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Wiley Z, Kulshreshtha A, Li D, Kubes J, Kandiah S, Leung S, Kobaidze K, Shin SR, Moanna A, Perkins J, Hogan M, Sims KM, Amzat T, Cantos VD, Elutilo-Ayoola T, Hanna J, Harris NM, Henry TL, Iheaku O, Japaridze M, Lanka V, Johnson TA, Mbaezue N, Rebolledo PA, Sexton ME, Surapaneni PK, Franks N. Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19. J Investig Med 2022; 70:1406-1415. [PMID: 35649686 PMCID: PMC9195155 DOI: 10.1136/jim-2022-002344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.
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Affiliation(s)
- Zanthia Wiley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dong Li
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julianne Kubes
- Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serena Leung
- Kaiser Permanente of Georgia, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Abeer Moanna
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Jonathan Perkins
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Hogan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kanika M Sims
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tolu Amzat
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jasmah Hanna
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine M Harris
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Onyinye Iheaku
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mariam Japaridze
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Vaishnavi Lanka
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nkechi Mbaezue
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Elizabeth Sexton
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nicole Franks
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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