Visit Entropy Associated with Hospital Readmission Rates

Abstract

Purpose: The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates; however, its effect before admission has not been well studied. Increased outpatient care organization and continuity before admission is hypothesized to reduce the odds of readmission.

Methods: In a cohort of 14,662 primary care patients from a Patient-Centered Medical Home (PCMH) practice, continuity of care in the 12 months before admission was assessed using 3 established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). In addition, because these established metrics may not accurately reflect continuity in planned team-based care, a new metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression was performed to examine the relationship between readmission within 30 days and continuity while controlling for known readmission risk factors abstracted from an electronic medical record.

Results: Higher VE was associated with readmission (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission.

Conclusions: Disorganized medical care, characterized by a higher VE, is associated with higher odds of readmission among hospitalized primary care patients. An association between traditional measures of continuity (UPC, COC, and SECON) and readmission was not found.

Keywords: Ambulatory Care; Chronic Disease; Continuity of Patient Care; Electronic Health Records; Entropy; Hospitalization; Logistic Models; Odds Ratio; Patient Readmission; Patient-centered Care; Primary Health Care; Risk Factors.