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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Few modifiable factors predict readmission following radical cystectomy</title><author><name sortKey="Minnillo, Brian J" sort="Minnillo, Brian J" uniqKey="Minnillo B" first="Brian J." last="Minnillo">Brian J. Minnillo</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author><author><name sortKey="Maurice, Matthew J" sort="Maurice, Matthew J" uniqKey="Maurice M" first="Matthew J." last="Maurice">Matthew J. Maurice</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author><author><name sortKey="Schiltz, Nicholas" sort="Schiltz, Nicholas" uniqKey="Schiltz N" first="Nicholas" last="Schiltz">Nicholas Schiltz</name><affiliation><nlm:aff id="af2-cuaj-7-8-e439">Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cuaj-7-8-e439">Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</nlm:aff></affiliation></author><author><name sortKey="Pillai, Aiswarya C" sort="Pillai, Aiswarya C" uniqKey="Pillai A" first="Aiswarya C." last="Pillai">Aiswarya C. Pillai</name><affiliation><nlm:aff id="af2-cuaj-7-8-e439">Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cuaj-7-8-e439">Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</nlm:aff></affiliation></author><author><name sortKey="Koroukian, Siran M" sort="Koroukian, Siran M" uniqKey="Koroukian S" first="Siran M." last="Koroukian">Siran M. Koroukian</name><affiliation><nlm:aff id="af2-cuaj-7-8-e439">Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cuaj-7-8-e439">Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</nlm:aff></affiliation></author><author><name sortKey="Daneshgari, Firouz" sort="Daneshgari, Firouz" uniqKey="Daneshgari F" first="Firouz" last="Daneshgari">Firouz Daneshgari</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author><author><name sortKey="Kim, Sim P" sort="Kim, Sim P" uniqKey="Kim S" first="Sim P." last="Kim">Sim P. Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff id="af3-cuaj-7-8-e439">Yale University, COPPER Center, New Haven, CT;</nlm:aff></affiliation></author><author><name sortKey="Abouassaly, Robert" sort="Abouassaly, Robert" uniqKey="Abouassaly R" first="Robert" last="Abouassaly">Robert Abouassaly</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26279713</idno><idno type="pmc">4514489</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514489</idno><idno type="RBID">PMC:4514489</idno><idno type="doi">10.5489/cuaj.2793</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000260</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000260</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Few modifiable factors predict readmission following radical cystectomy</title><author><name sortKey="Minnillo, Brian J" sort="Minnillo, Brian J" uniqKey="Minnillo B" first="Brian J." last="Minnillo">Brian J. Minnillo</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author><author><name sortKey="Maurice, Matthew J" sort="Maurice, Matthew J" uniqKey="Maurice M" first="Matthew J." last="Maurice">Matthew J. Maurice</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author><author><name sortKey="Schiltz, Nicholas" sort="Schiltz, Nicholas" uniqKey="Schiltz N" first="Nicholas" last="Schiltz">Nicholas Schiltz</name><affiliation><nlm:aff id="af2-cuaj-7-8-e439">Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cuaj-7-8-e439">Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</nlm:aff></affiliation></author><author><name sortKey="Pillai, Aiswarya C" sort="Pillai, Aiswarya C" uniqKey="Pillai A" first="Aiswarya C." last="Pillai">Aiswarya C. Pillai</name><affiliation><nlm:aff id="af2-cuaj-7-8-e439">Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cuaj-7-8-e439">Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</nlm:aff></affiliation></author><author><name sortKey="Koroukian, Siran M" sort="Koroukian, Siran M" uniqKey="Koroukian S" first="Siran M." last="Koroukian">Siran M. Koroukian</name><affiliation><nlm:aff id="af2-cuaj-7-8-e439">Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation><affiliation><nlm:aff id="af4-cuaj-7-8-e439">Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</nlm:aff></affiliation></author><author><name sortKey="Daneshgari, Firouz" sort="Daneshgari, Firouz" uniqKey="Daneshgari F" first="Firouz" last="Daneshgari">Firouz Daneshgari</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author><author><name sortKey="Kim, Sim P" sort="Kim, Sim P" uniqKey="Kim S" first="Sim P." last="Kim">Sim P. Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff id="af3-cuaj-7-8-e439">Yale University, COPPER Center, New Haven, CT;</nlm:aff></affiliation></author><author><name sortKey="Abouassaly, Robert" sort="Abouassaly, Robert" uniqKey="Abouassaly R" first="Robert" last="Abouassaly">Robert Abouassaly</name><affiliation><nlm:aff id="af1-cuaj-7-8-e439">Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</nlm:aff></affiliation></author></analytic><series><title level="j">Canadian Urological Association Journal</title><idno type="ISSN">1911-6470</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction:</title><p>We sought to determine the patient and provider-related factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement.</p></sec><sec><title>Methods:</title><p>We reviewed bladder cancer patients who underwent RC in California’s State Inpatient Database (2005–2009) of the Healthcare Cost and Utilization Project. We examined patient-(e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest.