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. 2020 Dec;77(6):574-583.
doi: 10.1177/1077558718823919. Epub 2019 Jan 18.

Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach

Peter May  1 , Melissa M Garrido  2   3 , Egidio Del Fabbro  4 , Danielle Noreika  4 , Charles Normand  1   5 , Nevena Skoro  4 , J Brian Cassel  4
Affiliations

Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach

Peter May et al. Med Care Res Rev. 2020 Dec.

Abstract

Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Eligible participants were adult inpatients admitted to an academic, safety-net medical center (2009-2015) with at least one diagnosis of cancer, heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure, AIDS/HIV, and selected neurodegenerative conditions. PC was associated with reduced 30-, 60-, and 90-day readmissions (subhazard ratios = 0.57, 0.53, and 0.52, respectively [all p < .001]). Hospital PC is associated with a reduction in readmissions, and this is not explained by higher mortality among PC patients. Performance measures only counting those alive at a given end point may underestimate systematically the effects of treatments with a high-mortality rate.

Keywords: hospital readmissions; mortality; palliative care; retrospective studies.

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Figures

Figure 1.
Figure 1.
Cumulative incidence of readmissions for palliative care and usual care treating mortality as a competing risk after weighting (N=6,761).
See this image and copyright information in PMC

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