Hospital Readmission of Adolescents and Young Adults With Complex Chronic Disease
| Autor: | Peter J. Dunbar, Jessica L. Bettenhausen, Jay G. Berry, Clarissa Hoover, Brigid Garrity, Matthew Hall, James M. Perrin, Morgan K. Crossman, Karen Kuhlthau, Jessica L. Markham |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Adolescent Databases Factual Cross-sectional study Population Patient Readmission Young Adult Risk Factors Interquartile range Odds Ratio Humans Medicine Young adult education Original Investigation Retrospective Studies Type 1 diabetes education.field_of_study business.industry Spina bifida Research Retrospective cohort study General Medicine Odds ratio medicine.disease Online Only Cross-Sectional Studies Logistic Models Chronic Disease Female business |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| DOI: | 10.1001/jamanetworkopen.2019.7613 |
| Popis: | Key Points Question How do readmission rates vary across complex chronic disease for adolescents and young adults with increasing age? Findings In this cross-sectional study of 215 580 adolescents and young adults hospitalized for treatment of complex chronic diseases (cystic fibrosis, type 1 diabetes, inflammatory bowel disease, spina bifida, or sickle cell anemia), 30-day hospital readmission rates varied significantly across disease categories. As age increased from 15 to 30 years, unadjusted, 30-day, unplanned hospital readmission rates increased significantly for all complex chronic disease cohorts. Meaning Further attention is needed to hospital discharge care, self-management, and prevention of readmission in adolescents and young adults with complex chronic disease. This cross-sectional study assesses variation in 30-day unplanned hospital readmission rates among adolescents and young adults with complex chronic disease as they advance in age. Importance Adolescents and young adults (AYA) who have complex chronic disease (CCD) are a growing population that requires hospitalization to treat severe, acute health problems. These patients may have increased risk of readmission as demands on their self-management increase and as they transfer care from pediatric to adult health care practitioners. Objective To assess variation across CCDs in the likelihood of readmission for AYA with increasing age. Design, Setting, and Participants Retrospective 1-year cross-sectional study of the 2014 Agency for Healthcare Research and Quality Nationwide Readmissions Database for all US hospitals. Participants were 215 580 hospitalized individuals aged 15 to 30 years with cystic fibrosis (n = 15 213), type 1 diabetes (n = 86 853), inflammatory bowel disease (n = 48 073), spina bifida (n = 7819), and sickle cell anemia (n = 57 622) from January 1, 2014, to December 1, 2014. Exposures Increasing age at index admission. Main Outcomes and Measures Unplanned 30-day hospital readmission. Readmission odds were compared by patients’ ages in 2-year epochs (with age 15-16 years as the reference) using logistic regression, accounting for confounding patient characteristics and data clustering by hospital. Results Of 215 580 participants, 115 982 (53.8%) were female; the median (interquartile range) age was 24 (20-27) years. Across CCDs, multimorbidity was common; the percentages of index hospitalizations with 4 or more coexisting conditions ranged from to 33.4% for inflammatory bowel disease to 74.2% for spina bifida. Thirty-day hospital readmission rates varied significantly across CCDs: 20.2% (cystic fibrosis), 19.8% (inflammatory bowel disease), 20.4% (spina bifida), 22.5% (type 1 diabetes), and 34.6% (sickle cell anemia). As age increased from 15 to 30 years, unadjusted, 30-day, unplanned hospital readmission rates increased significantly for all 5 CCD cohorts. In multivariable analysis, age trends in the adjusted odds of readmission varied across CCDs. For example, for AYA who had cystic fibrosis, the adjusted odds of readmission increased to 1.9 (95% CI, 1.5-2.3) by age 21 years and remained elevated through age 30 years. For AYA who had type 1 diabetes, the adjusted odds of readmission peaked at ages 23 to 24 years (odds ratio, 2.3; 95% CI, 2.1-2.6) and then declined through age 30 years. Conclusions and Relevance These findings suggest that hospitalized AYA who have CCDs have high rates of multimorbidity and 30-day readmission. The adjusted odds of readmission for AYA varied significantly across CCDs with increasing age. Further attention is needed to hospital discharge care, self-management, and prevention of readmission in AYA with CCD. |
| Databáze: | OpenAIRE |
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