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

• Published in: The American heart journal 2018-02, Vol.196, p.9-17
• Main Authors: Dupre, Matthew E., Xu, Hanzhang, Granger, Bradi B., Lynch, Scott M., Nelson, Alicia, Churchill, Erik, Willis, Janese M., Curtis, Lesley H., Peterson, Eric D.
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2017.10.001

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.