• Quality Improvement in Health Care
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• v.22 no.1
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• pp.29-37
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• 2016

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

• Health Policy and Management
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• v.26 no.2
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• pp.148-152
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• 2016

The hospital readmission rate has been widely used as an indicator of the quality of hospital care in many countries. However, the transferrability of this indicator that has been developed in a different health care system can be questioned. We reviewed what should be considered when using the risk-standardized readmission rate (RSRR) as a generic quality indicator in the Korean setting. We addressed the relationship between RSRR and the quality of hospital care, methodological aspects of RSRR, and use of RSRR for external purposes. These issues can influence the validity of the readmission rate as a generic quality indicator. Therefore RSRR should be used with care and further studies are needed to enhance the validity of the readmission rate indicator.

• Health Policy and Management
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• v.25 no.3
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• pp.197-206
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• 2015

Background: The purpose of this study was to propose a method for developing a measure of hospital-wide all-cause risk-standardized readmissions using administrative claims data in Korea and to discuss further considerations in the refinement and implementation of the readmission measure. Methods: By adapting the methodology of the United States Center for Medicare & Medicaid Services for creating a 30-day readmission measure, we developed a 6-step approach for generating a comparable measure using Korean datasets. Using the 2010 Korean National Health Insurance (NHI) claims data as the development dataset, hierarchical regression models were fitted to calculate a hospital-wide all-cause risk-standardized readmission measure. Six regression models were fitted to calculate the readmission rates of six clinical condition groups, respectively and a single, weighted, overall readmission rate was calculated from the readmission rates of these subgroups. Lastly, the case mix differences among hospitals were risk-adjusted using patient-level comorbidity variables. The model was validated using the 2009 NHI claims data as the validation dataset. Results: The unadjusted, hospital-wide all-cause readmission rate was 13.37%, and the adjusted risk-standardized rate was 10.90%, varying by hospital type. The highest risk-standardized readmission rate was in hospitals (11.43%), followed by general hospitals (9.40%) and tertiary hospitals (7.04%). Conclusion: The newly developed, hospital-wide all-cause readmission measure can be used in quality and performance evaluations of hospitals in Korea. Needed are further methodological refinements of the readmission measures and also strategies to implement the measure as a hospital performance indicator.

• Journal of Korean Clinical Nursing Research
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• v.19 no.2
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• pp.265-274
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• 2013

Purpose: The aim of this study was to determine the risk factors contributed to unplanned readmission to intensive care unit (ICU) and to investigate the prediction model of unplanned readmission. Methods: We retrospectively reviewed the electronic medical records which included the data of 3,903 patients who had discharged from ICUs in a university hospital in Seoul from January 2011 to April 2012. Results: The unplanned readmission rate was 4.8% (n=186). The nine variables were significantly different between the unplanned readmission and no readmission groups: age, clinical department, length of stay at 1st ICU, operation, use of ventilator during 24 hours a day, APACHE II score at ICU admission and discharge, direct nursing care hours and Glasgow coma scale total score at 1st ICU discharge. The clinical department, length of stay at 1st ICU, operation and APACHE II score at ICU admission were the significant predictors of unplanned ICU readmission. The predictive model's area under the curve was .802 (p<.001). Conclusion: We identified the risk factors and the prediction model associated with unplanned ICU readmission. Better patient assessment tools and knowledge about risk factors could contribute to reduce unplanned ICU readmission rate and mortality.

• Tuberculosis and Respiratory Diseases
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• v.83 no.4
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• pp.303-311
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• 2020

Background: If the duration of mechanical ventilation (MV) is related with the intensive care unit (ICU) readmission must be clarified. The purpose of this study was to elucidate if prolonged MV duration increases ICU readmission rate. Methods: The present observational cohort study analyzed national healthcare claims data from 2006 to 2015. Critically ill patients who received MV in the ICU were classified into five groups according to the MV duration: MV for <7 days, 7-13 days, 14-20 days, 21-27 days, and ≥28 days. The rate and risk of the ICU readmission were estimated according to the MV duration using the unadjusted and adjusted analyses. Results: We found that 12,929 patients had at least one episode of MV in the ICU. There was a significant linear relationship between the MV duration and the ICU readmission (R²=0.85, p=0.025). The total readmission rate was significantly higher as the MV duration is prolonged (MV for <7 days, 13.9%; for 7-13 days, 16.7%; for 14-20 days, 19.4%; for 21-27 days, 20.4%; for ≥28 days, 35.7%; p<0.001). The analyses adjusted by covariables and weighted with the multinomial propensity scores showed similar results. In the adjusted regression analysis with a Cox proportional hazards model, the MV duration was significantly related to the ICU readmission (hazard ratio, 1.058 [95% confidence interval, 1.047-1.069], p<0.001). Conclusion: The rate of readmission to the ICU was significantly higher in patients who received longer durations of the MV in the ICU. In the clinical setting, closer observation of patients discharged from the ICU after prolonged periods of MV is required.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.116-121
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• 2014

Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12- 3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001), bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046), American Society of Anesthesiologists (ASA) class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004), and obesity (body mass index ${\geq}30$) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

• Health Policy and Management
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• v.31 no.4
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• pp.451-461
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• 2021

Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion: "Reducing the readmission rate" is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

• Tuberculosis and Respiratory Diseases
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• v.83 no.2
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• pp.147-156
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• 2020

Background: Limited studies have been performed to assess readmission following hospitalization for community-acquired pneumonia (CAP) in an Asian population. We evaluated the rates, reasons, and risk factors for 30-day readmission following hospitalization for CAP in the general adult population of Korea. Methods: We performed a retrospective observational study of 1,021 patients with CAP hospitalized at Yeungnam University from March 2012 to February 2014. The primary end point was all-cause hospital readmission within 30 days following discharge after the initial hospitalization. Hospital readmission was classified as pneumonia-related or pneumonia-unrelated readmission. Results: During the study period, 862 patients who survived to hospital discharge were eligible for inclusion and among them 72 (8.4%) were rehospitalized within 30 days. In the multivariable analysis, pneumonia-related readmission was associated with para/hemiplegia, malignancy, pneumonia severity index class ≥4 and clinical instability ≥1 at hospital discharge. Comorbidities such as chronic lung disease and chronic kidney disease, treatment failure, and decompensation of comorbidities were associated with the pneumonia-unrelated 30-day readmission rate. Conclusion: Rehospitalizations within 30 days following discharge were frequent among patients with CAP. The risk factors for pneumonia-related and -unrelated readmission were different. Aspiration prevention, discharge at the optimal time, and close monitoring of comorbidities may reduce the frequency of readmission among patients with CAP.

• Journal of Korean Biological Nursing Science
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• v.24 no.4
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• pp.262-271
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• 2022

Purpose: The purpose of this study was to identify the factors affecting readmission in stroke patients. Methods: A retrospective study design was used. Participants were 3,675 adult cerebral stroke patients in the inpatient wards of the Department of Neurology and Neurosurgery of G University Hospital located in C city. Data were collected from January 1, 2016 to December 31, 2021 and data were analyzed using χ² test, independent t-test, and multivariate logistic regression with SPSS/WIN 24.0. Results: After discharge for stroke, the readmission rate was 23.7%, and the mortality rate was 0.3%. The variables with significant differences between the readmission group and non-readmission group were age, type of stroke, surgery, ICU treatment, mRS score, blood pressure, diabetes, and heart disease. Factors influencing an readmission in stroke patients were Age 65-74 (OR 1.30, 95% CI=1.03-1.64), ≥ 75 (OR 1.28, 95% CI=1.02-1.62), mRS score 2points (OR 2.50, 95% CI=1.99-3.13), HTN status (OR 1.26, 95% CI=1.07-1.50), CVD status (OR 1.38, 95% CI=1.01-1.90), TC (OR 1.60, 95% CI=1.05-2.44). Conclusion: To lower the readmission rate of stroke patients, it is essential to control lifestyle, including whether or not to take treatment drugs, after diagnosing risk factors such as high blood pressure, diabetes, and heart disease, hyperlipidemia. Nursing interventions that can provide information on risk factor management and coping strategies are urgently needed as symptoms change. In addition, research is needed to develop and implement an intervention strategy that can improve the function of stroke patients as much as possible at home or in society so that they can lead an independent life without the help of others, and verify their effectiveness.

• Pediatric Infection and Vaccine
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• v.24 no.3
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• pp.146-151
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• 2017

Purpose: We analyzed the risk factors affecting readmission of children with pneumonia. Methods: We retrospectively analyzed the medical records of pediatric patients admitted to the Department of Pediatrics at the Jeonju Presbyterian Medical Center from January 2007 to August 2016. We classified patients who were readmitted with pneumonia within 30 days of discharge as the readmission group and patients who were admitted with pneumonia for the first time as the first admission group. Results: Among 158 patients, the study (readmission) group included 82 patients and the control (first admission) group included 76 patients. Age, the percentage of segmented neutrophils and lymphocytes, the number of admissions in the last 12 months, the associated diseases (respiratory diseases such as asthma), and the affection of the right upper lung were analyzed as risk factors for readmission. However, based on a regression analysis, only age and associated diseases were found to be significant risk factors. The rate of readmission increased with younger age. When there were associated diseases, the rate of readmission also increased. Conclusions: Young age and associated diseases were significant risk factors for readmission for patients with pediatric pneumonia. When pediatric patients are admitted with pneumonia, if they are young and/or have associated diseases, a comprehensive approach is needed to reduce the rate of readmission with careful consideration of precise examination, treatment, timing of discharge, and follow-up.