title: Hospital readmissions of patients with heart failure: the impact of hospital and primary care organizational factors in Northern Italy.
abstract: BACKGROUND
  Primary health care is essential for an appropriate management of heart failure (HF), a disease which is a major clinical and public health issue and a leading cause of hospitalization. The aim of this study was to evaluate the impact of different organizational factors on readmissions of patients with HF.
  
  
  METHODS
  The study population included elderly resident in the Local Health Authority of Bologna (Northern Italy) and discharged with a diagnosis of HF from January to December 2010. Unplanned hospital readmissions were measured in four timeframes: 30 (short-term), 90 (medium-term), 180 (mid-long-term), and 365 days (long-term). Using multivariable multilevel Poisson regression analyses, we investigated the association between readmissions and organizational factors (discharge from a cardiology department, general practitioners' monodisciplinary organizational arrangement, and implementation of a specific HF care pathway).
  
  
  RESULTS
  The 1873 study patients had a median age of 83 years (interquartile range 77-87) and 55.5% were females; 52.0% were readmitted to the hospital for any reason after a year, while 20.1% were readmitted for HF. The presence of a HF care pathway was the only factor significantly associated with a lower risk of readmission for HF in the short-, medium-, mid-long- and long-term period (short-term: IRR [incidence rate ratio]=0.57, 95%CI [confidence interval]=0.35-0.92; medium-term: IRR=0.70, 95%CI=0.51-0.96; mid-long-term: IRR=0.79, 95%CI=0.64-0.98; long-term: IRR=0.82, 95%CI=0.67-0.99), and with a lower risk of all-cause readmission in the short-term period (IRR=0.73, 95%CI=0.57-0.94).
  
  
  CONCLUSIONS
  Our study shows that the HF care specific pathway implemented at the primary care level was associated with lower readmission rate for HF in each timeframe, and also with lower readmission rate for all causes in the short-term period. Our results suggest that the engagement of primary care professionals starting from the early post-discharge period may be relevant in the management of patients with HF.
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Vera Maria
authors.initials: VM
authors.lastname: Avaldi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Lenzi
authors.affiliation: Department of Programming and Control, Bologna Local Healthcare Authority, Bologna, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Castaldini
authors.affiliation: Department of Cardiology, Bellaria Hospital, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Urbinati
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.affiliation: Department of Primary Care, Bologna Local Healthcare Authority, Bologna, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Morini
authors.affiliation: Department of Programming and Control, Bologna Local Healthcare Authority, Bologna, Italy.
authors.forename: Adalgisa
authors.initials: A
authors.lastname: Protonotari
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006739:Hospital Administration / Q000379:methods* / Q000592:standards; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D012044:Regression Analysis; D013997:Time Factors