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The Association Between Patient-reported Clinical Factors and 30-day Acute Care Utilization in Chronic Heart Failure

Authors
  • Chen, Jinying1
  • Sadasivam, Rajani1
  • Blok, Amanda C.2
  • Ritchie, Christine S.3
  • Nagawa, Catherine1
  • Orvek, Elizabeth1
  • Patel, Kanan3
  • Houston, Thomas K.1
  • 1 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
  • 2 Center for Health care Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
  • 3 School of Medicine, University of California San Francisco, San Francisco, CA
Type
Published Article
Journal
Medical Care
Publisher
Lippincott Williams & Wilkins
Publication Date
Dec 05, 2019
Volume
58
Issue
4
Pages
336–343
Identifiers
DOI: 10.1097/MLR.0000000000001258
PMID: 32197028
PMCID: PMC7069395
Source
PubMed Central
Keywords
License
Green

Abstract

Heart failure patients have high rates of repeat acute care use. Current efforts for risk prediction often ignore postdischarge data. Objective: To identify postdischarge patient-reported clinical factors associated with repeat acute care use. Research Design: In a prospective cohort study that followed patients with chronic heart failure for 30 days postdischarge, for 7 days after discharge (or fewer days if patients used acute care within 7 days postdischarge), patients reported health status, heart failure symptoms, medication management, knowledge of follow-up plans, and other issues using a daily interactive automatic phone call. Subjects: A total of 156 patients who had responded to phone surveys. Measures: The outcome variable was dichotomous 30-day acute care use (rehospitalization or emergency department visit). We examined the association between each patient-reported issue and the outcome, using multivariable logistic regression to adjust for confounders. Results: Patients were 63 years old (SD=12.4), with 51% African-American and 53% women. Within 30 days postdischarge, 30 (19%) patients used acute care. After adjustment, poor health status [odds ratio (OR)=3.53; 95% confidence interval (CI), 1.06–11.76], pain (OR=2.44; 95% CI, 1.02–5.84), and poor appetite (OR=3.05; 95% CI, 1.13–8.23) were positively associated with 30-day acute care utilization. Among 58 reports of pain in follow-up nursing notes, 39 (67%) were noncardiac, 2 (3%) were cardiac, and 17 (29%) were indeterminate. Conclusions: Patient-reported poor health status, pain, and poor appetite were positively associated with 30-day acute care utilization. These novel postdischarge markers require further study before incorporation into risk prediction to drive quality improvement efforts.

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