TY - JOUR
T1 - Evaluating Hospital Readmissions for Persons With Serious and Complex Illness
T2 - A Competing Risks Approach
AU - May, Peter
AU - Garrido, Melissa M.
AU - Del Fabbro, Egidio
AU - Noreika, Danielle
AU - Normand, Charles
AU - Skoro, Nevena
AU - Cassel, J. Brian
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - 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.
AB - 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.
KW - hospital readmissions
KW - mortality
KW - palliative care
KW - retrospective studies
UR - http://www.scopus.com/inward/record.url?scp=85060589356&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060589356&partnerID=8YFLogxK
U2 - 10.1177/1077558718823919
DO - 10.1177/1077558718823919
M3 - Article
C2 - 30658539
AN - SCOPUS:85060589356
SN - 1077-5587
VL - 77
SP - 574
EP - 583
JO - Medical Care Research and Review
JF - Medical Care Research and Review
IS - 6
ER -
