title: Impact of Hospital Population Case-Mix, Including Poverty, on Hospital All-Cause and Infection-Related 30-Day Readmission Rates.
abstract: BACKGROUND
  Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospital risk factors for readmissions and infection-related readmissions may help optimize interventions to prevent readmissions.
  
  
  METHODS
  Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen's kappa.
  
  
  RESULTS
  We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions.
  
  
  CONCLUSIONS
  Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine.
authors.forename: Shruti K
authors.initials: SK
authors.lastname: Gohil
authors.affiliation: Department of Medicine, Yale School of Medicine.
authors.forename: Rupak
authors.initials: R
authors.lastname: Datta
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine.
authors.forename: Chenghua
authors.initials: C
authors.lastname: Cao
authors.affiliation: Department of Statistics, University of California, Irvine.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Phelan
authors.affiliation: Department of Statistics, University of California, Irvine.
authors.forename: Vinh
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine.
authors.forename: Armaan A
authors.initials: AA
authors.lastname: Rowther
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003141:Communicable Diseases / Q000453:epidemiology; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000592:standards / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: healthcare associated infections; hospital infections; poverty; readmissions