title: Geographical variation analysis of all-cause hospital readmission cases in Winnipeg, Canada.
abstract: BACKGROUND
  Hospital readmission is costly and potentially avoidable. The concept of virtual wards as a new model of care is intended to reduce hospital readmissions by providing short-term transitional care to high-risk and complex patients in the community. In order to provide information regarding the development of virtual wards in the Winnipeg Health Region, Canada, this study used spatial statistics to identify geographic variations of hospital readmissions in 25 neighborhood clusters.
  
  
  METHODS
  The data were obtained from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. We used a Bayesian Disease Mapping approach which applied Markov chain Monte Carlo (MCMC) for cluster detection.
  
  
  RESULTS
  Between 2005/06 and 2008/09, 123,842 patients were hospitalized in all Winnipeg hospitals. Of these, 41,551 (33%) were readmitted to hospital in the year following discharge. Most of these readmitted patients (89.4%) had 1-2 readmissions, while 11.6% of readmitted patients had more than 2 readmissions after initial discharge. The smoothed age- and sex- adjusted relative risk rates of hospital readmission in 25 Winnipeg neighborhood clusters ranged between 0.73 and 1.27. We found that there were spatial cluster variations of hospital readmission across the Winnipeg Health Region. Seven neighborhood clusters are more likely to be significant potential clusters for hospital readmissions (p < .05), while six neighborhood clusters are less likely to be significant potential clusters.
  
  
  CONCLUSIONS
  This study provides the foundation and implementation guide for the Winnipeg Regional Health Authority virtual ward program. The findings will also help to improve long-term condition management in community settings and will help program planners to assure the efficient use of healthcare resources.
authors.affiliation: Evaluation Platform, The George and Fay Yee Centre for Healthcare Innovation, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. umcui@myumanitoba.ca.|Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. umcui@myumanitoba.ca.|Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. umcui@myumanitoba.ca.
authors.forename: Yang
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. Mahmoud.Torabi@med.umanitoba.ca.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Torabi
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. Evelyn.Forget@med.umanitoba.ca.
authors.forename: Evelyn L
authors.initials: EL
authors.lastname: Forget
authors.affiliation: Evaluation Platform, The George and Fay Yee Centre for Healthcare Innovation, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. cmetge@wrha.mb.ca.|Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. cmetge@wrha.mb.ca.|Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. cmetge@wrha.mb.ca.
authors.forename: Colleen
authors.initials: C
authors.lastname: Metge
authors.affiliation: Evaluation Platform, The George and Fay Yee Centre for Healthcare Innovation, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. xye@wrha.mb.ca.|Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. xye@wrha.mb.ca.|Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. xye@wrha.mb.ca.
authors.forename: Xibiao
authors.initials: X
authors.lastname: Ye
authors.affiliation: Evaluation Platform, The George and Fay Yee Centre for Healthcare Innovation, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. mmoffatt@exchange.hsc.mb.ca.|Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba, R2K 2M9, Canada. mmoffatt@exchange.hsc.mb.ca.|Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. mmoffatt@exchange.hsc.mb.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Moffatt
authors.affiliation: Departments of Surgery & Family Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0 W1, Canada. Luis.Oppenheimer@gov.mb.ca.|Manitoba Health, 300 Carlton Street, Winnipeg, Manitoba, R3B 3 M9, Canada. Luis.Oppenheimer@gov.mb.ca.
authors.forename: Luis
authors.initials: L
authors.lastname: Oppenheimer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012737:Sex Factors; D017216:Telemedicine / Q000706:statistics & numerical data*