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Thirty-day hospital readmission rate among adults living with HIV

Berry, Stephen A.a; Fleishman, John A.b; Yehia, Baligh R.c; Korthuis, P. Toddd; Agwu, Allison L.a; Moore, Richard D.a; Gebo, Kelly A.a; for the HIV Research Network

doi: 10.1097/QAD.0b013e3283623d5f
Clinical Science

Objective: Thirty-day hospital readmission rate is receiving increasing attention as a quality-of-care indicator. The objective of this study was to determine readmission rates and to identify factors associated with readmission among persons living with HIV.

Design: Prospective multicenter observational cohort.

Setting: Nine US HIV clinics affiliated through the HIV Research Network.

Participants: Patients engaged in HIV care during 2005–2010.

Main outcome measure(s): Readmission rate was defined as the proportion of hospitalizations followed by a readmission within 30 days. Factors in multivariate analyses included diagnostic categories, patient demographic and clinical characteristics, and having an outpatient follow-up visit.

Results: Among 11 651 total index hospitalizations, the 30-day readmission rate was 19.3%. AIDS-defining illnesses (ADIs, 9.6% of index hospitalizations) and non-AIDS-defining infections (26.4% of index hospitalizations) had readmission rates of 26.2 and 16.6%, respectively. Factors independently associated with readmission included lower CD4+ cell count [adjusted odds ratio 1.80 (1.53–2.11) for CD4+ cell count <50 vs. ≥351 cells/μl], longer length of stay [1.77 (1.53–2.04) for ≥9 days vs. 1–3 days], and several diagnostic categories including ADI. Having an outpatient follow-up clinic visit was not associated with lower readmission risk [adjusted hazard ratio 0.98 (0.88–1.08)].

Conclusion: The 19.3% readmission rate exceeds the 13.3% rate reported for the general population of 18–64-year-olds. HIV providers may use the 19.3% rate as a basis of comparison. Policymakers may consider the impact of HIV when estimating expected readmissions for a hospital or region. Preventing or recovering from severe immune dysfunction may be the most important factor to reducing readmissions.

aJohns Hopkins University, Baltimore

bAgency for Healthcare Research and Quality, Rockville, Maryland

cUniversity of Pennsylvania, Philadelphia, Pennsylvania

dOregon Health and Science University, Portland, Oregon, USA.

Correspondence to Stephen A. Berry, MD, PhD, Assistant Professor of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, 1503 E. Jefferson St, Office 115, Baltimore, MD 21287, USA. E-mail: sberry8@jhmi.edu

Received 22 March, 2013

Revised 15 April, 2013

Accepted 15 April, 2013

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© 2013 Lippincott Williams & Wilkins, Inc.