TY - JOUR
T1 - Access to routine care and risks for 30-day readmission in patients with cardiovascular disease
AU - Dupre, Matthew E.
AU - Xu, Hanzhang
AU - Granger, Bradi B.
AU - Lynch, Scott M.
AU - Nelson, Alicia
AU - Churchill, Erik
AU - Willis, Janese M.
AU - Curtis, Lesley H.
AU - Peterson, Eric D.
N1 - Funding Information:
Funding/Support : This study was funded in part by the Social Science Research Institute (SSRI) at Duke University. Additional support by Duke's Office of Clinical Research was made possible by Grant Number UL1TR001117 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Background Studies have shown that access to routine medical care is associated with the prevention, diagnosis, and treatment of chronic diseases. However, studies have not examined whether patient-reported difficulties in access to care are associated with rehospitalization in patients with cardiovascular disease. Methods Electronic medical records and a standardized survey were used to examine cardiovascular patients admitted to a large medical center from January 1, 2015 through January 10, 2017 (n = 520). All-cause readmission within 30 days of discharge was the primary outcome for analysis. Logistic regression models were used to examine the association between access to care and 30-day readmission while adjusting for patient demographics, socioeconomic status, healthcare utilization, and health status. Results Nearly 1-in-6 patients (15.7%) reported difficulty in accessing routine medical care; and those who were younger, male, non-white, uninsured, with heart failure, and had low social support were significantly more likely to report difficulty. Patients who reported difficulty in accessing care had significantly higher rates of 30-day readmission than patients who did not report difficulty (33.3% vs. 17.9%; P =.001); and the risks remained largely unchanged after accounting for nearly two dozen covariates (unadjusted odds ratio [OR] = 2.29; 95% CI, 1.46-3.60 vs. adjusted OR = 2.17; 95% CI, 1.29-3.66). Risks for readmission were especially high for patients who reported issues with transportation (OR = 3.24; 95% CI, 1.28-8.16) and scheduling appointments (OR = 3.56; 95% CI, 1.43-8.84), but not for other reasons (OR = 1.47; 95% CI, 0.61-3.54). Conclusions Cardiovascular patients who reported difficulty in accessing routine care had substantial risks of readmission within 30 days after discharge. These findings have important implications for identifying high-risk patients and developing interventions to improve access to routine medical care.
AB - Background Studies have shown that access to routine medical care is associated with the prevention, diagnosis, and treatment of chronic diseases. However, studies have not examined whether patient-reported difficulties in access to care are associated with rehospitalization in patients with cardiovascular disease. Methods Electronic medical records and a standardized survey were used to examine cardiovascular patients admitted to a large medical center from January 1, 2015 through January 10, 2017 (n = 520). All-cause readmission within 30 days of discharge was the primary outcome for analysis. Logistic regression models were used to examine the association between access to care and 30-day readmission while adjusting for patient demographics, socioeconomic status, healthcare utilization, and health status. Results Nearly 1-in-6 patients (15.7%) reported difficulty in accessing routine medical care; and those who were younger, male, non-white, uninsured, with heart failure, and had low social support were significantly more likely to report difficulty. Patients who reported difficulty in accessing care had significantly higher rates of 30-day readmission than patients who did not report difficulty (33.3% vs. 17.9%; P =.001); and the risks remained largely unchanged after accounting for nearly two dozen covariates (unadjusted odds ratio [OR] = 2.29; 95% CI, 1.46-3.60 vs. adjusted OR = 2.17; 95% CI, 1.29-3.66). Risks for readmission were especially high for patients who reported issues with transportation (OR = 3.24; 95% CI, 1.28-8.16) and scheduling appointments (OR = 3.56; 95% CI, 1.43-8.84), but not for other reasons (OR = 1.47; 95% CI, 0.61-3.54). Conclusions Cardiovascular patients who reported difficulty in accessing routine care had substantial risks of readmission within 30 days after discharge. These findings have important implications for identifying high-risk patients and developing interventions to improve access to routine medical care.
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U2 - 10.1016/j.ahj.2017.10.001
DO - 10.1016/j.ahj.2017.10.001
M3 - Article
C2 - 29421019
AN - SCOPUS:85034611089
VL - 196
SP - 9
EP - 17
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -