Predictors of early hospital readmission in HIV-infected patients with pneumonia.
OBJECTIVE
Although hospitalization patterns have been studied, little is known about hospital readmission among HIV-infected patients in the era of highly active antiretroviral therapy. We explored the risk factors for early readmission to a tertiary care inner-city hospital among HIV-infected patients with pneumonia in Vancouver, Canada.


METHODS
Case-control study.


METHODS
Tertiary care, university-affiliated, inner-city hospital.


METHODS
All HIV-infected patients who were hospitalized with Pneumocystis carinii pneumonia (PCP) or bacterial pneumonia (BP) between January 1997 and December 2000. Case patients included those who had early readmissions, defined as being readmitted within 2 weeks of discharge (N = 131). Control patients were randomly selected HIV-infected patients admitted during the study period who were not readmitted within 2 weeks of discharge (N = 131), matched to the cases by proportion of PCP to BP.


METHODS
Sociodemographic, HIV risk category, and clinical data were compared using chi2 test for categorical variables, and the Wilcoxon rank-sum test was used for continuous variables. Multivariable logistic regression was performed to determine the factors independently associated with early readmission. We also reviewed the medical records of 132 patients admitted to the HIV/AIDS ward during the study period and collected more detailed clinical data for a subanalysis.


RESULTS
Patients were at significantly increased odds of early readmission if they left the hospital against medical advice (AMA) (adjusted odds ratio [OR], 4.26; 95% confidence interval [95% CI], 2.13 to 8.55), lived in the poorest urban neighborhood (OR, 2.03; 95% CI, 1.09 to 3.77), were hospitalized in summer season (May though October, OR, 2.36; 95% CI, 1.36 to 4.10), or had been admitted in the preceding 6 months (OR, 2.55; 95% CI, 1.46 to 4.47). Gender, age, history of AIDS-defining illness, and injection drug use status were not significantly associated with early readmission.


CONCLUSIONS
Predictors of early readmission of HIV-infected patients with pneumonia included: leaving hospital AMA, living in the poorest urban neighborhood, being hospitalized in the preceding 6 months and during the summer months. Interventions involving social work may address some of the underlying reasons why these patients leave hospital AMA and should be further studied.
Palepu
Anita
A
Received from the Department of Internal Medicine, the Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
Sun
Huiying
H
Kuyper
Laura
L
Schechter
Martin T
MT
O'Shaughnessy
Michael V
MV
Anis
Aslam H
AH
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000523:psychology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors