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2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization
OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients wi...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799699/ http://dx.doi.org/10.1017/cts.2018.303 |
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author | Weerahandi, Himali Li, Li Herrin, Jeph Dharmarajan, Kumar Kim, Lucy Ross, Joseph Jones, Simon Horwitz, Leora |
author_facet | Weerahandi, Himali Li, Li Herrin, Jeph Dharmarajan, Kumar Kim, Lucy Ross, Joseph Jones, Simon Horwitz, Leora |
author_sort | Weerahandi, Himali |
collection | PubMed |
description | OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1–6 days, 7–13 days, 14–30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0–3 days post SNF discharge and 4–30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78–89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11–22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3–18). The hazard rate of readmission for each group was significantly increased on days 0–3 after discharge from SNF compared with days 4–30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0–3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF. |
format | Online Article Text |
id | pubmed-6799699 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-67996992019-10-28 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization Weerahandi, Himali Li, Li Herrin, Jeph Dharmarajan, Kumar Kim, Lucy Ross, Joseph Jones, Simon Horwitz, Leora J Clin Transl Sci Science and Health Policy/Ethics/Health Impacts/Outcomes Research OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1–6 days, 7–13 days, 14–30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0–3 days post SNF discharge and 4–30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78–89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11–22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3–18). The hazard rate of readmission for each group was significantly increased on days 0–3 after discharge from SNF compared with days 4–30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0–3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF. Cambridge University Press 2018-11-21 /pmc/articles/PMC6799699/ http://dx.doi.org/10.1017/cts.2018.303 Text en © The Association for Clinical and Translational Science 2018 http://creativecommons.org/licenses/by/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Science and Health Policy/Ethics/Health Impacts/Outcomes Research Weerahandi, Himali Li, Li Herrin, Jeph Dharmarajan, Kumar Kim, Lucy Ross, Joseph Jones, Simon Horwitz, Leora 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
title | 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
title_full | 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
title_fullStr | 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
title_full_unstemmed | 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
title_short | 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
title_sort | 2492 risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization |
topic | Science and Health Policy/Ethics/Health Impacts/Outcomes Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799699/ http://dx.doi.org/10.1017/cts.2018.303 |
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