Abstract
Background
Unplanned readmissions cost the US economy approximately $17 billion in 2009 with
a 30-day incidence of 19.6%. Despite the recognised impact of socio–economic status
(SES) on readmission in diagnostic populations such as cardiovascular patients, its
impact in trauma patients is unclear. We examined the effect of SES on unplanned readmission
following injury in a setting with universal health insurance. We also evaluated whether
additional adjustment for SES influenced risk-adjusted readmission rates, used as
a quality indicator (QI).
Study design
We conducted a multicenter cohort study in an integrated Canadian trauma system involving
56 adult trauma centres using trauma registry and hospital discharge data collected
between 2005 and 2010. The main outcome was unplanned 30-day readmission; all cause,
due to complications of injury and due to subsequent injury. SES was determined using
ecological indices of material and social deprivation. Odds ratios of readmission
and 95% confidence intervals adjusted for covariates were generated using multivariable
logistic regression with a correction for hospital clusters. We then compared a readmission
QI validated previously (original QI) to a QI with additional adjustment for SES (SES-adjusted
QI) using the mean absolute difference.
Results
The cohort consisted of 52,122 trauma admissions of which 6.5% were rehospitalised
within 30 days of discharge. Compared to patients in the lowest quintile of social
deprivation, those in the highest quintile had a 20% increase in the odds of all-cause
unplanned readmission (95% CI = 1.06–1.36) and a 27% increase in the odds of readmission due to complications of injury
(95% CI = 1.04–1.54). No association was observed for material deprivation or for readmissions
due to subsequent injuries. We observed a strong agreement between the original and
SES-adjusted readmission (mean absolute difference = 0.04%).
Conclusions
Patients admitted for traumatic injury who suffer from social deprivation have an
increased risk of unplanned rehospitalisation due to complications of injury in the
30 days following discharge. Better discharge planning or follow up for such patients
may improve patient outcome and resource use for trauma admissions. Despite observed
associations, results suggest that the trauma QI based on unplanned readmission does
not require additional adjustment for SES.
Keywords
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References
- Derivation and validation of a quality indicator for 30-day unplanned hospital readmission to evaluate trauma care.J Trauma Acute Care Surg. 2014; 76: 1310-1316
- A review of injury epidemiology in the UK and Europe: some methodological considerations in constructing rates.BMC Public Health. 2009; 9: 226
CIHI. Injury Hospitalizations and Socio-Economic Status. Available at: https://secure.cihi.ca/free_products/Injury_aib_vE4CCF_v3_en.pdf. Accessed February 10, 2014.
- Significant variations in mortality occur at similarly designated trauma centers.Arch Surg. 2009; 144: 64-68
- Readmission after colectomy for cancer predicts one-year mortality.Ann Surg. 2010; 251: 659-669
CIHI. All-Cause Readmission to Acute Care and Return to the Emergency Department. Available at: https://secure.cihi.ca/free_products/Readmission_to_acutecare_en.pdf. Accessed February 10, 2014.
- Rates, patterns, and determinants of unplanned readmission after traumatic injury: a multicenter cohort study.Ann Surg. 2014; 259: 374-380
- Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review.J Gen Intern Med. 2013; 28: 269-282
- Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis.Intern Med J. 2012; 42: e129-e136
- Socioeconomic disparities in outcomes after acute myocardial infarction.Am Heart J. 2007; 153: 313-319
- Influence of socioeconomic status on trauma center performance evaluations in a Canadian trauma system.J Am Coll Surg. 2011; 213: 402-409
- Factoring socioeconomic status into cardiac performance profiling for hospitals: does it matter?.Med Care. 2002; 40: 60-67
Cadre normatif - Registre des traumatismes du Québec (RTQ). Available at: http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2007/07-912-01_c1.pdf. Accessed May 1, 2013.
- An evaluation of provider-related and disease-related morbidity in a level I university trauma service: directions for quality improvement.J Trauma. 1992; 33: 586-601
- Indice de défavorisation matérielle et sociale: son application au secteur de la santé et du bien-être.Santê Soc Solidar. 2003; : 191-208
- An area-based material and social deprivation index for public health in Quebec and Canada.Can J Public Health. 2012; 103: S17-S22
- Impact of socioeconomic deprivation and area of residence on access to coronary revascularization and mortality after a first acute myocardial infarction in Quebec.Can J Cardiol. 2012; 28: 169-177
- A deprivation index for health planning in Canada.Chronic Dis Can. 2009; 29: 178-191
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Social deprivation and psychiatric admission rates in Amsterdam.Soc Psychiatry Psychiatr Epidemiol. 1997; 32: 485-492
- Medication adherence and heart failure.Curr Cardiol Rep. 2014; 16: 458
- Using routine data to monitor inequalities in an acute trust: a retrospective study.BMC Health Serv Res. 2012; 12: 104
- Significance of social demographic data for rehospitalization of schizophrenic patients.J Health Soc Behav. 1974; 15: 117-126
- Heart failure and socioeconomic status: accumulating evidence of inequality.Eur J Heart Fail. 2012; 14: 138-146
- The use of end-quintile comparisons to identify under-servicing of the poor and over-servicing of the rich: a longitudinal study describing the effect of socioeconomic status on healthcare.BMC Health Serv Res. 2005; 5: 61
- Hospital readmissions--not just a measure of quality.JAMA. 2011; 306: 1796-1797
- Social factors and hospitalization.Can Resp J. 2008; 15: 343-344
- Factors leading to 30 day readmission following hospitalization for heart failure.J Am Coll Cardiol. 2010; 55 (A144.E1349)
- Racial/ethnic disparities in potentially preventable readmissions: The case of diabetes.Am J Public Health. 2005; 95: 1561-1567
- Factors affecting the likelihood of presentation to the emergency department of trauma patients after discharge.Ann Emerg Med. 2011; 58: 431-437
- Impact of race and socioeconomic status on presentation and management of ventral hernias.Arch Surg. 2010; 145: 776-780
- Socioeconomic status, Medicaid coverage, clinical comorbidity, and rehospitalization or death after an incident heart failure hospitalization: atherosclerosis Risk in Communities cohort (1987 to 2004).Circ Heart Fail. 2011; 4: 308-316
- Place of residence and outcomes of patients with heart failure: an analysis from the TELE-HF trial participants.J Am Coll Cardiol. 2013; 61: E783
- Income distribution and readmission rates for acute coronary syndrome after PCI with drug eluting stents.Circulation. 2012; : 126
- Ecological measures of socioeconomic status and hospital readmissions for asthma among Canadian adults.Respir Med. 2004; 98: 446-453
- Socioeconomic status and hospital utilization among younger adult pneumonia admissions at a Canadian hospital.BMC Health Serv Res. 2006; 6: 152
- Influence of neighborhood household income on early death or urgent hospital readmission.J Hosp Med. 2013; 8: 261-266
- Determinants of access to an integrated trauma system: a population-based cohort study.Injury. 2014; (submitted for publication)
- Race, site of care, and hospital readmission rates.JAMA. 2011; 305: 1965-1966
- The mismeasurement of quality by readmission rate: how blunt is too blunt an instrument?.: a quantitative bias analysis.Med Care. 2013; 51: 418-424
Keltie G. Aging, deprivation, and health: A “triple jeopardy” faced by the older population. Available at: http://hdl.handle.net/1974/8341 [accessed 25.03.14].
Article info
Publication history
Published online: December 11, 2015
Accepted:
November 21,
2015
Identification
Copyright
© 2016 Published by Elsevier Ltd.
