Chest Infections |

Thirty Day All-Cause Readmissions by Initial Pneumonia Type and Overall in Harlem FREE TO VIEW

Anita Akhtar, MD; Munib Aftab, MD; Jehanzeb Khan, MD; Gene Pesola, MD
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Columbia University at Harlem Hospital, New York, NY

Chest. 2015;148(4_MeetingAbstracts):123A. doi:10.1378/chest.2281478
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SESSION TITLE: Chest infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Recently, re-admission of any type within 30 days after an initial pneumonia episode has become a CMS standard of measurement for re-imbursement to hospitals. All-cause readmissions can occur after either community acquired (CAP) or health care associated pneumonia (HCAP). The purpose of this study was to evaluate re-admissions by initial pneumonia subtype and overall.

METHODS: Over 9 months, re-admissions after an initial pneumonia were analyzed to determine the 30 day all-cause re-admission rate. Pneumonias were divided into (CAP) and (HCAP) based on first admission. Diagnosis of pneumonia was by chest imaging with infiltrate and appropriate clinical picture. The t-test compared differences between groups. Logistic regression evaluated for factors independently associated with all-cause re-admission. Data is mean + S.D. NS = not significant.

RESULTS: A total of 186 patients, 131 CAP and 55 HCAP, were evaluated. Mean ages for CAP and HCAP were different at 57 + 16 and 67 + 20 years, respectively (p < 0.01). Fifteen of 131 (11.5%) and 18/55 (32.7%) were readmitted within 30 days (p < 0.01, Chi Square). Combining pneumonia overall, the mean age was 60 + 18 years for the group with ages of 65 + 18 and 59 + 18 for those readmitted versus not readmitted, respectively (NS). There was a 36.1 (95% C.I.; 8.7 to 150.5); 7.0 (2.0 to 24.9); 3.3 (0.9 to 11.8); 3.0 (0.8 to 10.9); and 2.8-fold greater odds of having end stage renal disease on hemodialysis (ESRD), HIV infection, CHF, previous CVA, or COPD respectively, in those readmitted within 30 days for any cause after an initial diagnosis of pneumonia (compared to not being readmitted).

CONCLUSIONS: All-cause readmissions after a pneumonia episode within 30 days are much more likely to occur in those with HCAP compared to CAP. Risk factors for readmission within 30 days include comorbidities of ESRD, HIV infection, CHF, previous CVA and COPD.

CLINICAL IMPLICATIONS: Patients with HCAP and those with several chronic medical conditions need to be targeted on discharge to try to prevent all-cause readmissions within 30 days.

DISCLOSURE: The following authors have nothing to disclose: Anita Akhtar, Munib Aftab, Jehanzeb Khan, Gene Pesola

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