Predictors of readmission in a medical department of a tertiary university hospital in the Philippines.

BACKGROUND: Identifying factors that increase the risk for hospital readmission helps in determining potential targets for quality improvement efforts. The main objective of this study was to examine factors that predict increased risk of hospital readmission within 30 days of hospital discharge of patients under the General Medicine service of a tertiary government hospital in Manila, Philippines. METHODS: We performed a retrospective cohort study which included service patients 19 years old and above readmitted within 30 days following discharge. A total of 324 hospital readmissions within 30 days of discharge from January 1 to December 31, 2019 were reviewed. We estimated the rate of 30-day readmission and identified factors associated with preventable readmissions using multivariable logistic regression. RESULTS: Of the 4,010 hospitalizations under General Medicine service in 2019, 602 (18%) were readmissions within 30 days of discharge, majority of which were related to the index admission (90%) and unplanned (68%). Predictors of preventable readmission were emergency readmission (OR 3.37, 95% CI 1.72 to 6.60), having five to ten medications at discharge (OR 1.78, 95% CI 1.10 to 2.87), and presence of nosocomial infection (OR 1.86, 95% CI 1.09 to 3.17). The most frequent reason for readmission among preventable ones is health-care related infection (42.9%). CONCLUSIONS: We identified factors which increased the likelihood of preventable readmissions such as type of readmission, number of medications per day, and presence of nosocomial infections. We propose that these issues be addressed to improve healthcare delivery and reduce readmission-related expenditures. Further studies should be pursued to identify impactful evidence-based practices.

Outcomes of nutritionally at-risk Coronavirus Disease 2019 (COVID 19) patients admitted in a tertiary government hospital: A follow-up study of the MalnutriCoV study.

BACKGROUND AND AIMS: The prevalence of malnutrition among adult Filipino patients with COVID 19 is 71.83%. Malnutrition has long been associated with poor outcomes among patients with pneumonia. This may be due to the increased risk of malnourished patients to develop impaired muscle and respiratory function. We aimed to determine the outcomes of adult COVID 19 patients admitted in a tertiary government hospital accordingly to nutrition status and risk. METHODS: Retrospective study on the adult COVID 19 patients admitted from July 15 to September 15, 2020 who were screened using the Philippine Society for Parenteral and Enteral Nutrition modified Subjective Global Assessment Grade tool. Chi-square or Fisher exact test, as well as Mann-Whitney U test or Kruskal-Wallis with post-hoc Dunn test, as appropriate were done. Survival analysis for mortality was done with right-censored data length of initial admission in days. Cox proportional hazard regression was done to determine the association of the main variables of interest with mortality with a 95% confidence interval. RESULTS: Malnourished patients were 30% less likely to be discharged [HR 0.70 95% CI (0.50, 0.97)]; malnutrition was also associated with length of hospital stay as those who were malnourished had longer lengths of hospital stay of about 4 days on the average [HR 3.55 95% CI (0.83, 6.27)]. High nutrition risk was significantly associated with length of hospital stay [HR 4.36 95% CI (0.89, 7.83)]. CONCLUSION: The only risk factor for mortality shown in this study is ICU transfer. Malnutrition, moderate nutrition risk, and high nutrition risk were risk factors of having longer lengths of hospital stays. While only malnutrition was the risk factor for being less likely to be discharged. We reiterate that nutrition assessment and support are important in mitigating the effects of COVID 19.

The prevalence of malnutrition and analysis of related factors among adult patients with the Coronavirus Disease 2019 (COVID 19) in a tertiary government hospital: The MalnutriCoV study.

BACKGROUND AND AIMS: As of November 2020, the Coronavirus Disease 2019 (COVID 19) has infected more than 396,000 people in the Philippines. Although no study has been done on malnutrition among a general cohort of patients with COVID 19, it has long been associated with increased mortality and poor long-term outcomes. We aimed to determine the prevalence of malnutrition among patients with COVID 19 admitted in a tertiary government hospital. METHODS: Cross-sectional study on COVID 19-confirmed patients admitted to the COVID 19 wards from July 15 to September 15, 2020. Nutritional status was assessed using the Philippine Society for Parenteral and Enteral Nutrition (PhilSPEN) modified Subjective Global Assessment Grade (SGA) tool. Malnutrition was defined as those with SGA grades B and C. Chi-square test or Fisher exact test of association, as appropriate, was used to identify factors that have a significant association with malnutrition. Furthermore, logistic regression was done on factors with significant association. RESULTS: Among the 355 adult patients in the study, 71.83% (255/355) were malnourished [SGA B: 67.84% (173/255); SGA C: 32.16% (82/255)]. The following were shown to have significant association with malnutrition: community-acquired pneumonia (CAP) [p-value < 0.001], hospital-acquired pneumonia (HAP) [p-value 0.002], and chronic kidney disease (p-value 0.033). Multivariable logistic regression revealed that age [OR 1.02, CI 95% 1.00, 1.04, p-value 0.027] and CAP-Moderate Risk (MR) [OR 3.02, CI 95% 1.73, 5.27, p-value < 0.001] are significant predictors of malnutrition. All patients with CAP- High Risk and HAP were malnourished. CONCLUSION: The prevalence of malnutrition was high (71.83%) in a general cohort of COVID 19 patients as measured by the modified SGA tool. The following are risk factors of malnutrition among patients with COVID 19: age, CAP, and HAP. Nutritional support and management of comorbidities are of paramount importance in the care of patients with COVID 19.