Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.200
Peer-review started: February 20, 2018
First decision: March 9, 2018
Revised: March 12, 2018
Accepted: April 2, 2018
Article in press: April 2, 2018
Published online: September 16, 2018
To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.
We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database, which captures statewide readmissions. We excluded patients who died during the hospitalization, and calculated 30 and 90-d unplanned readmission and care fragmentation rates. Readmission to a non-index hospital (i.e., different from the hospital of the index admission) was considered as care fragmentation. A multivariate Cox regression model was used to analyze predictors of 30-d readmissions. Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation. Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission. Mortality during the first readmission, hospitalization cost, length of stay, and rates of 60-d readmission were compared between those with and without care fragmentation.
There were 30064 admissions with a primary diagnosis of gastroparesis. The rates of 30 and 90-d readmissions were 26.8% and 45.6%, respectively. Younger age, male patient, diabetes, parenteral nutrition, ≥ 4 Elixhauser comorbidities, longer hospital stay (> 5 d), large and metropolitan hospital, and Medicaid insurance were associated with increased hazards of 30-d readmissions. Gastric surgery, routine discharge and private insurance were associated with lower 30-d readmissions. The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%, respectively. Younger age, longer hospital stay (> 5 d), self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation. Diabetes, enteral tube placement, parenteral nutrition, large metropolitan hospital, and routine discharge were associated with decreased risk of 30-d fragmentation. Patients who were readmitted to a non-index hospital had longer length of stay (6.5 vs 5.8 d, P = 0.03), and higher mean hospitalization cost ($15645 vs $12311, P < 0.0001), compared to those readmitted to the index hospital. There were no differences in mortality (1.0% vs 1.3%, P = 0.84), and 60-d readmission rate (55.3% vs 54.6%, P = 0.99) between the two groups.
Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis. Knowledge of these predictors can play a role in implementing effective preventive interventions to high-risk patients.
Core tip: Gastroparesis is associated with high 30-d readmission, and 1 in 4 readmissions occur at a hospital different from the index hospitalization. Measuring same-hospital readmission rates without accounting for non-index hospitalization underestimates readmission rates by 20%. Several factors are associated with 30-d readmission and care fragmentation, and can play a role in implementing effective preventive interventions to high-risk patients. Care fragmentation is associated with increased cost of readmissions and longer hospital stays. Optimizing post discharge care coordination and data sharing between hospitals could decrease care fragmentation and cost of care.