Adults With HIV Have 1.5 Times Higher Hospital Readmission Risk: AHRQ Study

Adults living with HIV have a higher likelihood of being readmitted to the hospital within 30 days than those not infected with the virus, according to a new AHRQ study. Risk-adjusted 30-day hospital readmission rates are a commonly used benchmark for hospital care quality and Medicare reimbursement. In this study, researchers used AHRQ’s 2011 Healthcare Cost and Utilization Project hospital discharge data from nine states to compare readmission rates. Nonadjusted readmission rates were 11.2 percent for people without HIV and 19.7 percent for those with HIV. Predicted, adjusted readmission rates were higher for people with HIV in every insurance category, including Medicaid and Medicare, and within every diagnostic category. The findings should encourage policymakers and insurers to consider HIV status when setting readmission standards, researchers stated. The study, “Thirty-Day Hospital Readmissions for Adults With and Without HIV Infection,” andabstract were published July 14 in the journal HIV Medicine.

2015 Jul 14. doi: 10.1111/hiv.12287. [Epub ahead of print]

Thirty-day hospital readmissions for adults with and without HIV infection.

Berry SA1, Fleishman JA2, Moore RD1, Gebo KA1.

Author information

Abstract

OBJECTIVES:

Risk-adjusted 30-day hospital readmission rate is a commonly used benchmark for hospital quality of care and for Medicare reimbursement. Persons living with HIV (PLWH) may have high readmission rates. This study compared 30-day readmission rates by HIV status in a multi-state sample with planned subgroup comparisons by insurance and diagnostic categories.

METHODS:

Data for all acute care, nonmilitary hospitalizations in nine states in 2011 were obtained from the Healthcare Costs and Utilization Project. The primary outcome was readmission for any cause within 30 days of hospital discharge. Factors associated with readmission were evaluated using multivariate logistic regression.

RESULTS:

A total of 5 484 245 persons, including 33 556 (0.6%) PLWH, had a total of 6 441 695 index hospitalizations, including 45 382 (0.7%) among PLWH. Unadjusted readmission rates for hospitalizations of HIV-uninfected persons and PLWH were 11.2% [95% confidence interval (CI) 11.2, 11.2%] and 19.7% (95% CI 19.3, 20.0%), respectively. After adjustment for age, gender, race, insurance, and diagnostic category, HIV infection was associated with 1.50 (95% CI 1.46, 1.54) times higher odds of readmission. Predicted, adjusted readmission rates were higher for PLWH within every insurance category, including Medicaid [12.9% (95% CI 12.8, 13.0%) and 19.1% (95% CI 18.4, 19.7%) for HIV-uninfected persons and PLWH, respectively] and Medicare [13.2% (95% CI 13.1, 13.3%) and 18.0% (95% CI 17.4, 18.7%), respectively], and within everydiagnostic category.

CONCLUSIONS:

HIV infection is associated with significantly increased readmission risk independent of demographics, insurance, and diagnosticcategory. The 19.7% 30-day readmission rate may serve as a preliminary benchmark for assessing quality of care of PLWH. Policy-makers may consider adjusting for HIV infection when calculating a hospital's expected readmission rate.