Thirty-Day Readmissions Among HIV-Infected Individuals at a Safety-Net Hospital: Predictors and Preventability

Abstract

Background. Readmissions within 30 days of hospital discharge, a key quality indicator under the Affordable Care Act, are costly and potentially preventable. Readmissions disproportionately affect vulnerable populations, including patients in safety-net hospitals or with HIV. Limited data exist on the predictors and preventability of readmissions in this population. Methods. A retrospective chart review included all inpatient admissions among HIV-infected adults to Parkland Health and Hospital System in Dallas, TX, between 1 March 2015 and 28 February 2016. Clinical data and barriers to care were abstracted from the electronic medical record. Multivariate logistic regression was performed to determine predictors of 30-day readmissions. Results. A total of 1465 admissions occurred among 918 unique individuals with HIV. They were 71% male, 56% black, 22% Hispanic with a mean age of 43 years. Of the 918, 85 (9.3%) were readmitted within 30 days. Predictors of readmission included having Medicaid insurance (aOR 1.8, 95% CI 1.0-2.8, P = 0.02), HIV viral load (aOR 0.8, 0.7-0.9, P < 0.01), leaving against medical advice (aOR 5.6, 1.7-7.2, P <0.01), or reporting 1 or more barrier(s) to care (such as mental health disorder, substance use, homelessness, incarceration, aOR 2.2, 1.2-4.2, P = 0.01). The most common reason for the index admission among those readmitted were: AIDS-defining illness (29%), non-AIDS related infections (14%), and GI/liver (14%). Overall, nearly half (45%) of readmissions were deemed potentially preventable. Of these, two thirds (66%) were readmitted for the same reason as the index admission. Furthermore, chart review of the inpatient to outpatient transition identified preventable causes for readmissions in 71% during the index admission, 45% during the discharge process, and 25% during post-hospital follow-up. Conclusion. Readmissions remain common among HIV-infected patients in a safety-net hospital system. Nearly half of readmissions may be preventable due to contributions from both clinical management and social needs perspectives. Future efforts to reduce readmissions should include coordination of medical care and intensive case management initiated early in the hospitalization.