30-Day Readmission Rate, by Principal Discharge Diagnosis.

30-day Readmission Rate, by Principal Discharge Diagnosis

 

Readmissions may occur either very shortly after discharge or several weeks later. The etiology of early versus late readmissions likely differs substantially. Very early readmissions may reflect inappropriately premature discharge or poor preparation for discharge. Readmission may, in fact, occur before the patient receives outpatient dialysis, as in the case of a patient discharged on Friday and not scheduled to dialyze until Monday. On the other hand, late readmissions may reflect poor adherence to newly prescribed medications or suboptimal treatment by dialysis providers, leading to recurrence of cardiovascular instability or worsening infection.

In 2011, the cumulative readmission rate was 5.3 percent within three days after discharge and 12.1 percent within seven days. With each subsequent seven-day interval, the cumulative readmission rate decreased more slowly.

Rates of both readmission and death during the 30 days following live discharge vary according to the principal discharge diagnosis. For discharges with cardiovascular disease, the 30-day readmission rate in 2011 was 35.4 percent; the corresponding rate for discharges with infection was 33.5 percent.

Among discharges with cardiovascular disease, 30-day readmission is most likely for acute coronary syndrome, primarily due to higher risk of early readmission, as is consistent with worsening heart failure after myocardial infarction. Readmission is least likely for heart failure and cardiomyopathy. Risk of death within 30 days of discharge is also highest for acute coronary syndrome.

Among discharges with infection, 30-day readmission is most likely for intestinal infection with C. difficile and for bacteremia and septicemia. For both categories, readmission rates within 10 days of discharge exceed 18 percent. The readmission rate is lowest for dialysis access infections. Risk of death within 30 days of discharge is highest for bacteremia and septicemia, at 4.2 percent.

The rate of 30-day readmission is relatively high for acute respiratory failure and relatively low for dialysis access complications, excluding infection.

30-day readmission rates among live discharges on chronic dialysis, by days following discharge (2011).

30-day readmission rates among live discharges on chronic dialysis, by days following discharge (2011).

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