Care Discontinuity in Emergency General Surgery: Does Hospital Quality Matter?
*Manuel Castillo-Angeles, *Molly Jarman, *Daniel J Sturgeon, *Zara Cooper, Ali Salim, Joaquim Havens
Brigham and Women's Hospital, Boston, MA
Objective: Changes in care providers and hospitals following emergency general surgery (care discontinuity) are associated with increased morbidity and mortality. The cause of these worse outcomes is unknown. Our goal was to determine if the hospital quality contributes to the outcomes of readmitted emergency general surgery patients with and without care discontinuity.
Design: Retrospective analysis of the Medicare inpatient Claims file (2007-2015).
Setting: Data collected by Medicare from more than 45 million beneficiaries across the US.
Patients: All inpatients that underwent one of 7 EGS procedures shown to represent 80% of EGS volume, complications, and mortality nationally.
Interventions: Care discontinuity was defined as readmission within 30 days to non-index hospitals. Hospital quality was determined by hospital-level risk-adjusted mortality rates by EGS procedure and categorized into high (HQ) and low (LQ).
Main Outcome Measures: The primary outcome was overall mortality.
Results: There were 918,564 EGS patients, of which 79,948 were readmitted within 30 days of discharge. Care discontinuity was independently associated with mortality (OR 1.22; 95% CI 1.17-1.28). When readmitted patients were stratified by quality of index and readmitting hospital we found mortality was associated with the quality of both the index hospital and the readmitting hospital. The highest mortality rate was observed in patients with index admissions at low quality hospitals and readmission to low quality non-index hospitals (Figure 1).
Conclusions: Both care discontinuity and hospital quality are independently associated with mortality in EGS patients. These data support maintaining continuity of care even at low performing hospitals.
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