Journal Article

Access to routine care and risks for 30-day readmission in patients with cardiovascular disease

Nelson, Alicia, Dupre, Matthew E., Churchill, Erik, Lynch, Scott M., Peterson, Eric D., Xu, Hanzhang, Granger, Bradi B., Curtis, Lesley H., Willis, Janese M.

2018

Overview

Studies have shown that access to routine medical care is associated with the prevention, diagnosis, and treatment of chronic diseases. However, studies have not examined whether patient-reported difficulties in access to care are associated with rehospitalization in patients with cardiovascular disease. Electronic medical records and a standardized survey were used to examine cardiovascular patients admitted to a large medical center from January 1, 2015 through January 10, 2017 (n=520). All-cause readmission within 30 days of discharge was the primary outcome for analysis. Logistic regression models were used to examine the association between access to care and 30-day readmission while adjusting for patient demographics, socioeconomic status, healthcare utilization, and health status. Nearly 1-in-6 patients (15.7%) reported difficulty in accessing routine medical care; and those who were younger, male, non-white, uninsured, with heart failure, and had low social support were significantly more likely to report difficulty. Patients who reported difficulty in accessing care had significantly higher rates of 30-day readmission than patients who did not report difficulty (33.3% vs. 17.9%; P=.001); and the risks remained largely unchanged after accounting for nearly two dozen covariates (unadjusted odds ratio [OR]=2.29; 95% CI, 1.46-3.60 vs. adjusted OR=2.17; 95% CI, 1.29-3.66). Risks for readmission were especially high for patients who reported issues with transportation (OR=3.24; 95% CI, 1.28-8.16) and scheduling appointments (OR=3.56; 95% CI, 1.43-8.84), but not for other reasons (OR=1.47; 95% CI, 0.61-3.54). Cardiovascular patients who reported difficulty in accessing routine care had substantial risks of readmission within 30 days after discharge. These findings have important implications for identifying high-risk patients and developing interventions to improve access to routine medical care.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Academic Medical Centers / Activities of daily living / Adult / Age Factors / Aged / Ambulatory care / Analysis of Variance / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - diagnosis / Cardiovascular Diseases - therapy / Cohort Studies / Confidence Intervals / Databases, Factual / Demographics / Demography / Discharge / Electronic health records / Electronic medical records / Female / Health care / Health care access / Health care facilities / Health care policy / Heart / Heart diseases / Heart failure / Hospitalization - statistics & numerical data / Humans / Incidence / Length of Stay - statistics & numerical data / Logistic Models / Male / Medicaid / Medical records / Medical treatment / Middle Aged / Multivariate Analysis / North Carolina / Older people / Patient Acceptance of Health Care - statistics & numerical data / Patient admissions / Patient Discharge - statistics & numerical data / Patient Readmission - statistics & numerical data / Patients / Primary care / Prognosis / Regression analysis / Regression models / Retrospective Studies / Risk Assessment / Risk factors / Risk groups / Scheduling / Sex Factors / Social interactions / Socioeconomic Factors / Socioeconomics / Standard of Care / Systematic review / Treatment Outcome