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Vol. 35. Issue 1.
Pages 4-11 (January - February 2020)
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Vol. 35. Issue 1.
Pages 4-11 (January - February 2020)
Original Article
DOI: 10.1016/j.jhqr.2019.09.002
Is obesity a risk factor for readmission after acute myocardial infarction?
¿Es la obesidad un factor de riesgo de reingreso, tras un infarto de miocardio agudo?
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K.A. Schuller
Department of Social and Public Health, Ohio University, Grover Center W333, 1 Ohio University, Athens, OH 45701, United States
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Tables (3)
Table 1. Frequency of all-cause AMI readmissions by patient characteristics according to the presence of obesitya
Table 2. Logistic regression of AMI hospital readmissions by patient characteristics.
Table 3. Logistic regression of readmissions based on presence of obesity.
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Abstract
Introduction and objectives

Hospital readmissions are a major concern in terms of both cost and quality of care. The purpose of this study was to determine which patients were more likely to experience hospital readmissions after acute myocardial infarction in order to help develop more targeted programs and policies.

Patients and materials and methods

The 2014 Nationwide Readmissions Database was used to calculate the national readmission rate by patient characteristics. All U.S. patients who presented to the hospital with acute myocardial infarction in 2014 and incurred a readmission were included in this analysis. The main outcome of interest was the rate of readmission by obesity. Obesity was measured using the comorbidity indicator found in the dataset. National secondary data of a sample of U.S. hospital discharges was used to measure hospital readmission rates. Bivariate analysis and logistic regression were used to determine if a significant relationship existed between readmissions and the patient characteristics. For this purpose odds ratio (OR) and 95% confidence interval has been calculated.

Results

There were 11.66% hospital readmissions in the database. Non-obese adults were 21% less likely to be readmitted than obese adults. Non-obese patients were 21.2% less likely to be readmitted than obese patients (OR 0.788, CI 0.751–0.827, p-value <.0001). Obese patients with no insurance had significantly higher readmissions compared to obese Medicare patients.

Conclusions

The Hospital Readmissions Reduction Program has been effective at reducing hospital readmissions. However, greater focus needs to be placed on reducing hospital readmissions for patients with chronic conditions, especially obesity.

Keywords:
Quality improvement
Quality of care
Hospital readmissions
Acute myocardial infarction
Obesity
Resumen
Introducción y objetivos

Los reingresos hospitalarios son una preocupación mayor en términos de coste y calidad de la atención. El objetivo de este estudio fue determinar qué pacientes tenían más probabilidad de experimentar reingresos tras un infarto de miocardio agudo, a fin de contribuir al desarrollo de programas y políticas más específicos.

Pacientes y materiales y métodos

Se utilizó la base de datos de reingresos nacionales de 2014 para calcular la tasa nacional de reingresos por características del paciente. Se incluyó en este análisis a todos los pacientes de EE. UU. que ingresaron en el hospital con infarto de miocardio agudo en 2014, y que reingresaron posteriormente. El resultado de interés principal fue la tasa de reingreso por obesidad, que fue medida utilizando el indicador de comorbilidad encontrado en el conjunto de datos. Se utilizaron los datos secundarios nacionales de una muestra de altas hospitalarias de EE. UU. para medir las tasas de reingreso hospitalario. Se utilizaron análisis bivariante y regresiones logísticas para determinar si existía una relación significativa entre los reingresos y las características del paciente. A tal fin, se calcularon el odds ratio (OR) y el intervalo de confianza (IC) del 95%.

Resultados

En la base de datos existía un 11,66% de reingresos hospitalarios. Los adultos no obesos tenían un 21% menos de probabilidad de ser reingresados que los adultos obesos. Los pacientes no obesos tenían un 21,2% menos de probabilidad de ser reingresados que los pacientes obesos (OR: 0,788; IC 95%: 0,751-0,827; valor p<0,0001). Los pacientes obesos que carecían de seguro reflejaron una tasa de reingresos significativamente superior, en comparación con los pacientes de Medicare obesos.

Conclusiones

El programa de reducción de reingresos hospitalarios ha reflejado su eficacia a la hora de reducir los reingresos hospitalarios. Sin embargo, debe hacerse mayor hincapié en la reducción de los reingresos hospitalarios de los pacientes con situaciones crónicas, y en especial la obesidad.

Palabras clave:
Mejora de la calidad
Calidad de la atención
Reingresos hospitalarios
Infarto de miocardio agudo
Obesidad

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