Patient hospitalization rates based on discharge data that include repeat hospitalizations may overestimate disease incidence in individuals, particularly for conditions with a high proportion of repeat hospitalizations, a new study found.
Stephanie Benjamin, Ph.D., of the department of health sciences at California State University, Northridge, and her associates said that this is the first study to quantify the overestimation of hospitalization rates of individuals for common diabetes-related causes from the inclusion of repeat hospitalizations, and to determine whether this in turn affects comparisons of diabetes to nondiabetes rates. The results of the study, published online in Preventing Chronic Diseases, suggest that the use of repeat hospitalizations substantially overestimated hospitalization rates for both the diabetic and nondiabetic populations and that this overestimation varied by cause (2015 Nov 19;12:150274 ).
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The research team analyzed 2011 hospitalization data for adults aged 18 years or older from the State Inpatient Databases of the Agency for Healthcare Research and Quality. The researchers examined data (a total of 10,384,306 hospital discharges) from 12 states (Arkansas, California, Florida, Hawaii, Iowa, Massachusetts, Mississippi, Nebraska, New Mexico, New York, Vermont, and Washington) whose discharge data distinguished repeat hospitalizations among individuals. They then calculated percentage increases from repeat hospitalizations in rates and compared the ratio of diabetes with nondiabetes rates while excluding and including repeat hospitalizations.
Regardless of diabetes status, hospitalization rates were considerably higher when repeat hospitalizations within a calendar year were included. The magnitude of the differences varied by condition, Dr. Benjamin and her associates found. Among adults with diabetes, rates ranged from 13.0% higher for stroke to 41.6% higher for heart failure; for adults without diabetes, these rates ranged from 9.5% higher for stroke to 25.2% higher for heart failure. Ratios of diabetes versus nondiabetes rates were similar with and without repeat hospitalizations.
While the study’s findings may not be generalizable to the national population or any one region of the country, Dr. Benjamin said, the impact of repeat hospitalizations on rates and rate ratios were consistent across all 12 states, suggesting that the relationships described “may be robust, especially because the 12 states evaluated were distributed across the country.”
Dr. Benjamin and her coauthors suggest that, when such data are used to examine trends, consideration should be given to the possible impact of any change in frequency of repeat hospitalizations. For example, successful efforts to reduce 30-day readmission rates could reduce repeat hospitalizations without reducing disease incidence rates among individuals.
Read the entire study at the PCD website.
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