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Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study

BACKGROUND: Over recent years increased emphasis has been given to performance monitoring of NHS hospitals, including overall number of hospital readmissions, which however are often sub-optimally adjusted for case-mix. We therefore conducted a study to examine the effect of various patient and dise...

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Autores principales: Lyratzopoulos, Georgios, Havely, Daniel, Gemmell, Islay, Cook, Gary A
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC548275/
https://www.ncbi.nlm.nih.gov/pubmed/15663793
http://dx.doi.org/10.1186/1471-227X-5-1
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author Lyratzopoulos, Georgios
Havely, Daniel
Gemmell, Islay
Cook, Gary A
author_facet Lyratzopoulos, Georgios
Havely, Daniel
Gemmell, Islay
Cook, Gary A
author_sort Lyratzopoulos, Georgios
collection PubMed
description BACKGROUND: Over recent years increased emphasis has been given to performance monitoring of NHS hospitals, including overall number of hospital readmissions, which however are often sub-optimally adjusted for case-mix. We therefore conducted a study to examine the effect of various patient and disease factors on the risk of emergency medical readmission. METHODS: The study setting was a District General Hospital in Greater Manchester and the study period was 4.5-years. All index emergency medical admission during the study period leading to a live discharge were included in the study (n = 20,209). A multivariable proportional hazards modelling was used, based on Hospital Episodes Statistics data, to examine the influence of various baseline factors on readmission risk. Deprivation status was measured with the Townsend deprivation index score. Hazard ratios (HR) and associated 95% confidence intervals (CI) of unplanned emergency medical admission by sex, age group, admission method, diagnostic group, number of coded co-morbidities, length of stay and patient's deprivation status quartile, were calculated. RESULTS: Significant independent predictors of readmission risk at 12 months were male sex (HR 1.13, CI: 1.07–1.2), age (age >75 (HR 1.57, CI 1.45–1.7), number of coded co-morbidities (HR for >4 coded co-morbidities: 1.49 CI: 1.26–1.76), admission via GP referral (HR 0.93, CI 0.88–0.99) and primary diagnosis of heart failure (HR 1.33, CI: 1.16–1.53) and chronic obstructive pulmonary disease/asthma (HR 1.34, CI: 1.21–1.48). Higher level of deprivation was also significantly and independently associated and with increased emergency medical readmission risk at three (HR for the most deprived quartile 1.21, CI: 1.08–1.35), six (HR 1.21, CI: 1.1–1.33) and twelve months (HR 1.25, CI: 1.16–1.36). CONCLUSIONS: There is a potential for improving health and reducing demand for emergency medical admissions with more effective management of patients with heart failure and chronic obstructive airways disease/asthma. There is also a potential for improving health and reducing demand if reasons for increased readmission risk in more deprived patients are understood. The potential influence of deprivation status on readmission risk should be acknowledged, and NHS performance indicators adjustment for deprivation case-mix would be prudent.
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spelling pubmed-5482752005-02-06 Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study Lyratzopoulos, Georgios Havely, Daniel Gemmell, Islay Cook, Gary A BMC Emerg Med Research Article BACKGROUND: Over recent years increased emphasis has been given to performance monitoring of NHS hospitals, including overall number of hospital readmissions, which however are often sub-optimally adjusted for case-mix. We therefore conducted a study to examine the effect of various patient and disease factors on the risk of emergency medical readmission. METHODS: The study setting was a District General Hospital in Greater Manchester and the study period was 4.5-years. All index emergency medical admission during the study period leading to a live discharge were included in the study (n = 20,209). A multivariable proportional hazards modelling was used, based on Hospital Episodes Statistics data, to examine the influence of various baseline factors on readmission risk. Deprivation status was measured with the Townsend deprivation index score. Hazard ratios (HR) and associated 95% confidence intervals (CI) of unplanned emergency medical admission by sex, age group, admission method, diagnostic group, number of coded co-morbidities, length of stay and patient's deprivation status quartile, were calculated. RESULTS: Significant independent predictors of readmission risk at 12 months were male sex (HR 1.13, CI: 1.07–1.2), age (age >75 (HR 1.57, CI 1.45–1.7), number of coded co-morbidities (HR for >4 coded co-morbidities: 1.49 CI: 1.26–1.76), admission via GP referral (HR 0.93, CI 0.88–0.99) and primary diagnosis of heart failure (HR 1.33, CI: 1.16–1.53) and chronic obstructive pulmonary disease/asthma (HR 1.34, CI: 1.21–1.48). Higher level of deprivation was also significantly and independently associated and with increased emergency medical readmission risk at three (HR for the most deprived quartile 1.21, CI: 1.08–1.35), six (HR 1.21, CI: 1.1–1.33) and twelve months (HR 1.25, CI: 1.16–1.36). CONCLUSIONS: There is a potential for improving health and reducing demand for emergency medical admissions with more effective management of patients with heart failure and chronic obstructive airways disease/asthma. There is also a potential for improving health and reducing demand if reasons for increased readmission risk in more deprived patients are understood. The potential influence of deprivation status on readmission risk should be acknowledged, and NHS performance indicators adjustment for deprivation case-mix would be prudent. BioMed Central 2005-01-21 /pmc/articles/PMC548275/ /pubmed/15663793 http://dx.doi.org/10.1186/1471-227X-5-1 Text en Copyright © 2005 Lyratzopoulos et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Lyratzopoulos, Georgios
Havely, Daniel
Gemmell, Islay
Cook, Gary A
Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study
title Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study
title_full Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study
title_fullStr Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study
title_full_unstemmed Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study
title_short Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study
title_sort factors influencing emergency medical readmission risk in a uk district general hospital: a prospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC548275/
https://www.ncbi.nlm.nih.gov/pubmed/15663793
http://dx.doi.org/10.1186/1471-227X-5-1
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