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. 2023 May;71(5):1416-1428.
doi: 10.1111/jgs.18210. Epub 2022 Dec 27.

Ambulance use and subsequent fragmented hospital readmission among older adults

Sara D Turbow  1   2 , Steven D Culler  3 , Camille P Vaughan  4   5 , Kimberly J Rask  6 , Molly M Perkins  4 , Carolyn K Clevenger  7 , Mohammed K Ali  2   8
Affiliations

Ambulance use and subsequent fragmented hospital readmission among older adults

Sara D Turbow et al. J Am Geriatr Soc. 2023 May.

Abstract

Background: Interhospital care fragmentation, when a patient is readmitted to a different hospital than they were originally discharged from, occurs in 20%-25% of readmissions. Mode of transport to the hospital, specifically ambulance use, may be a risk factor for fragmented readmissions. Our study seeks to further understand the relationship between ambulance transport and fragmented readmissions in older adults, a population that is at increased risk for poor outcomes following fragmented readmissions.

Methods: We analyzed inpatient claims from Medicare beneficiaries in 2018 who had a hospital admission for select Hospital Readmission Reduction Program Conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia) as well as dehydration, syncope, urinary tract infection, or behavioral issues. We evaluated the associations between ambulance transport and a fragmented readmission using logistic regression models adjusted for demographic, clinical, and hospital characteristics.

Results: The study included 1,186,600 30-day readmissions. Of these, 46.8% (n = 555,847) required ambulance transport. In fully adjusted models, taking an ambulance to the readmission hospital increased the odds of a fragmented readmission by 38% (95% CI 1.32, 1.44). When this association was examined by readmission major diagnostic category (MDC), the strongest associations were seen for Factors Influencing Health Status and Other Contacts with Health Services (i.e., rehabilitation, aftercare) (AOR 3.66, 95% CI 3.11, 4.32), Mental Diseases and Disorders (AOR 2.69, 95% CI 2.44, 2.97), and Multiple Significant Trauma (AOR 2.61, 95% CI 1.56, 4.35). When the model was stratified by patient origin, ambulance use remained associated with fragmented readmissions across all locations.

Conclusions: Ambulance use is associated with increased odds of a fragmented readmission, though the strength of the association varies by readmission diagnosis and origin. Patient-, hospital-, and system-level interventions should be developed, implemented, and evaluated to address this modifiable risk factor.

Keywords: Medicare; ambulance; care fragmentation; older adults; readmission.

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Conflict of interest statement

ST and MKA have received funding from Merck & Co. for research unrelated to this work.

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number K23AG065505 and by the Program for Retaining, Supporting, and EleVating Early-career Researchers at Emory (PeRSEVERE) from the Emory School of Medicine, a gift from the Doris Duke Charitable Foundation, and through the Georgia CTSA NIH award (UL1-TR002378). This material is the result of work supported with resources and the use of facilities at the Atlanta VA Health Care System. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs. The sponsors had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the manuscript.

Figures

Figure 1:
Figure 1:
Summary Figure of Research Question
Figure 2:
Figure 2:
Development of Sample for Association of Ambulance Use and Fragmented Readmissions, Medicare Beneficiaries, 2018
Figure 3:
Figure 3:
Ambulance Use and Fragmentation Status by Major Diagnostic Criteria (MDC), Medicare Beneficiaries, 2018
Figure 4:
Figure 4:
Adjusted Odds Ratios for Association between Ambulance Use and a Fragmented Readmission, Medicare Beneficiaries, 2018
See this image and copyright information in PMC

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