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ORIGINAL ARTICLE
Minerva Gastroenterology 2023 December;69(4):470-8
DOI: 10.23736/S2724-5985.22.03232-6
Copyright © 2022 EDIZIONI MINERVA MEDICA
language: English
National frequency, trends, and healthcare burden of care fragmentation in readmissions for end-stage liver disease in the USA
Olufunso AGBALAJOBI 1, Ebehiwele EBHOHON 2, Chineye B. AMUCHI 3, Edwige C. NZUGANG 4, Elizabeth O. SOLADOYE 5, Oyedotun BABAJIDE 6, Adeyinka C. ADEJUMO 7, 8 ✉
1 Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 2 Department of Internal Medicine, Lincoln Medical Center, New York, NY, USA; 3 School of Public Health, Boston University School of Public Health, Boston, MA, USA; 4 Department of Internal Medicine, Beth Israel Lahey Health, Burlington, VT, USA; 5 Nebraska Institute of Forensic Sciences Inc, Lincoln, NE, USA; 6 Department of Internal Medicine, Interfaith Medical Center, New York, NY, USA; 7 Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA; 8 Individualized Genomics and Health Program, Johns Hopkins University, Baltimore, MD, USA
BACKGROUND: End-stage liver disease (ESLD) patients have frequent readmissions to the same facility or a different hospital (care fragmentation). Care fragmentation results in care delivery from an unfamiliar clinical team or setting, a potential source of suboptimal clinical outcomes. We examined the occurrence, trends, and association between care fragmentation and outcomes during readmissions for ESLD.
METHODS: From the Nationwide Readmissions Database (January to September 2010-2014), we followed adult (age ≥18 years) hospitalizations for ESLD who were discharged alive for 90 days. During 30- and 90-day readmissions, we calculated the frequency, determinants, and clinical outcomes of care fragmentation (SAS 9.4).
RESULTS: Of the 67,480 ESLD hospitalizations surviving at discharge from 2010-2014, 35% (23,872) and 52% (35,549) were readmitted in 30- and 90-days respectively. During readmissions, the frequencies of care fragmentation were similar (30-day: 25.4% and 90-day: 25.8%) and remained stable from 2010 to 2014 (P trends>0.5). Similarly, factors associated with care fragmentation were consistent across 30- and 90-day readmissions. These included ages: 18-44 years, liver cancer, receipt of liver transplantation, hepatorenal syndrome, prolonged length of stay, and hospitalization in non-teaching facilities. During 30- and 90-day readmissions, care fragmentation was associated with higher risk of mortality (adjusted mean ratio: 1.13[1.03-1.24] and 1.14 [1.06-1.23]; P values<0.0001), prolonged length of stay (4.6-days vs. 4.1-days and 5.2-days vs. 4.6-days; P values<0.0001), and higher hospital charges ($36,884 vs. $28,932 and $37,354 vs. $30,851; P values<0.0001).
CONCLUSIONS: Care fragmentation is high among readmissions for ESLD and is associated with poorer outcomes.
KEY WORDS: Mortality; Odds, ratio; Length of stay; Cholangitis