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. 2016 Mar;17(3):167-77.
doi: 10.1111/hiv.12287. Epub 2015 Jul 14.

Thirty-day hospital readmissions for adults with and without HIV infection

S A Berry  1 , J A Fleishman  2 , R D Moore  1 , K A Gebo  1
Affiliations

Thirty-day hospital readmissions for adults with and without HIV infection

S A Berry et al. HIV Med. 2016 Mar.

Abstract

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 Healthcare Costs and Utilization Project. 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.

Keywords: Medicaid; Medicare; health care utilization; hospital readmission.

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Conflict of interest statement

Conflicts of Interest

S.A.B. has been a consultant for Bristol-Myers Squibb. K.A.G. has been a consultant for Bristol-Myers Squibb and Tibotec, has received research support from Tibotec, and has been an expert witness for the US government. There were no potential conflicts for the remaining authors.

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