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Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study.

Publication ,  Journal Article
Dupre, ME; Nelson, A; Lynch, SM; Granger, BB; Xu, H; Willis, JM; Curtis, LH; Peterson, ED
Published in: JMIR Res Protoc
June 15, 2017

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of hospitalization in older adults and high readmission rates have attracted considerable attention as actionable targets to promote efficiency in care and to reduce costs. Despite a plethora of research over the past decade, current strategies to predict readmissions have been largely ineffective and efforts to identify novel clinical predictors have been largely unsuccessful. OBJECTIVE: The objective of this study is to examine a wide array of socioeconomic, psychosocial, behavioral, and clinical factors to predict risks of 30-day hospital readmission in cardiovascular patients. METHODS: The study includes patients (aged 18 years and older) admitted for the treatment of cardiovascular-related illnesses at the Duke Heart Center, which is among the nation's largest and top-ranked cardiovascular care hospitals. The study uses a novel standardized survey to ascertain data on a comprehensive array of patient characteristics that will be linked to their electronic medical records. A series of univariate and multivariate models will be used to estimate the associations between the patient-level factors and 30-day readmissions. The performance of the risk models will be examined based on 2 components of accuracy-model calibration and discrimination-to determine how closely the predicted outcome agrees with the observed (actual) outcome and how well the model distinguishes patients who were readmitted and those who were not. The purpose of this paper is to present the protocol for the implementation of this study. RESULTS: The study was launched in February 2014 and is actively recruiting patients from the Heart Center. Approximately 550 patients have been enrolled to date and the study is expected to continue recruitment until February 2018. Preliminary results show that participants in the study were aged 63.6 years on average (SD 14.0), predominately male (61.2%), and primarily non-Hispanic white (64.6%) or non-Hispanic black (31.7%). The demographic characteristics of study participants were not significantly different from all patients admitted to the Heart Center during this period with an average age of 65.0 years (SD 15.3) and predominately male (58.6%), non-Hispanic white (62.9%) or non-Hispanic black (31.8%) The integration of the interview data with clinical data from the patient electronic medical records is currently underway. The study has received funding and ethical approval. CONCLUSIONS: Many US hospitals continue to struggle with high readmission rates in patients with cardiovascular disease. The primary objective of this study is to collect and integrate a comprehensive array of patient attributes to develop a powerful yet parsimonious model to stratify risks of rehospitalization in cardiovascular patients. The results of this research also have the potential to identify actionable targets for tailored interventions to improve patient outcomes.

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Published In

JMIR Res Protoc

DOI

ISSN

1929-0748

Publication Date

June 15, 2017

Volume

6

Issue

6

Start / End Page

e118

Location

Canada

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
 

Citation

APA
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Dupre, M. E., Nelson, A., Lynch, S. M., Granger, B. B., Xu, H., Willis, J. M., … Peterson, E. D. (2017). Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study. JMIR Res Protoc, 6(6), e118. https://doi.org/10.2196/resprot.7434
Dupre, Matthew E., Alicia Nelson, Scott M. Lynch, Bradi B. Granger, Hanzhang Xu, Janese M. Willis, Lesley H. Curtis, and Eric D. Peterson. “Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study.JMIR Res Protoc 6, no. 6 (June 15, 2017): e118. https://doi.org/10.2196/resprot.7434.
Dupre ME, Nelson A, Lynch SM, Granger BB, Xu H, Willis JM, et al. Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study. JMIR Res Protoc. 2017 Jun 15;6(6):e118.
Dupre, Matthew E., et al. “Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study.JMIR Res Protoc, vol. 6, no. 6, June 2017, p. e118. Pubmed, doi:10.2196/resprot.7434.
Dupre ME, Nelson A, Lynch SM, Granger BB, Xu H, Willis JM, Curtis LH, Peterson ED. Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study. JMIR Res Protoc. 2017 Jun 15;6(6):e118.

Published In

JMIR Res Protoc

DOI

ISSN

1929-0748

Publication Date

June 15, 2017

Volume

6

Issue

6

Start / End Page

e118

Location

Canada

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences