Journal of General Internal Medicine

, Volume 18, Issue 4, pp 242–247

Predictors of early hospital readmission in HIV-infected patients with pneumonia

  • Anita Palepu
  • Huiying Sun
  • Laura Kuyper
  • Martin T. Schechter
  • Michael V. O’Shaughnessy
  • Aslam H. Anis
Original Articles

Abstract

OBJECTIVE: Although hospitalization patterns have been studied, little is known about hospital readmission among HIV-infected patients in the era of highly active antiretroviral therapy. We explored the risk factors for early readmission to a tertiary care inner-city hospital among HIV-infected patients with pneumonia in Vancouver, Canada.

DESIGN: Case-control study.

SETTING: Tertiary care, university-affiliated, inner-city hospital.

PARTICIPANTS: All HIV-infected patients who were hospitalized with Pneumocystis carinii pneumonia (PCP) or bacterial pneumonia (BP) between January 1997 and December 2000. Case patients included those who had early readmissions, defined as being readmitted within 2 weeks of discharge (N=131). Control patients were randomly selected HIV-infected patients admitted during the study period who were not readmitted within 2 weeks of discharge (N=131), matched to the cases by proportion of PCP to BP.

MEASUREMENTS: Sociodemographic, HIV risk category, and clinical data were compared using x2 test for categorical variables, and the Wilcoxon rank-sum test was used for continuous variables. Multivariable logistic regression was performed to determine the factors independently associated with early readmission. We also reviewed the medical records of 132 patients admitted to the HIV/AIDS ward during the study period and collected more detailed clinical data for a subanalysis.

MAIN RESULTS: Patients were at significantly increased odds of early readmission if they left the hospital against medical advice (AMA) (adjusted odds ratio [OR], 4.26; 95% confidence interval [95% CI], 2.13 to 8.55), lived in the poorest urban neighborhood (OR, 2.03; 95% CI, 1.09 to 3.77), were hospitalized in summer season (May though October, OR, 2.36; 95% CI, 1.36 to 4.10), or had been admitted in the preceding 6 months (OR, 2.55; 95% CI, 1.46 to 4.47). Gender, age, history of AIDS-defining illness, and injection drug use status were not significantly associated with early readmission.

CONCLUSIONS: Predictors of early readmission of HIV-infected patients with pneumonia included: leaving hospital AMA, living in the poorest urban neighborhood, being hospitalized in the preceding 6 months and during the summer months. Interventions involving social work may address some of the underlying reasons why these patients leave hospital AMA and should be further studied.

Key words

case-control hospital readmission HIV AIDS bacterial pneumonia PCP antiretroviral therapy 

