Post-acute care referral in United States of America: a multiregional study of factors associated with referral destination in a cohort of patients with coronary artery bypass graft or valve replacement

Ineen Sultana, Madhav Erraguntla, Hye Chung Kum, Dursun Delen, Mark Lawley

Research output: Contribution to journalArticle

Abstract

Background: The use of post-acute care (PAC) for cardiovascular conditions is highly variable across geographical regions. Although PAC benefits include lower readmission rates, better clinical outcomes, and lower mortality, referral patterns vary widely, raising concerns about substandard care and inflated costs. The objective of this study is to identify factors associated with PAC referral decisions at acute care discharge. Methods: This study is a retrospective Electronic Health Records (EHR) based review of a cohort of patients with coronary artery bypass graft (CABG) and valve replacement (VR). EHR records were extracted from the Cerner Health-Facts Data warehouse and covered 49 hospitals in the United States of America (U.S.) from January 2010 to December 2015. Multinomial logistic regression was used to identify associations of 29 variables comprising patient characteristics, hospital profiles, and patient conditions at discharge. Results: The cohort had 14,224 patients with mean age 63.5 years, with 10,234 (71.9%) male and 11,946 (84%) Caucasian, with 5827 (40.96%) being discharged to home without additional care (Home), 5226 (36.74%) to home health care (HHC), 1721 (12.10%) to skilled nursing facilities (SNF), 1168 (8.22%) to inpatient rehabilitation facilities (IRF), 164 (1.15%) to long term care hospitals (LTCH), and 118 (0.83%) to other locations. Census division, hospital size, teaching hospital status, gender, age, marital status, length of stay, and Charlson comorbidity index were identified as highly significant variables (p- values < 0.001) that influence the PAC referral decision. Overall model accuracy was 62.6%, and multiclass Area Under the Curve (AUC) values were for Home: 0.72; HHC: 0.72; SNF: 0.58; IRF: 0.53; LTCH: 0.52, and others: 0.46. Conclusions: Census location of the acute care hospital was highly associated with PAC referral practices, as was hospital capacity, with larger hospitals referring patients to PAC at a greater rate than smaller hospitals. Race and gender were also statistically significant, with Asians, Hispanics, and Native Americans being less likely to be referred to PAC compared to Caucasians, and female patients being more likely to be referred than males. Additional analysis indicated that PAC referral practices are also influenced by the mix of PAC services offered in each region.

Original languageEnglish
Article number223
JournalBMC Medical Informatics and Decision Making
Volume19
Issue number1
DOIs
StatePublished - 14 Nov 2019
Externally publishedYes

Fingerprint

Subacute Care
Coronary Artery Bypass
Referral and Consultation
Transplants
Home Care Services
Skilled Nursing Facilities
Electronic Health Records
Long-Term Care
Censuses
Inpatients
Rehabilitation
Health Facility Size
Delivery of Health Care
Asian Americans
North American Indians
Marital Status
Hispanic Americans
Teaching Hospitals
Area Under Curve
Comorbidity

Keywords

  • Coronary artery bypass
  • Length of stay
  • Patient discharge
  • Post-acute care
  • Referral

Cite this

@article{013d5e7050064ce69d666aef10e6e9a5,
title = "Post-acute care referral in United States of America: a multiregional study of factors associated with referral destination in a cohort of patients with coronary artery bypass graft or valve replacement",
abstract = "Background: The use of post-acute care (PAC) for cardiovascular conditions is highly variable across geographical regions. Although PAC benefits include lower readmission rates, better clinical outcomes, and lower mortality, referral patterns vary widely, raising concerns about substandard care and inflated costs. The objective of this study is to identify factors associated with PAC referral decisions at acute care discharge. Methods: This study is a retrospective Electronic Health Records (EHR) based review of a cohort of patients with coronary artery bypass graft (CABG) and valve replacement (VR). EHR records were extracted from the Cerner Health-Facts Data warehouse and covered 49 hospitals in the United States of America (U.S.) from January 2010 to December 2015. Multinomial logistic regression was used to identify associations of 29 variables comprising patient characteristics, hospital profiles, and patient conditions at discharge. Results: The cohort had 14,224 patients with mean age 63.5 years, with 10,234 (71.9{\%}) male and 11,946 (84{\%}) Caucasian, with 5827 (40.96{\%}) being discharged to home without additional care (Home), 5226 (36.74{\%}) to home health care (HHC), 1721 (12.10{\%}) to skilled nursing facilities (SNF), 1168 (8.22{\%}) to inpatient rehabilitation facilities (IRF), 164 (1.15{\%}) to long term care hospitals (LTCH), and 118 (0.83{\%}) to other locations. Census division, hospital size, teaching hospital status, gender, age, marital status, length of stay, and Charlson comorbidity index were identified as highly significant variables (p- values < 0.001) that influence the PAC referral decision. Overall model accuracy was 62.6{\%}, and multiclass Area Under the Curve (AUC) values were for Home: 0.72; HHC: 0.72; SNF: 0.58; IRF: 0.53; LTCH: 0.52, and others: 0.46. Conclusions: Census location of the acute care hospital was highly associated with PAC referral practices, as was hospital capacity, with larger hospitals referring patients to PAC at a greater rate than smaller hospitals. Race and gender were also statistically significant, with Asians, Hispanics, and Native Americans being less likely to be referred to PAC compared to Caucasians, and female patients being more likely to be referred than males. Additional analysis indicated that PAC referral practices are also influenced by the mix of PAC services offered in each region.",
keywords = "Coronary artery bypass, Length of stay, Patient discharge, Post-acute care, Referral",
author = "Ineen Sultana and Madhav Erraguntla and Kum, {Hye Chung} and Dursun Delen and Mark Lawley",
year = "2019",
month = "11",
day = "14",
doi = "10.1186/s12911-019-0955-0",
language = "English",
volume = "19",
journal = "BMC Medical Informatics and Decision Making",
issn = "1472-6947",
number = "1",

