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. 2022 Jan 20;17(1):e0260664.
doi: 10.1371/journal.pone.0260664. eCollection 2022.

Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis

Melissa R Riester  1   2 , Elliott Bosco  1   2 , Joe B B Silva  1   2 , Barbara H Bardenheier  1   2   3 , Parag Goyal  4 , Emily T O'Neil  1   2 , Robertus van Aalst  5   6 , Ayman Chit  5   7 , Stefan Gravenstein  1   2   8   9 , Andrew R Zullo  1   2   3   9
Affiliations

Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis

Melissa R Riester et al. PLoS One. .

Abstract

Background: Pneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis.

Methods and findings: This national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up.

Conclusion: Among older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: R.V.A. and A.C. are employed by Sanofi Pasteur and may hold shares and/or stock options in the company. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Daily risk of 30-day unplanned hospital readmission among older adults discharged to skilled nursing facilities following an index hospitalization for pneumonia, 2012–2013.
Presents the daily risk of unplanned hospital readmission for four common causes of readmission (infectious, respiratory, circulatory, genitourinary). Each year started on the Sunday of Morbidity and Mortality Weekly Report week 27 and ended on the Saturday of Morbidity and Mortality Weekly Report week 26 of the following year.
Fig 2
Fig 2. Daily risk of 30-day unplanned hospital readmission among older adults discharged to skilled nursing facilities following an index hospitalization for pneumonia, 2013–2014.
Presents the daily risk of unplanned hospital readmission for four common causes of readmission (infectious, respiratory, circulatory, genitourinary). Each year started on the Sunday of Morbidity and Mortality Weekly Report week 27 and ended on the Saturday of Morbidity and Mortality Weekly Report week 26 of the following year.
Fig 3
Fig 3. Daily risk of 30-day unplanned hospital readmission among older adults discharged to skilled nursing facilities following an index hospitalization for pneumonia, 2014–2015.
Presents the daily risk of unplanned hospital readmission for four common causes of readmission (infectious, respiratory, circulatory, genitourinary). Each year started on the Sunday of Morbidity and Mortality Weekly Report week 27 and ended on the Saturday of Morbidity and Mortality Weekly Report week 26 of the following year.
Fig 4
Fig 4. Daily risk of 30-day unplanned hospital readmission among older adults discharged to skilled nursing facilities following an index hospitalization for sepsis, 2012–2013.
Presents the daily risk of unplanned hospital readmission for four common causes of readmission (infectious, respiratory, circulatory, genitourinary). Each year started on the Sunday of Morbidity and Mortality Weekly Report week 27 and ended on the Saturday of Morbidity and Mortality Weekly Report week 26 of the following year.
Fig 5
Fig 5. Daily risk of 30-day unplanned hospital readmission among older adults discharged to skilled nursing facilities following an index hospitalization for sepsis, 2013–2014.
Presents the daily risk of unplanned hospital readmission for four common causes of readmission (infectious, respiratory, circulatory, genitourinary). Each year started on the Sunday of Morbidity and Mortality Weekly Report week 27 and ended on the Saturday of Morbidity and Mortality Weekly Report week 26 of the following year.
Fig 6
Fig 6. Daily risk of 30-day unplanned hospital readmission among older adults discharged to skilled nursing facilities following an index hospitalization for sepsis, 2014–2015.
Presents the daily risk of unplanned hospital readmission for four common causes of readmission (infectious, respiratory, circulatory, genitourinary). Each year started on the Sunday of Morbidity and Mortality Weekly Report week 27 and ended on the Saturday of Morbidity and Mortality Weekly Report week 26 of the following year.
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References

    1. Torio C (AHRQ), Moore B (Truven Health Analytics). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013. HCUP Statistical Brief #204. May 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hosp.... - PubMed
    1. File T. M., Marrie T. J. Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010;122(2):130–41. doi: 10.3810/pgm.2010.03.2130 - DOI - PubMed
    1. Yu H., Rubin J., Dunning S., Li S., Sato R. Clinical and economic burden of community-acquired pneumonia in the Medicare fee-for-service population. J Am Geriatr Soc. 2012;60(11):2137–43. doi: 10.1111/j.1532-5415.2012.04208.x - DOI - PubMed
    1. Buchman T. G., Simpson S. Q., Sciarretta K. L., Finne K. P., Sowers N., Collier M., et al.. Sepsis among Medicare beneficiaries: 1. The burdens of sepsis, 2012–2018. Crit Care Med. 2020;48(3):276–88. doi: 10.1097/CCM.0000000000004224 - DOI - PMC - PubMed
    1. Storms A. D., Chen J., Jackson L. A., Nordin J. D., Naleway A. L., Glanz J. M., et al.. Rates and risk factors associated with hospitalization for pneumonia with ICU admission among adults. BMC Pulm Med. 2017;17(1):208. doi: 10.1186/s12890-017-0552-x - DOI - PMC - PubMed