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Thirty‐day hospital readmissions for adults with and without HIV infection
Author(s) -
Berry SA,
Fleishman JA,
Moore RD,
Gebo KA
Publication year - 2016
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12287
Subject(s) - medicine , human immunodeficiency virus (hiv) , emergency medicine , family medicine
Objectives Risk‐adjusted 30‐day hospital readmission rate is a commonly used benchmark for hospital quality of care and for Medicare reimbursement. Persons living with HIV ( PLWH ) may have high readmission rates. This study compared 30‐day readmission rates by HIV status in a multi‐state sample with planned subgroup comparisons by insurance and diagnostic categories. Methods Data for all acute care, nonmilitary hospitalizations in nine states in 2011 were obtained from the H ealthcare C osts and U tilization P roject. The primary outcome was readmission for any cause within 30 days of hospital discharge. Factors associated with readmission were evaluated using multivariate logistic regression. Results A total of 5 484 245 persons, including 33 556 (0.6%) PLWH , had a total of 6 441 695 index hospitalizations, including 45 382 (0.7%) among PLWH . Unadjusted readmission rates for hospitalizations of HIV ‐uninfected persons and PLWH were 11.2% [95% confidence interval ( CI ) 11.2, 11.2%] and 19.7% (95% CI 19.3, 20.0%), respectively. After adjustment for age, gender, race, insurance, and diagnostic category, HIV infection was associated with 1.50 (95% CI 1.46, 1.54) times higher odds of readmission. Predicted, adjusted readmission rates were higher for PLWH within every insurance category, including Medicaid [12.9% (95% CI 12.8, 13.0%) and 19.1% (95% CI 18.4, 19.7%) for HIV ‐uninfected persons and PLWH , respectively] and Medicare [13.2% (95% CI 13.1, 13.3%) and 18.0% (95% CI 17.4, 18.7%), respectively], and within every diagnostic category. Conclusions HIV infection is associated with significantly increased readmission risk independent of demographics, insurance, and diagnostic category. The 19.7% 30‐day readmission rate may serve as a preliminary benchmark for assessing quality of care of PLWH . Policy‐makers may consider adjusting for HIV infection when calculating a hospital's expected readmission rate.