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References

  1. 1.
    Frankl SE, Breeling JL, Goldman L. Preventability of emergent hospital readmission. Am J Med. 1991;90:667–74.PubMedGoogle Scholar
  2. 2.
    Phillips RS, Safran C, Cleary PD, Delbanco TL. Predicting emergency readmissions for patients discharged from the medical service of a teaching hospital. J Gen Intern Med. 1987;2:400–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Weissman JS, Ayanian JZ, Chasan-Taber S, Sherwood MJ, Roth C, Epstein AM. Hospital readmissions and quality of care. Med Care. 1999;37:490–501.PubMedCrossRefGoogle Scholar
  4. 4.
    Grant RW, Charlebois ED, Wachter RM. Risk factors for early hospital readmission in patients with AIDS and pneumonia. J Gen Intern Med. 1999;14:531–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Philbin EF, Dec GW, Jenkins PL, DiSalvo TG. Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol. 2001;87:1367–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Anderson G, Steinberg E. Hospital readmission in the Medicare population. N Engl J Med. 1984;311:1349–53.PubMedCrossRefGoogle Scholar
  7. 7.
    Glazier RH, Badley EM, Gilbert JE, Rothman L. The nature of increased hospital use in poor neighbourhoods: findings from a Canadian inner city. Can J Public Health. 2000;91:268–73.PubMedGoogle Scholar
  8. 8.
    Weber AE, Yip B, O’Shaughnessy MV, Montaner JS, Hogg RS. Determinants of hospital admission among HIV-positive people in British Columbia. CMAJ. 2000;162:783–6.PubMedGoogle Scholar
  9. 9.
    Hogg RS, Yip B, Kully C, et al. Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ. 1999;160:659–65.PubMedGoogle Scholar
  10. 10.
    Revicki DA, Moyle G, Stellbrink HJ, Barker C. Quality of life outcomes of combination zalcitabine-zidovudine, saquinavirzidovudine, and saquinavir-zalcitabine-zidovudine therapy for HIV-infected adults with CD4 cell counts between 50 and 350 per cubic millimeter. PISCES (SV14604) Study Group. AIDS. 1999;13:851–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Palella FJ Jr., Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. New Engl J Med. 1998;338:853–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Statistics Canada. 1996 Population Census of Canada. Ottawa: Statistics Canada; 1997.Google Scholar
  13. 13.
    Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O’Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. CMAJ. 2002;167:633–7.PubMedGoogle Scholar
  14. 14.
    Jeremiah J, O’Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med. 1995;10:403–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Weingart SN, Davis RB, Phillips RS. Patients discharged against medical advice from a general medicine service. J Gen Intern Med. 1998;13:568–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Pages KP, Russo JE, Wingerson DK, Ries RK, Roy-Byrne PP, Cowley DS. Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatr Serv. 1998;49:1187–92.PubMedGoogle Scholar
  17. 17.
    Dalrymple AJ, Fata M. Cross-validating factors associated with discharges against medical advice. Can J Psychiatry. 1993;38:285–9.PubMedGoogle Scholar
  18. 18.
    Targum SD, Capodanno AE, Hoffman HA, Foudraine C. An intervention to reduce the rate of hospital discharges against medical advice. Am J Psychiatry. 1982;139:657–9.PubMedGoogle Scholar
  19. 19.
    Olfson M, Mechanic D, Boyer CA, Hansell S, Walkup J, Weiden PJ. Assessing clinical predictions of early rehospitalization in schizophrenia. J Nerv Ment Dis. 1999;187:721–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL Jr, Davis JM, Lewis DA. Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry. 1995;152:856–61.PubMedGoogle Scholar
  21. 21.
    Havassy BE, Arns PG. Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients. Psychiatr Serv. 1998;49:935–40.PubMedGoogle Scholar
  22. 22.
    Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11:F59–65.PubMedCrossRefGoogle Scholar
  23. 23.
    Korkeila JA, Lehtinen V, Tuori T, Helenius H. Frequently hospitalised psychiatric patients: a study of predictive factors. Soc Psychiatry Psychiatr Epidemiol. 1998;33:528–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Palepu A, Strathdee S, Hogg R, et al. The social determinants of emergency department and hospital use by injection drug users in Canada. Urban Health. 1999;76:409–18.CrossRefGoogle Scholar
  25. 25.
    Palepu A, Tyndall MW, Leon H, et al. Hospital utilization and costs in a cohort of injection drug users. CMAJ. 2001;165:415–20.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Anita Palepu
    • 1
    • 6
  • Huiying Sun
    • 2
    • 3
  • Laura Kuyper
    • 2
  • Martin T. Schechter
    • 2
    • 6
    • 3
    • 4
  • Michael V. O’Shaughnessy
    • 6
    • 3
    • 4
    • 5
  • Aslam H. Anis
    • 2
    • 6
    • 3
    • 4
  1. 1.Received from the Department of Internal MedicineSt. Paul’s HospitalUSA
  2. 2.the Centre for Health Evaluation and Outcome SciencesSt. Paul’s HospitalUSA
  3. 3.the Canadian HIV Trials NetworkUniversity of British ColumbiaVancouverCanada
  4. 4.the Department of Health Care and EpidemiologyUniversity of British ColumbiaVancouverCanada
  5. 5.the Department of PathologyUniversity of British ColumbiaVancouverCanada
  6. 6.BC Centre for Excellence for HIV/AIDSSt. Paul’s HospitalVancouverCanada

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