title: Hospital Factors Associated With Care Discontinuity Following Emergency General Surgery.
abstract: Although there is evidence that changes in clinicians during the continuum of care (care discontinuity) are associated with higher mortality and complications among surgical patients, little is known regarding the drivers of care discontinuity among emergency general surgery (EGS) patients.
  
  
  
  To identify hospital factors associated with care discontinuity among EGS patients.
  
  
  
  We performed a retrospective analysis of the 100% Medicare inpatient claims file, from January 1, 2008, to November 30, 2011, and matched patient details to hospital information in the 2011 American Hospital Association Annual Survey database. We selected patients aged 65 years and older who had the most common procedures associated with the previously defined American Association for the Surgery of Trauma EGS diagnosis categories and survived to hospital discharge across the United States. The current analysis was conducted from February 1, 2016, to March 24, 2016.
  
  
  
  Care discontinuity defined as readmission within 30 days to nonindex hospitals.
  
  
  
  There were 109 443 EGS patients readmitted within 30 days of discharge and 20 396 (18.6%) were readmitted to nonindex hospitals. Of the readmitted patients, 61 340 (56%) were female. Care discontinuity was higher among patients who were male (19.5% vs 18.0%), those younger than 85 years old (19.0% vs 16.6%), and those who lived 12.8 km (8 miles) or more away from the index hospitals (23.7% vs 14.8%) (all P < .001). Care discontinuity was independently associated with mortality (adjusted odds ratio [aOR], 1.16; 95% CI, 1.08-1.25). Hospital factors associated with care discontinuity included bed size of 200 or more (aOR, 1.45; 95% CI, 1.36-1.54), safety-net status (aOR, 1.35; 95% CI, 1.27-1.43), and teaching status (aOR, 1.18; 95% CI, 1.09-1.28). Care discontinuity was significantly lower among designated trauma centers (aOR, 0.89; 95% CI, 0.83-0.94) and highest among hospitals in the Midwest (aOR, 1.15; 95% CI, 1.05-1.26).
  
  
  
  Nearly 1 in 5 older EGS patients is readmitted to a hospital other than where their original procedure was performed. This care discontinuity is independently associated with mortality and is highest among EGS patients who are treated at large, teaching, safety-net hospitals. These data underscore the need for sustained efforts in increasing continuity of care among these hospitals and highlight the importance of accounting for these factors in risk-adjusted hospital comparisons.
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts2Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Havens
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts2Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Olubode A
authors.initials: OA
authors.lastname: Olufajo
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Tsai
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Columbus
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Nitzschke
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts2Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts2Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D015996:Survival Rate; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States