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Readmission Rates for Patients with HIV Infection

August 19, 2013

Readmission Rates for Patients with HIV Infection

  1. Paul E. Sax, MD

The overall rate was higher than in the general population, and was especially high in individuals with advanced immunosuppression.

  1. Paul E. Sax, MD

Readmission after hospitalization is common in the U.S. and is considered an important metric for quality of care, with high 30-day readmission rates considered a negative quality indicator. In a recent prospective, multicenter cohort study, researchers examined the readmission rate among patients with HIV infection, as well as factors associated with an increased likelihood of repeat hospitalization.

The study population consisted of 19,943 adults in active care for at least 1 year at any of nine HIV clinics in the U.S. between 2005 and 2010. Out of 11,651 index hospitalizations, 2252 (19.3%) were followed by a readmission within 30 days. Patients with advanced immunosuppression (i.e., CD4 count ≤50 cells/mm3) had a readmission rate of 26.1%. In multivariate analysis, independent medical risk factors for readmission were lower CD4-cell count, longer length of stay in the first hospitalization, and certain specific diagnoses, including AIDS-defining infections, malignancy, and gastrointestinal, metabolic, and neurologic disorders. Having a postdischarge follow-up appointment was not associated with a reduced likelihood of readmission. In most cases, the primary diagnoses for readmission were different than those for the index admission.

Comment

The 19.3% rate of readmissions is higher than the 13.3% reported in the U.S. for adults aged 18 to 64, underscoring the medical and psychosocial challenges of caring for HIV-infected patients. The powerful effect of immunosuppression in increasing readmissions is probably due to the fact that lower CD4-cell counts are risk factors for both infectious and noninfectious complications. Indeed, that readmissions were frequently for diagnoses different than those for the index admission demonstrates the high susceptibility to medical problems in this heavily immunosuppressed population. The findings from this study should be added to the long list of reasons for stressing early HIV diagnosis — before advanced HIV disease — as well as subsequent retention in care.

  • Disclosures for Paul E. Sax, MD at time of publication Consultant / Advisory board Bristol-Myers Squibb; Gilead; GlaxoSmithKline; Janssen; Merck Grant / research support NIH; Bristol-Myers Squibb; Gilead; GlaxoSmithKline; Merck Editorial boards Medscape; UpToDate Leadership positions in professional societies Mass ID Society (Vice President)

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