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Table 3 Studies of preventable readmissions of cardiovascular-related index admissions and readmissions among adults, United States, 2000-2009

From: Determinants of preventable readmissions in the United States: a systematic review

Citation Reported readmission type (and explanation if provided) Index condition* Readmit condition Timeframe Population and Setting Design and Sample size Data source(s) Risk factors/associated factors Conceptually linked admissions Strategy for patient linkage Used multivariate statistics§
Ahmed et al [21] Early Congestive heart failure primary discharge diagnosis Congestive heart failure 180 days Congestive heart failure patients from VA medical center in TX Retrospective cohort
(198)
Hospital databases Patient
Decreasing temperature
Yes No Yes
Aujeskey et al [23] Early Pulmonary embolism Any and complications of pulmonary embolism (recurrent venous thrombo-embolism and bleeding) 30 days Patients ≥18 years in PA Retrospective cohort
(14,426)
Pennsylvania Healthcare Cost Containment
Council database
Patient
African American (any or venous thromboembolism)
Increasing PESI risk class (any cause only)
Encounter
Medicaid
Discharge to home with supplementary care (any cause)
Left hospital against medical advice (any cause only)
Organizational
Hospital teaching status (bleeding only)
Non-Pittsburg area
Yes Yes Yes
Ferraris et al [46] Early unplanned Cardiac surgery Any condition 30 days Cardiac patients from single WV medical center Prospective cohort
(2,650)
Hospital database, Interviews Patient
Female
Diabetes
Preoperative atrial fibrillation
COPD
Renal dysfunction
Environment
Residential zip code
No Yes Yes||
García et al [25] Potentially avoidable Acute myocardial infarction Acute myocardial infarction - related admissions 56 days to 3 years Coronary artery disease in CA Retrospective cohort
(683)
California Hospital Outcomes Validation
Project dataset
Patient
AMI history
Encounter
Medicaid
Less likely with CABG on admission
Yes Yes Yes
Hallerbach et al [50] Early Congestive heart failure Congestive heart failure exacerbation admission 30 days Congestive heart failure patients from single PA hospital Case control
(58)
Chart review No statistically significant factors reported Yes No No
Hannan et al [27] Early Coronary artery bypass graft Likely to be complications of Coronary artery bypass graft surgery 30 days Coronary artery bypass graft surgery patients in NY Retrospective cohort
(16,325)
New York State's Cardiac Surgery
Reporting System linked with the Statewide
Planning and Research Cooperative
System
Patient
Increasing age
Women
Body surface area
Myocardial infarction 7 days prior
Femoral disease
Congestive heart failure
Chronic obstructive pulmonary disease
Diabetes
Hepatic failure
Dialysis
Encounter
Low annual surgeon volume
Discharge to skilled nursing or rehabilitation facility
Increasing length of stay
Organizational
High hospital risk adjusted mortality rate
Yes Yes Yes||
Harjai, Nunez et al [28] Early Heart failure Heart failure 30 days Heart failure patients from single LA hospital Retrospective cohort
(576)
Hospital databases, Chart review Encounter
Treatment with angiotensin-converting enzyme and aspirin
Yes No Yes
Harjai, Thompson et al [29] Early Heart failure and shock Any condition or heart failure 30 days Heart failure and shock patients from single LA hospital Retrospective cohort
(434)
Hospital databases Patient
COPD (any cause and HF)
No. of hospitalizations in prior 6 months (any cause and HF)
Male (HF only)
Increasing blood urea nitrogen (any cause only)
Yes No Yes
Howie-Esquivel and Dracup [47] Early Acutely decompensated heart failure Primary diagnosis of heart failure or other cardiac cause 90 days Heart failure patients from single CA academic medical center Prospective cohort
(44)
Chart review Patient
Female
Encounter
Increasing length of stay
Yes Yes Yes
Keenan et al [32] Readmissions to the hospital shortly after discharge Heart failure Any condition 30 days Fee for service Medicare Parts A and B nationwide Retrospective cohort
(1,129,210)
Medicare
inpatient, outpatient, and carrier Standard Analytic Files, Medicare Enrollment Database, National Heart Failure Project database
Patient
History of coronary artery bypass graft surgery less likely
Congestive heart failure
Acute coronary syndrome
Arrhythmias
Cardiorespiratory failure and shock
Valvular and rheumatic heart disease
Vascular or circulatory disease
Chronic atherosclerosis
Other heart disease
Paralysis
Stroke
Renal failure
COPD
Diabetes
Fluid disorders
Urinary tract infections
Gastrointestinal disorders
Severe hematologic disorder
Nephritis
Cancer
Liver disease
Asthma
Pneumonia
Drug/alcohol abuse or psychosis
Fibrosis of the lung
Protein-calorie malnutrition
(validation dataset not reported)
No Yes Yes
Kumbhani et al [34] Unplanned Cardiac surgery Related to complications of cardiac surgery 30 days and
6 months
Underwent intra- operative online monitoring of myocardial tissue pH at VA medical center in MA Retrospective cohort
(221)
Hospital databases Patient
Low pH at end of bypass
Postoperative atrial fibrillation
High ASA class
Preoperative ejection fraction
Encounter
Length of stay less than 6 days
Myocardial tissue pH < 6.85 at the end of bypass
Yes Yes Yes
Lagoe et al [35] Non-elective and unplanned Congestive heart failure Same DRG as index admission 30 days Congestive heart failure patients from multiple sites in Syracuse Retrospective cohort
(Not reported)
New York Statewide Planning and Research
Cooperative System
Organizational
Rates varied by hospital
Yes Yes No
Sun et al [48] Early CABG surgery Any condition 30 days Low risk CABG patients from Single DC hospital Prospective cohort
(2,157)
Hospital databases, Interviews Patient
Diabetes
No Yes Yes
  1. * All exclusion criteria or specific diagnostic codes not reported - see original article for additional details.
  2. Explicitly specified a biological, theoretical or conceptual model linking the readmission condition to the index condition (includes readmissions for same condition)
  3. Specified a strategy or research design to guard against loss to follow up
  4. § Used multivariate statistics
  5. ||Modeling technique did not account of non-independence of observations in analysis