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Targeting zero preventable trauma readmissions
- Source :
- Journal of Trauma and Acute Care Surgery. 91:728-735
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- BACKGROUND Nearly 1-in-10 trauma patients in the United States are readmitted within 30 days of discharge, with a median hospital cost of more than $8,000 per readmission. There are national efforts to reduce readmissions in trauma care, but we do not yet understand which are potentially preventable. Our study aims to quantify the potentially preventable readmissions (PPRs) in trauma care to serve as the anchor point for ongoing efforts to curb hospital readmissions and ultimately, bring preventable readmissions to zero. METHODS We identified inpatient hospitalizations after trauma and readmissions within 90 days in the 2017 National Readmissions Database (NRD). Potentially preventable readmissions were defined as the Agency for Healthcare Research and Quality-defined Ambulatory Care Sensitive Conditions, in addition to superficial surgical site infection, acute kidney injury/acute renal failure, and aspiration pneumonitis. Mean costs for these admissions were calculated using the NRD. A multivariable logistic regression model was used to characterize the relationship between patient characteristics and PPR. RESULTS A total of 1,320,083 patients were admitted for trauma care in the 2017 NRD, and 137,854 (10.4%) were readmitted within 90 days of discharge. Of these readmissions, 22.7% were potentially preventable. The mean cost was $10,001/PPR, resulting in $313,802,278 in cost to the US health care system. Of readmitted trauma patients younger than 65 years, Medicaid or Medicare patients had 2.7-fold increased odds of PPRs compared with privately insured patients. Patients of any age with congestive heart failure had 2.9 times increased odds of PPR, those with chronic obstructive pulmonary disease or complicated diabetes mellitus had 1.8 times increased odds, and those with chronic kidney disease had 1.7 times increased odds. Furthermore, as the days from discharge increased, the proportion of readmissions due to PPRs increased. CONCLUSION One-in-five trauma readmissions are potentially preventable, which account for more than $300 million annually in health care costs. Improved access to postdischarge ambulatory care may be key to minimizing PPRs, especially for those with certain comorbidities. LEVEL OF EVIDENCE Economic and value-based evaluations, level II.
- Subjects :
- medicine.medical_specialty
Databases, Factual
Aftercare
Comorbidity
Medicare
Critical Care and Intensive Care Medicine
Logistic regression
Patient Readmission
Odds
Ambulatory care
Cost Savings
Risk Factors
Health care
Ambulatory Care
medicine
Humans
Hospital Costs
Aged
Retrospective Studies
Medicaid
business.industry
Acute kidney injury
medicine.disease
United States
Heart failure
Emergency medicine
Wounds and Injuries
Surgery
business
Kidney disease
Subjects
Details
- ISSN :
- 21630763 and 21630755
- Volume :
- 91
- Database :
- OpenAIRE
- Journal :
- Journal of Trauma and Acute Care Surgery
- Accession number :
- edsair.doi.dedup.....7e5a27a850b1b6f72f21cfc26e2b4de3