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Access to routine care and risks for 30-day readmission in patients with cardiovascular disease.
Dupre, Matthew E; Xu, Hanzhang; Granger, Bradi B; Lynch, Scott M; Nelson, Alicia; Churchill, Erik; Willis, Janese M; Curtis, Lesley H; Peterson, Eric D.
Afiliação
  • Dupre ME; Duke Clinical Research Institute, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC; Department of Sociology, Duke University, Durham, NC. Electronic address: matthew.dupre@duke.edu.
  • Xu H; Duke School of Nursing, Duke University Medical Center, Durham, NC.
  • Granger BB; Duke School of Nursing, Duke University Medical Center, Durham, NC.
  • Lynch SM; Department of Sociology, Duke University, Durham, NC.
  • Nelson A; Department of Population Health Sciences, Duke University, Durham, NC.
  • Churchill E; Duke Office of Clinical Research, Duke University Medical Center, Durham, NC.
  • Willis JM; Department of Population Health Sciences, Duke University, Durham, NC.
  • Curtis LH; Duke Clinical Research Institute, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC.
  • Peterson ED; Duke Clinical Research Institute, Duke University, Durham, NC; Department of Medicine, Division of Cardiology, Duke University, Durham, NC.
Am Heart J ; 196: 9-17, 2018 02.
Article em En | MEDLINE | ID: mdl-29421019
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Readmissão do Paciente / Doenças Cardiovasculares / Aceitação pelo Paciente de Cuidados de Saúde / Padrão de Cuidado Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Am Heart J Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Readmissão do Paciente / Doenças Cardiovasculares / Aceitação pelo Paciente de Cuidados de Saúde / Padrão de Cuidado Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Am Heart J Ano de publicação: 2018 Tipo de documento: Article