}

TY - JOUR

T1 - Post-acute care referral in United States of America

T2 - a multiregional study of factors associated with referral destination in a cohort of patients with coronary artery bypass graft or valve replacement

AU - Sultana, Ineen

AU - Erraguntla, Madhav

AU - Kum, Hye Chung

AU - Delen, Dursun

AU - Lawley, Mark

PY - 2019/11/14

Y1 - 2019/11/14

N2 - Background: The use of post-acute care (PAC) for cardiovascular conditions is highly variable across geographical regions. Although PAC benefits include lower readmission rates, better clinical outcomes, and lower mortality, referral patterns vary widely, raising concerns about substandard care and inflated costs. The objective of this study is to identify factors associated with PAC referral decisions at acute care discharge. Methods: This study is a retrospective Electronic Health Records (EHR) based review of a cohort of patients with coronary artery bypass graft (CABG) and valve replacement (VR). EHR records were extracted from the Cerner Health-Facts Data warehouse and covered 49 hospitals in the United States of America (U.S.) from January 2010 to December 2015. Multinomial logistic regression was used to identify associations of 29 variables comprising patient characteristics, hospital profiles, and patient conditions at discharge. Results: The cohort had 14,224 patients with mean age 63.5 years, with 10,234 (71.9%) male and 11,946 (84%) Caucasian, with 5827 (40.96%) being discharged to home without additional care (Home), 5226 (36.74%) to home health care (HHC), 1721 (12.10%) to skilled nursing facilities (SNF), 1168 (8.22%) to inpatient rehabilitation facilities (IRF), 164 (1.15%) to long term care hospitals (LTCH), and 118 (0.83%) to other locations. Census division, hospital size, teaching hospital status, gender, age, marital status, length of stay, and Charlson comorbidity index were identified as highly significant variables (p- values < 0.001) that influence the PAC referral decision. Overall model accuracy was 62.6%, and multiclass Area Under the Curve (AUC) values were for Home: 0.72; HHC: 0.72; SNF: 0.58; IRF: 0.53; LTCH: 0.52, and others: 0.46. Conclusions: Census location of the acute care hospital was highly associated with PAC referral practices, as was hospital capacity, with larger hospitals referring patients to PAC at a greater rate than smaller hospitals. Race and gender were also statistically significant, with Asians, Hispanics, and Native Americans being less likely to be referred to PAC compared to Caucasians, and female patients being more likely to be referred than males. Additional analysis indicated that PAC referral practices are also influenced by the mix of PAC services offered in each region.

AB - Background: The use of post-acute care (PAC) for cardiovascular conditions is highly variable across geographical regions. Although PAC benefits include lower readmission rates, better clinical outcomes, and lower mortality, referral patterns vary widely, raising concerns about substandard care and inflated costs. The objective of this study is to identify factors associated with PAC referral decisions at acute care discharge. Methods: This study is a retrospective Electronic Health Records (EHR) based review of a cohort of patients with coronary artery bypass graft (CABG) and valve replacement (VR). EHR records were extracted from the Cerner Health-Facts Data warehouse and covered 49 hospitals in the United States of America (U.S.) from January 2010 to December 2015. Multinomial logistic regression was used to identify associations of 29 variables comprising patient characteristics, hospital profiles, and patient conditions at discharge. Results: The cohort had 14,224 patients with mean age 63.5 years, with 10,234 (71.9%) male and 11,946 (84%) Caucasian, with 5827 (40.96%) being discharged to home without additional care (Home), 5226 (36.74%) to home health care (HHC), 1721 (12.10%) to skilled nursing facilities (SNF), 1168 (8.22%) to inpatient rehabilitation facilities (IRF), 164 (1.15%) to long term care hospitals (LTCH), and 118 (0.83%) to other locations. Census division, hospital size, teaching hospital status, gender, age, marital status, length of stay, and Charlson comorbidity index were identified as highly significant variables (p- values < 0.001) that influence the PAC referral decision. Overall model accuracy was 62.6%, and multiclass Area Under the Curve (AUC) values were for Home: 0.72; HHC: 0.72; SNF: 0.58; IRF: 0.53; LTCH: 0.52, and others: 0.46. Conclusions: Census location of the acute care hospital was highly associated with PAC referral practices, as was hospital capacity, with larger hospitals referring patients to PAC at a greater rate than smaller hospitals. Race and gender were also statistically significant, with Asians, Hispanics, and Native Americans being less likely to be referred to PAC compared to Caucasians, and female patients being more likely to be referred than males. Additional analysis indicated that PAC referral practices are also influenced by the mix of PAC services offered in each region.

KW - Coronary artery bypass

KW - Length of stay

KW - Patient discharge

KW - Post-acute care

KW - Referral

UR - http://www.scopus.com/inward/record.url?scp=85075114732&partnerID=8YFLogxK

U2 - 10.1186/s12911-019-0955-0

DO - 10.1186/s12911-019-0955-0

M3 - Article

C2 - 31727058

AN - SCOPUS:85075114732

VL - 19

JO - BMC Medical Informatics and Decision Making

JF - BMC Medical Informatics and Decision Making

SN - 1472-6947

IS - 1

M1 - 223

ER -