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dc.contributor.authorDordunoo, Dzifa
dc.date.accessioned2015-01-21T17:49:56Z
dc.date.available2015-01-21T17:49:56Z
dc.date.issued2014
dc.identifier.urihttp://hdl.handle.net/10713/4373
dc.descriptionUniversity of Maryland, Baltimore. Nursing. Ph.D. 2014en_US
dc.description.abstractBackground: All-cause 30-day hospital readmission among patients with heart failure (HF) is a quality of care indicator and cost the healthcare system $30.7 million in 2012. Although Centers for Medicare & Medicaid has started penalizing hospitals, it unclear how hospitals can best use limited resources to decrease readmissions. Purpose: The purpose of this study is to determine whether the addition of hospital level factors (discharging nursing unit, attending medical service and unit HF volume), predict all-cause 30-day readmission beyond patient factors alone at a large, urban academic center. Methods: The primary data were from a retrospective chart review of 461 patients discharged with the primary diagnosis of HF in 2011. Generalized estimating equations were used to control for clustering and hypotheses testing. Results: The patients studied were mostly (63%) Black/African American with the mean age of 62.1 (±14.6). Gender was evenly distributed with men representing 49.7%. Thirty-three percent had non-ischemic HF, 30% had preserved ejection fraction, 27% with implantable cardioverter defibrillator, and 17% had permanent pacemaker. The average length of stay for the cohort was 6.0 days and all-cause 30-day hospital readmission rate was 20%. Of all the investigated patient and hospital level factors, only patient factors were associated with all-cause 30-day hospital readmission: hyponatremia (OR=2.54, 95% CI 1.61-4.01), abnormal creatinine (OR=1.83, 95% CI 1.36-2.48), discharge without loop diuretics (OR=. 44 95% CI-.20-.98), discharge without beta blockers (OR=20.25, 95% CI 2.41-183.02), and discharge heart rate (OR=1.03, 95% CI 1.01-1.06). There was a statistically significant interaction between heart rate and discharge without beta blockers suggesting on average, the lower discharge heart rate, the lower the association of no beta blockers with the odds of all-cause 30-day hospital readmission (OR=.97, 95% CI=.95-.997). Median household income, emergency room presentation time and being married had conflicting associations with all-cause 30-day hospital readmission. Conclusion: Biological patient factors were associated with increased odds while discharge without loop diuretics was associated with reduced odds of all-cause 30-day hospital readmission. These findings suggest hospitals can use clinical factors to identify patients needing additional monitoring due to inability to optimize HF regimen to reduce readmissions.en_US
dc.language.isoen_USen_US
dc.subject.meshPatient Readmissionen_US
dc.subject.meshHeart Failure--nursingen_US
dc.titlePredictors of all-cause 30-day hospital readmission among patients with heart failureen_US
dc.typedissertationen_US
dc.contributor.advisorThomas, Sue Ann, 1947-
refterms.dateFOA2019-02-19T18:02:38Z


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