title: Unplanned Readmissions After Hospitalization for Severe Sepsis at Academic Medical Center-Affiliated Hospitals.
abstract: OBJECTIVE
  In the United States, national efforts to reduce hospital readmissions have been enacted, including the application of substantial insurance reimbursement penalties for hospitals with elevated rates. Readmissions after severe sepsis remain understudied and could possibly signify lapses in care and missed opportunities for intervention. We sought to characterize 7- and 30-day readmission rates following hospital admission for severe sepsis as well as institutional variations in readmission.
  
  
  METHODS
  Retrospective analysis of 345,657 severe sepsis discharges from University HealthSystem Consortium hospitals in 2012.
  
  
  METHODS
  United States.
  
  
  METHODS
  We applied the commonly cited method described by Angus et al for identification of severe sepsis, including only discharges with sepsis present at admission.
  
  
  METHODS
  None.
  
  
  RESULTS
  We identified unplanned, all-cause readmissions within 7 and 30 days of discharge using claims-based algorithms. Using mixed-effects logistic regression, we determined factors associated with 30-day readmission. We used risk-standardized readmission rates to assess institutional variations. Among 216,328 eligible severe sepsis discharges, there were 14,932 readmissions within 7 days (6.9%; 95% CI, 6.8-7.0) and 43,092 within 30 days (19.9%; 95% CI, 19.8-20.1). Among those readmitted within 30 days, 66.9% had an infection and 40.3% had severe sepsis at readmission. Patient severity, length of stay, and specific diagnoses were associated with increased odds of 30-day readmission. Observed institutional 7-day readmission rates ranged from 0% to 12.3%, 30-day rates from 3.6% to 29.1%, and 30-day risk-standardized readmission rates from 14.1% to 31.1%. Greater institutional volume, teaching status, trauma services, location in the Northeast, and lower ICU rates were associated with poor risk-standardized readmission rate performance.
  
  
  CONCLUSIONS
  Severe sepsis readmission places a substantial burden on the healthcare system, with one in 15 and one in five severe sepsis discharges readmitted within 7 and 30 days, respectively. Hospitals and clinicians should be aware of this important sequela of severe sepsis.
authors.affiliation: 1Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL. 2Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. 3Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL. 4University HealthSystem Consortium, Chicago, IL. 5Department of Health Systems Management, Rush University, Chicago, IL.
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000628:therapy*; D013997:Time Factors; D014481:United States