Department of Population and Quantitative Health Sciences; Graduate School of Biomedical Sciences
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Administration | Health Services Research
BACKGROUND: Heart failure patients have high rates of repeat acute care use. Current efforts for risk prediction often ignore postdischarge data.
OBJECTIVE: To identify postdischarge patient-reported clinical factors associated with repeat acute care use.
RESEARCH DESIGN: In a prospective cohort study that followed patients with chronic heart failure for 30 days postdischarge, for 7 days after discharge (or fewer days if patients used acute care within 7 days postdischarge), patients reported health status, heart failure symptoms, medication management, knowledge of follow-up plans, and other issues using a daily interactive automatic phone call.
SUBJECTS: A total of 156 patients who had responded to phone surveys.
MEASURES: The outcome variable was dichotomous 30-day acute care use (rehospitalization or emergency department visit). We examined the association between each patient-reported issue and the outcome, using multivariable logistic regression to adjust for confounders.
RESULTS: Patients were 63 years old (SD=12.4), with 51% African-American and 53% women. Within 30 days postdischarge, 30 (19%) patients used acute care. After adjustment, poor health status [odds ratio (OR)=3.53; 95% confidence interval (CI), 1.06-11.76], pain (OR=2.44; 95% CI, 1.02-5.84), and poor appetite (OR=3.05; 95% CI, 1.13-8.23) were positively associated with 30-day acute care utilization. Among 58 reports of pain in follow-up nursing notes, 39 (67%) were noncardiac, 2 (3%) were cardiac, and 17 (29%) were indeterminate.
CONCLUSIONS: Patient-reported poor health status, pain, and poor appetite were positively associated with 30-day acute care utilization. These novel postdischarge markers require further study before incorporation into risk prediction to drive quality improvement efforts.
consumer health informatics, cardiovascular disease, care transitions, health services research, patient safety
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Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
DOI of Published Version
Chen J, Sadasivam R, Blok AC, Ritchie CS, Nagawa C, Orvek E, Patel K, Houston TK. The Association Between Patient-reported Clinical Factors and 30-day Acute Care Utilization in Chronic Heart Failure. Med Care. 2020 Apr;58(4):336-343. doi: 10.1097/MLR.0000000000001258. PMID: 32197028; PMCID: PMC7069395. Link to article on publisher's site
Chen J, Sadasivam RS, Blok AC, Ritchie CS, Nagawa CS, Orvek EA, Patel K, Houston TK. (2020). The Association Between Patient-reported Clinical Factors and 30-day Acute Care Utilization in Chronic Heart Failure. Population and Quantitative Health Sciences Publications. https://doi.org/10.1097/MLR.0000000000001258. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1342
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.