THIRTY-DAY HOSPITAL READMISSIONS FOR ADULTS WITH AND WITHOUT HIV INFECTION

Abstract

Introduction

Risk adjusted thirty-day hospital readmission rate is a commonly used benchmark for hospital quality of care and for Medicare reimbursement. Persons living with HIV (PLWH) may have high readmission rates. This study compared 30-day readmission rates by HIV status in a multi-state sample with planned subgroup comparisons by insurance and diagnostic categories.

Methods

Data for all acute care, non-military hospitalizations in 9 states in 2011 were obtained from the Healthcare Costs and Utilization Project. The primary outcome was readmission for any cause within 30 days of hospital discharge. Factors associated with readmission were evaluated using multivariate logistic regression.

Results

5,484,245 persons, including 33,556 (0.6%) PLWH, had a total of 6,441,695 index hospitalizations, including 45,382 (0.7%) among PLWH. Unadjusted readmission rates for hospitalizations of HIV-uninfected persons and PLWH were 11.2% (95% CI: 11.2, 11.2) and 19.7% (19.3, 20.0), respectively. After adjustment for age, gender, race, insurance, and diagnostic category, HIV was associated with 1.50 (1.46, 1.54) times higher odds of readmission. Predicted, adjusted readmission rates were higher for PLWH within every insurance category, including Medicaid (12.9% [12.8, 13.0] and 19.1% [18.4, 19.7] for HIV-uninfected persons and PLWH, respectively) and Medicare (13.2% [13.1, 13.3] and 18.0% [17.4, 18.7], respectively) and within every diagnostic category.

Discussion

HIV is associated with significantly increased readmission risk independent of demographics, insurance, and diagnostic category. The 19.7% 30-day readmission rate may serve as a preliminary benchmark for assessing quality of care of PLWH. Policymakers may consider adjusting for HIV when calculating a hospital’s expected readmission rate.