The Association between Interhospital Care Fragmentation on 30-day Readmissions for Hyperglycemic Crisis States and Non-Hyperglycemic Crisis States and Outcomes within the USA in 2018 Open Access
Chirumamilla, Siri (Summer 2023)
Abstract
Background: Hospital readmissions are considered a quality indicator and cost containment metric for hospitals. As a result, healthcare systems have attempted to understand the factors that could cause excess 30-day readmission rates and impact on patient outcomes, which can vary by population, medical or surgical condition, or hospital. One such factor is interhospital care fragmentation, which is readmission to a different hospital from the index admission. While there is information regarding interhospital care fragmentation on certain high-prevalence conditions such as myocardial infarction and heart failure, there is limited information on the impact of interhospital care fragmentation on hyperglycemic crisis states (diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS)), which result from uncontrolled diabetes mellitus, a disease that affects 37.3 million people (11.3%) within the USA. The focus of the study is to understand the association between interhospital care fragmentation and patient-level outcomes (in-hospital mortality, readmission length-of-stay, readmission cost) in 30-day readmissions among patients initially admitted for hyperglycemic crisis state (DKA/HHS admissions) in a nationally representative dataset in 2018, as well as whether these outcomes differed by whether the readmission was for a hyperglycemic crisis (DKA/HHS readmissions) or some other non-hyperglycemic crisis diagnosis (non-DKA/HHS readmissions).
Methods: Data from the Agency of Healthcare Research and Quality’s National Readmission Database (NRD) was utilized to identify index DKA/HHS (DKA/HHS admissions) and associated fragmented 30-day hospital readmissions (based on ICD-10 codes) for diabetes-related hyperglycemic states (DKA/HHS readmission) or readmission for another diagnosis that was non-diabetes-related (Non-DKA/HHS readmission). Logistic and linear regression models were utilized to assess the associations between interhospital fragmentation and patient outcomes during the readmission (in-hospital mortality, length of stay, and cost).
Results: There were 14,917 weighted index DKA/HHS admissions. Among those with DKA/HHS readmissions (n = 8159, 55%), 1605 (20%) were fragmented. Among those with non-DKA/HHS readmissions (n = 6758, 45%), 1665 (25%) were fragmented. Compared to those with nonfragmented DKA/HHS readmissions, those with fragmented DKA/HHS readmissions had no statistically significant difference in the odds of in-hospital mortality, readmission length of stay, and cost. Compared to those with nonfragmented non-DKA/HHS readmissions, those with fragmented non-DKA/HHS readmissions had no statistically significant difference in the odds of in-hospital mortality but did have significantly increased average readmission length of stay by 1.24 days and increased average readmission cost of $19,807.19.
Conclusions: This study found that interhospital care fragmentation did not have a significant impact on readmission patient outcomes such as length of stay, hospital cost, and in-hospital mortality for those patients that had index DKA/HHS admissions and readmitted for hyperglycemic crisis states (DKA/HHS readmissions). In contrast, interhospital care fragmentation did significantly increase readmission length of stay and hospital cost in patients that had index DKA/HHS admissions but readmitted for a non-diabetes-related readmissions (non-DKA/HHS readmissions). This current study reinforces the importance of understanding the impact of interhospital care fragmentation on individual medical conditions and patient outcomes.
Table of Contents
Introduction
Review of Literature
Methodology
Results
Discussion
Tables
References
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The Association between Interhospital Care Fragmentation on 30-day Readmissions for Hyperglycemic Crisis States and Non-Hyperglycemic Crisis States and Outcomes within the USA in 2018 () | 2023-07-24 13:13:23 -0400 |
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