</p></sec><sec><title>Results:</title><p>Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% were discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07–2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06–1.91), receiving a neobladder (OR 1.45, 95% CI 1.09–1.93), and discharged to a PACF (OR 3.79, 95% CI 2.88–4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, 95% CI 0.27–0.67, <italic>p</italic> = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission.</p></sec><sec><title>Conclusions:</title><p>About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Can Urol Assoc J</journal-id><journal-id journal-id-type="iso-abbrev">Can Urol Assoc J</journal-id><journal-id journal-id-type="publisher-id">CUAJ</journal-id><journal-title-group><journal-title>Canadian Urological Association Journal</journal-title></journal-title-group><issn pub-type="ppub">1911-6470</issn><publisher><publisher-name>Canadian Medical Association</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26279713</article-id><article-id pub-id-type="pmc">4514489</article-id><article-id pub-id-type="doi">10.5489/cuaj.2793</article-id><article-id pub-id-type="publisher-id">cuaj-7-8-e439</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Few modifiable factors predict readmission following radical cystectomy</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Minnillo</surname><given-names>Brian J.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af1-cuaj-7-8-e439"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Maurice</surname><given-names>Matthew J.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af1-cuaj-7-8-e439"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Schiltz</surname><given-names>Nicholas</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="af2-cuaj-7-8-e439"><sup>†</sup></xref><xref ref-type="aff" rid="af4-cuaj-7-8-e439"><sup>¥</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pillai</surname><given-names>Aiswarya C.</given-names></name><degrees>MD, MSc</degrees><xref ref-type="aff" rid="af2-cuaj-7-8-e439"><sup>†</sup></xref><xref ref-type="aff" rid="af4-cuaj-7-8-e439"><sup>¥</sup></xref></contrib><contrib contrib-type="author"><name><surname>Koroukian</surname><given-names>Siran M.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="af2-cuaj-7-8-e439"><sup>†</sup></xref><xref ref-type="aff" rid="af4-cuaj-7-8-e439"><sup>¥</sup></xref></contrib><contrib contrib-type="author"><name><surname>Daneshgari</surname><given-names>Firouz</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af1-cuaj-7-8-e439"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Sim P.</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="af1-cuaj-7-8-e439"><sup>†</sup></xref><xref ref-type="aff" rid="af3-cuaj-7-8-e439"><sup>§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Abouassaly</surname><given-names>Robert</given-names></name><degrees>MD, MSc</degrees><xref ref-type="aff" rid="af1-cuaj-7-8-e439"><sup>*</sup></xref><xref rid="c1-cuaj-7-8-e439" ref-type="corresp"></xref></contrib></contrib-group><aff id="af1-cuaj-7-8-e439"><label>*</label>Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;</aff><aff id="af2-cuaj-7-8-e439"><label>†</label>Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH;</aff><aff id="af3-cuaj-7-8-e439"><label>§</label>Yale University, COPPER Center, New Haven, CT;</aff><aff id="af4-cuaj-7-8-e439"><label>¥</label>Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH</aff><author-notes><corresp id="c1-cuaj-7-8-e439">Correspondence: Dr. Robert Abouassaly, Assistant Professor, Department of Urology, Case Western Reserve University, Urological Institute, University Hospitals Case Medical Center, Mailstop LKD 5046, Office 4576, 11100 Euclid Ave., Cleveland, OH; <email>robert.abouassaly@uhhospitals.org</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jul-Aug</season><year>2015</year></pub-date><pub-date pub-type="epub"><day>17</day><month>7</month><year>2015</year></pub-date><volume>9</volume><issue>7-8</issue><fpage>E439</fpage><lpage>E446</lpage><permissions><copyright-statement>Copyright: © 2015 Canadian Urological Association or its licensors</copyright-statement><copyright-year>2015</copyright-year></permissions><abstract><sec><title>Introduction:</title><p>We sought to determine the patient and provider-related factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement.</p></sec><sec><title>Methods:</title><p>We reviewed bladder cancer patients who underwent RC in California’s State Inpatient Database (2005–2009) of the Healthcare Cost and Utilization Project. We examined patient-(e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest.</p></sec><sec><title>Results:</title><p>Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% were discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07–2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06–1.91), receiving a neobladder (OR 1.45, 95% CI 1.09–1.93), and discharged to a PACF (OR 3.79, 95% CI 2.88–4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, 95% CI 0.27–0.67, <italic>p</italic> = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission.</p></sec><sec><title>Conclusions:</title><p>About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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