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Xu H, Farmer HR, Granger BB, Thomas KL, Peterson ED, Dupre ME. Perceived Versus Actual Risks of 30-Day Readmission in Patients With Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2021; 14:e006586. [PMID: 33430612 DOI: 10.1161/circoutcomes.120.006586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of hospitalization in the United States, and patients with CVD are at a high risk of readmission after discharge. We examined whether patients' perceived risk of readmission at discharge was associated with actual 30-day readmissions in patients hospitalized with CVD. METHODS We recruited 730 patients from the Duke Heart Center who were admitted for treatment of CVD between January 1, 2015, and August 31, 2017. A standardized survey was linked with electronic health records to ascertain patients' perceived risk of readmission, and other sociodemographic, psychosocial, behavioral, and clinical data before discharge. All-cause readmission within 30 days after discharge was examined. RESULTS Nearly 1-in-3 patients perceived a high risk of readmission at index admission and those who perceived a high risk had significantly more readmissions within 30 days than patients who perceived low risks of readmission (23.6% versus 15.8%, P=0.016). Among those who perceived a high risk of readmission, non-White patients (odds ratio [OR], 2.07 [95% CI, 1.28-3.36]), those with poor self-rated health (OR, 2.30 [95% CI, 1.38-3.85]), difficulty accessing care (OR, 2.72 [95% CI, 1.24-6.00]), and prior hospitalizations in the past year (OR, 2.13 [95% CI, 1.21-3.74]) were more likely to be readmitted. Among those who perceived a low risk of readmission, patients who were widowed (OR, 2.69 [95% CI, 1.60-4.51]) and reported difficulty accessing care (OR, 1.89 [95% CI, 1.07-3.33]) were more likely to be readmitted. CONCLUSIONS Patients who perceived a high risk of readmission had a higher rate of 30-day readmission than patients who perceived a low risk. These findings have important implications for identifying CVD patients at a high risk of 30-day readmission and targeting the factors associated with perceived and actual risks of readmission.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community Health (H.X.), Duke University, Durham, NC.,Duke University School of Nursing (H.X., B.B.G.), Duke University, Durham, NC.,Center for the Study of Aging and Human Development (H.X., M.E.D.), Duke University, Durham, NC
| | - Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark (H.R.F.)
| | - Bradi B Granger
- Duke University School of Nursing (H.X., B.B.G.), Duke University, Durham, NC
| | - Kevin L Thomas
- Duke Clinical Research Institute (K.L.T., E.D.P., M.E.D.), Duke University, Durham, NC.,Division of Cardiology, Department of Medicine (K.L.T.), Duke University, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute (K.L.T., E.D.P., M.E.D.), Duke University, Durham, NC.,Department of Internal Medicine, University of Texas Southwestern Medical Center (E.D.P)
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development (H.X., M.E.D.), Duke University, Durham, NC.,Duke Clinical Research Institute (K.L.T., E.D.P., M.E.D.), Duke University, Durham, NC.,Department of Population Health Sciences (M.E.D.), Duke University, Durham, NC.,Department of Sociology (M.E.D.), Duke University, Durham, NC
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