Prevalence and temporal pattern of hospital readmissions for patients with type I and type II diabetes - PubMed (original) (raw)

Prevalence and temporal pattern of hospital readmissions for patients with type I and type II diabetes

Xiaoqian Liu et al. BMJ Open. 2015.

Abstract

Objective: Repeated hospitalisation for patients is common and costly, yet partly preventable. However, we know little about readmissions for patients with diabetes in China. The current study aims to assess the frequency and temporal pattern of and risk factors for all-cause readmission among hospitalised patients with diabetes in Tianjin, China.

Method: This retrospective, cohort analysis used the Tianjin Basic Medical Insurance Register System data of 2011. The patterns of and the reasons for all-cause readmissions for patients with diabetes were described. The differences of readmission-free survival (RFS) between newly and previously diagnosed patients were compared. Time-dependent Cox models were established to identify the risk factors for readmission at different time intervals after discharge.

Results: Readmission rates were approximately 30%, with the most common diagnoses of cerebral infarction (for type I) or diabetes (for type II) for patients with diabetes. The majority of patients were readmitted to the hospital after more than 90 days, followed by 8-30 days (all p=0.002). Approximately 37.2% and 42.8% of readmitted patients with type I and type II diabetes were diagnosed previously, and the RFS rates for previously diagnosed patients were significantly lower than for newly diagnosed patients at any time interval after discharge. Prior history of diabetes (all p<0.05), length of stay (all p<0.01) and reimbursement ratio (90% vs >92%, all p<0.0002) were consistently associated with the RFS for patients readmitted to the hospital at <7, 8-30, 31-60 and 61-90 days.

Conclusions: Hospital readmissions among patients with diabetes were affected by the diagnosis status. Patient characteristics and the quality of healthcare might regulate short-interval and long-interval hospital readmission, respectively, after discharge.

Keywords: hospital readmission.

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Figures

Figure 1

Figure 1

The proportions of readmission for newly and previously diagnosed patients with diabetes showed that, for both type of diabetes, the proportions of readmission for previously diagnosed patients with diabetes were higher than for newly diagnosed patients at intervals of 31–60, 61–90 and >90 days (p=0.002).

Figure 2

Figure 2

Kaplan–Meier (KM)-survival curves for readmission-free survival (RFS) of patients with (A) type I and (B) type II diabetes by diagnosis status. The 1-year RFS rate of patients with previously diagnosed type I or type II diabetes was significantly lower than that of newly diagnosed patients (p<0.0001).

Figure 3

Figure 3

KM-survival curves for readmission-free survival (RFS) of patients with diabetes by predicted risk groups. The KM-survival curves for RFS as predicted in baseline 1-year readmission model from the HRs. Two curves represented low-risk group (upper) and high-risk group (lower) for readmission, respectively, and were well separated, confirming our model has good discrimination.

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