Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

Abstract

Aim: To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Care fragmentation; Gastroparesis; Hospital readmission.

Figure 1

Data selection for Gastroparesis admissions. ¹Duplicate index events are records that fit the criteria for index gastroparesis admission, but were also identified as readmissions within 30 d of a previous index gastroparesis admission. These records were not analyzed as a separate index admission, but were included in the readmission analysis.

Figure 2

Multivariable proportional hazard analysis of predictors of 30-d readmission in Patients hospitalized with gastroparesis, National Readmission Database, 2010-2014.

Figure 3

Proportion of 30 and 90-d readmissions to index and non-index hospitals. Blue represents non-index only readmissions, which is also the percent underestimation of care if only institutional databases are used. Blue and red represent fragmentation of care.

Figure 4

Multivariable logistic regression analysis of predictors of 30-d readmission to non-index hospital (care fragmentation) in patients hospitalized with gastroparesis, National Readmission Database, 2010-2014.