Early Hospital Readmission and Related Resources Utilizations for Older Heart Failure Adults in Taiwan

Presenter: Ying-Chun Li, NSYSU

Abstract

Rationale: Congestive heart failure (CHF) is one of the leading causes of hospital admission among patients over the age of 65 years. This syndrome is associated with high rates of hospital readmission. Early readmission has been suggested as a surrogate marker of inpatient quality of care. Meanwhile, hospital readmissions involve returns for the most expensive type of health services and lead to huge resource consumptions. However, the patterns of early hospital readmission for older CHF adults are not well-studied in Taiwan as a whole.

Objective: This study aimed to evaluate critical factors affecting early hospital readmission and its related resource utilizations for older CHF adults in Taiwan using Taiwanese inpatient data.

Methodology: This study conducted retrospective analyses to explore the prediction of early hospital readmission within 14 days after hospital discharge for older CHF patients. Taiwan inpatient claim data from January 2003 to December 2004 were analyzed. Charlson Comorbidity Index (CCI) was applied to measure individual health status. Population-based descriptive analyses were used to examine related health care utilizations. Multivariate logistic regression models were applied to estimate the probability of early hospital readmissions controlling individual factors and medical institution characteristics.

Results: Among 108,846 observations, with a mean age of 78.88 years, 50.39% were men. 2,871 (2.64%) were readmitted within 14 days after hospital discharge. Stratified by early readmission status, univariate analyses identified significant associations of age (p<0.01), hospital level (p<0.001), hospital ownership (p<0.001), length of stay in index hospitalization (p<0.05) with readmitted cases. The readmitted older CHF patients on average consumed more than 40% of total hospital charges than those without readmission (p<0.001). The multivariate logistic regression models revealed that patients with one or two comorbidities were more likely to have early hospital readmission than those have no comorbidity (OR=1.28, 95%CI: 1.18-1.40 and OR=1.26, 95% CI: 1.14-1.38, respectively). Patients treated at medical center, non-for-profit or private hospitals, and with shorter length of stay in the index hospitalizations were more likely to be readmitted.

Conclusions: Early hospital readmission within 14 days after hospital discharge may suggest possible differences in quality of health care and care efficiency during index hospitalization. After more than a decade of introducing NHI universal health care coverage and improving access to care in Taiwan, it is crucial now to pay more attention to efficient disease management and continuous quality improvement. Particularly, how to prevent older adults with more comorbidities from severer health outcomes will be a critical challenge for policy makers and health care delivery system in Taiwan.