Souchek, J
    Wray, NP
    Mansyur, CL
    [J]. MEDICAL CARE, 1997, 35 (10) : 1044 - 1059
  • [4] Long-term outcomes of ground-level falls in the elderly
    Ayoung-Chee, Patricia
    McIntyre, Lisa
    Ebel, Beth E.
    Mack, Christopher D.
    McCormick, Wayne
    Maier, Ronald V.
    [J]. JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2014, 76 (02) : 498 - 503
  • [5] Outcomes and Health Care Resource Utilization in Super-Elderly Trauma Patients
    Bennett, Kyla M.
    Scarborough, John E.
    Vaslef, Steven
    [J]. JOURNAL OF SURGICAL RESEARCH, 2010, 163 (01) : 127 - 131
  • [6] Trauma in the Older Adult Epidemiology and Evolving Geriatric Trauma Principles
    Bonne, Stephanie
    Schuerer, Douglas J. E.
    [J]. CLINICS IN GERIATRIC MEDICINE, 2013, 29 (01) : 137 - +
  • [7] Cost Burden of 30-Day Readmissions Following Medicare Total Hip and Knee Arthroplasty
    Bosco, Joseph A., III
    Karkenny, Alexa J.
    Hutzler, Lorraine H.
    Slover, James D.
    Iorio, Richard
    [J]. JOURNAL OF ARTHROPLASTY, 2014, 29 (05) : 903 - 905
  • [8] Moving Beyond Traditional Measurement of Mortality after Injury: Evaluation of Risks for Late Death
    Claridge, Jeffrey A.
    Leukhardt, William H.
    Golob, Joseph F.
    McCoy, Andrew M.
    Malangoni, Mark A.
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2010, 210 (05) : 788 - 794
  • [9] Long-term Survival of Adult Trauma Patients
    Davidson, Giana H.
    Hamlat, Christian A.
    Rivara, Frederick P.
    Koepsell, Thomas D.
    Jurkovich, Gregory J.
    Arbabi, Saman
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 305 (10): : 1001 - 1007
  • [10] Comanagement of Geriatric Patients With Hip Fractures: A Retrospective, Controlled, Cohort Study
    Della Rocca, Gregory J.
    Moylan, Kyle C.
    Crist, Brett D.
    Volgas, David A.
    Stannard, James P.
    Mehr, David R.
    [J]. GERIATRIC ORTHOPAEDIC SURGERY & REHABILITATION, 2013, 4 (01) : 10 - 15