title: Thirty-day hospital readmission rate among adults living with HIV.
abstract: OBJECTIVE
  Thirty-day hospital readmission rate is receiving increasing attention as a quality-of-care indicator. The objective of this study was to determine readmission rates and to identify factors associated with readmission among persons living with HIV.
  
  
  METHODS
  Prospective multicenter observational cohort.
  
  
  METHODS
  Nine US HIV clinics affiliated through the HIV Research Network.
  
  
  METHODS
  Patients engaged in HIV care during 2005-2010.
  
  
  METHODS
  Readmission rate was defined as the proportion of hospitalizations followed by a readmission within 30 days. Factors in multivariate analyses included diagnostic categories, patient demographic and clinical characteristics, and having an outpatient follow-up visit.
  
  
  RESULTS
  Among 11,651 total index hospitalizations, the 30-day readmission rate was 19.3%. AIDS-defining illnesses (ADIs, 9.6% of index hospitalizations) and non-AIDS-defining infections (26.4% of index hospitalizations) had readmission rates of 26.2 and 16.6%, respectively. Factors independently associated with readmission included lower CD4 cell count [adjusted odds ratio 1.80 (1.53-2.11) for CD4 cell count <50 vs. ≥351 cells/μl], longer length of stay [1.77 (1.53-2.04) for ≥9 days vs. 1-3 days], and several diagnostic categories including ADI. Having an outpatient follow-up clinic visit was not associated with lower readmission risk [adjusted hazard ratio 0.98 (0.88-1.08)].
  
  
  CONCLUSIONS
  The 19.3% readmission rate exceeds the 13.3% rate reported for the general population of 18-64-year-olds. HIV providers may use the 19.3% rate as a basis of comparison. Policymakers may consider the impact of HIV when estimating expected readmissions for a hospital or region. Preventing or recovering from severe immune dysfunction may be the most important factor to reducing readmissions.
authors.affiliation: aJohns Hopkins University, Baltimore bAgency for Healthcare Research and Quality, Rockville, Maryland cUniversity of Pennsylvania, Philadelphia, Pennsylvania dOregon Health and Science University, Portland, Oregon, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Berry
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult