title: Variation in Postsepsis Readmission Patterns: A Cohort Study of Veterans Affairs Beneficiaries.
abstract: BACKGROUND
  Rehospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations.
  
  
  OBJECTIVE
  To examine the variation in postsepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries.
  
  
  METHODS
  Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 vs. ≥65 yr), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital. In the primary analysis, sepsis hospitalizations were identified using a previously validated method. Sensitivity analyses were performed using alternative definitions with explicit International Classification of Diseases, Ninth Revision, Clinical Modification, codes for sepsis, and separately for severe sepsis and septic shock.
  
  
  RESULTS
  The primary outcomes were rate of 90-day all-cause hospital readmission after sepsis hospitalization and proportion of readmissions resulting from specific diagnoses, including the proportion of "potentially preventable" readmissions. Readmission diagnoses were similar from 2009 to 2011, with little variation in readmission rates across hospitals. The top six readmission diagnoses (heart failure, pneumonia, sepsis, urinary tract infection, acute renal failure, and chronic obstructive pulmonary disease) accounted for 30% of all readmissions. Although about one in five readmissions had a principal diagnosis for infection, 58% of all readmissions received early systemic antibiotics. Infection accounted for a greater proportion of readmissions among patients discharged to nursing facilities compared with patients discharged to home (25.0-27.1% vs. 16.8%) and among older vs. younger patients (22.2% vs. 15.8%). Potentially preventable readmissions accounted for a quarter of readmissions overall and were more common among older patients and patients discharged to nursing facilities.
  
  
  CONCLUSIONS
  Hospital readmission rates after sepsis were similar by site and admission year. Heart failure, pneumonia, sepsis, and urinary tract infection were common readmission diagnoses across all patient groups. Readmission for infection and potentially preventable diagnoses were more common in older patients and patients discharged to nursing facilities.
authors.affiliation: 1 VA Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and.|2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hallie C
authors.identifier: http://orcid.org/0000-0002-8442-6724
authors.initials: HC
authors.lastname: Prescott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D012866:Skilled Nursing Facilities; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: hospitalization; patient outcomes assessment; patient readmission; sepsis; skilled nursing facility