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Readmission following hospitalization for pneumonia: the impact of pneumonia type and its implication for hospitals.

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Citation: Clinical Infectious Diseases. 57(3):362-7, 2013 Aug.PMID: 23677872Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Patient Readmission/sn [Statistics & Numerical Data] | *Pneumonia, Bacterial/ep [Epidemiology] | Adult | Aged | Aged, 80 and over | Community-Acquired Infections/ep [Epidemiology] | Cross Infection/ep [Epidemiology] | Female | Humans | Male | Middle Aged | Retrospective StudiesYear: 2013 Local holdings: Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007ISSN:

1058-4838

Name of journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaAbstract: BACKGROUND: Readmission rates following discharge after pneumonia are thought to represent the quality of care. Factors associated with readmission, however, remain poorly described. It is unclear if readmission rates vary based on pneumonia type.CONCLUSIONS: Readmission for pneumonia is common but varies based on pneumonia type. The variables associated with readmission do not reflect factors that hospitals directly control. Use of one rule to guide payment that fails to account for HCAP and the HCAP criteria on readmission seems inappropriate.METHODS: We retrospectively identified adults admitted to an index hospital with non-nosocomial pneumonia (January through December 2010) and who survived to discharge. We only included patients with bacterial evidence of infection. Readmission in the 30 days following discharge to any of 9 hospitals comprising the index hospital's healthcare system served as the primary end point. We recorded demographics, severity of illness, comorbidities, and infection-related factors. We noted whether the patient had healthcare-associated pneumonia (HCAP) versus community-acquired pneumonia. We utilized logistic regression analysis to determine factors independently associated with readmission.RESULTS: The cohort included 977 subjects; 78.9% survived to discharge. The readmission rate equaled 20%. Neither disease severity nor the rate of initially inappropriate antibiotic therapy correlated with readmission. Subjects with HCAP were 7.5 (95% confidence interval [CI], 3.6-15.7) times more likely to be readmitted. Four HCAP criteria were independently associated with readmission: admission from long-term care (adjusted odds ratio [AOR], 2.2 [95% CI, 1.4-3.4]); immunosuppression (AOR, 1.9 [95% CI, 1.3-2.9]); prior antibiotics (AOR, 1.7 [95% CI, 1.2-2.6]); and prior hospitalization (AOR, 1.7 [95% CI, 1.1-2.5]).All authors: Hoban A, Hoffman J, Kan J, Kollef MH, Micek ST, Reichley R, Shorr AF, Zilberberg MDFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1093/cid/cit254

Date added to catalog: 2014-02-24

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	23677872	Available		23677872

Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007

BACKGROUND: Readmission rates following discharge after pneumonia are thought to represent the quality of care. Factors associated with readmission, however, remain poorly described. It is unclear if readmission rates vary based on pneumonia type.

CONCLUSIONS: Readmission for pneumonia is common but varies based on pneumonia type. The variables associated with readmission do not reflect factors that hospitals directly control. Use of one rule to guide payment that fails to account for HCAP and the HCAP criteria on readmission seems inappropriate.

METHODS: We retrospectively identified adults admitted to an index hospital with non-nosocomial pneumonia (January through December 2010) and who survived to discharge. We only included patients with bacterial evidence of infection. Readmission in the 30 days following discharge to any of 9 hospitals comprising the index hospital's healthcare system served as the primary end point. We recorded demographics, severity of illness, comorbidities, and infection-related factors. We noted whether the patient had healthcare-associated pneumonia (HCAP) versus community-acquired pneumonia. We utilized logistic regression analysis to determine factors independently associated with readmission.

RESULTS: The cohort included 977 subjects; 78.9% survived to discharge. The readmission rate equaled 20%. Neither disease severity nor the rate of initially inappropriate antibiotic therapy correlated with readmission. Subjects with HCAP were 7.5 (95% confidence interval [CI], 3.6-15.7) times more likely to be readmitted. Four HCAP criteria were independently associated with readmission: admission from long-term care (adjusted odds ratio [AOR], 2.2 [95% CI, 1.4-3.4]); immunosuppression (AOR, 1.9 [95% CI, 1.3-2.9]); prior antibiotics (AOR, 1.7 [95% CI, 1.2-2.6]); and prior hospitalization (AOR, 1.7 [95% CI, 1.1-2.5]).

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