@Article{info:doi/10.2196/18147,
author="Kaleta, Michaela
and Niederkrotenthaler, Thomas
and Kautzky-Willer, Alexandra
and Klimek, Peter",
title="How Specialist Aftercare Impacts Long-Term Readmission Risks in Elderly Patients With Metabolic, Cardiac, and Chronic Obstructive Pulmonary Diseases: Cohort Study Using Administrative Data",
journal="JMIR Med Inform",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e18147",
keywords="multimorbity; patient-sharing networks; network analysis; gender medicine; chronic disease; morbidity; elderly; older adults; cohort study",
abstract="Background: The health state of elderly patients is typically characterized by multiple co-occurring diseases requiring the involvement of several types of health care providers. Objective: We aimed to quantify the benefit for multimorbid patients from seeking specialist care in terms of long-term readmission risks. Methods: From an administrative database, we identified 225,238 elderly patients with 97 different diagnosis (ICD-10 codes) from hospital stays and contact with 13 medical specialties. For each diagnosis associated with the first hospital stay, we used multiple logistic regression analysis to quantify the sex-specific and age-adjusted long-term all-cause readmission risk (hospitalizations occurring between 3 months and 3 years after the first admission) and how specialist contact impacts these risks. Results: Men have a higher readmission risk than women (mean difference over all first diagnoses 1.9{\%}, P<.001), but similar reduction in readmission risk after receiving specialist care. Specialist care can reduce readmission risk by almost 50{\%}. We found the greatest reductions in risk when the first hospital stay was associated with diagnoses corresponding to complex chronic diseases such as acute myocardial infarction (57.6{\%} reduction in readmission risk, SE 7.6{\%} for men [m]; 55.9{\%} reduction, SE 9.8{\%} for women [w]), diabetic and other retinopathies (m: 62.3{\%}, SE 8.0; w: 60.1{\%}, SE 8.4{\%}), chronic obstructive pulmonary disease (m: 63.9{\%}, SE 7.8{\%}; w: 58.1{\%}, SE 7.5{\%}), disorders of lipoprotein metabolism (m: 64.7{\%}, SE 3.7{\%}; w: 63.8{\%}, SE 4.0{\%}), and chronic ischemic heart diseases (m: 63.6{\%}, SE 3.1{\%}; w: 65.4{\%}, SE 3.0{\%}). Conclusions: Specialist care can greatly reduce long-term readmission risk for patients with chronic and multimorbid diseases. Further research is needed to identify the specific reasons for these findings and to understand the detected sex-specific differences. ",
issn="2291-9694",
doi="10.2196/18147",
url="http://medinform.jmir.org/2020/9/e18147/",
url="https://doi.org/10.2196/18147",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936077"
}