Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 200-209
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.200
Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis
Emad Qayed, Mayssan Muftah
Emad Qayed, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
Emad Qayed, Department of Gastroenterology, Grady Memorial Hospital, Atlanta, GA 30303, United States
Mayssan Muftah, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, United States
Author contributions: Qayed E designed the research, analyzed the data, drafted and revised the manuscript; Muftah M drafted and revised the manuscript; all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and deemed exempt from review by the Emory University Institutional Review Board because the database is publicly available and does not contain any identifiable information that can be linked to any specific subject.
Informed consent statement: Informed consent was not required as this research involves an administrative database and does not contain any identifiable information that can be linked to any specific subject.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Emad Qayed, MD, MPH, FACG, Assistant Professor, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, 49 Jesse Hill Jr Street, Atlanta, GA 30303, United States. eqayed@emory.edu
Telephone: +1-404-7781685 Fax: +1-404-7781681
Received: February 20, 2018
Peer-review started: February 20, 2018
First decision: March 9, 2018
Revised: March 12, 2018
Accepted: April 2, 2018
Article in press: April 2, 2018
Published online: September 16, 2018
Processing time: 208 Days and 13.2 Hours
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: Gastroparesis; Hospital readmission; Care fragmentation

Core tip: Gastroparesis is associated with high 30-d readmission, and 1 in 4 readmissions occur at a hospital different from the index hospitalization. Measuring same-hospital readmission rates without accounting for non-index hospitalization underestimates readmission rates by 20%. Several factors are associated with 30-d readmission and care fragmentation, and can play a role in implementing effective preventive interventions to high-risk patients. Care fragmentation is associated with increased cost of readmissions and longer hospital stays. Optimizing post discharge care coordination and data sharing between hospitals could decrease care fragmentation and cost of care.