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Type: Thesis
Title: Readmissions in Australian Patients with Cardiovascular Disease
Author: Labrosciano, Clementine
Issue Date: 2019
School/Discipline: Adelaide Medical School
Abstract: Background and objectives: The overall objective of this thesis is to investigate readmissions in Australian hospitals in patients previously admitted with heart failure (HF) or an acute myocardial infarction (AMI). The specific aims of this thesis are: 1. To conduct a scoping review of the contemporary Australian literature regarding readmissions with an index admission of any cardiovascular disease (CVD). 2. To determine the rates of readmission and mortality in Australian and New Zealand HF patients between 2010-15. 3. To determine the accuracy of the LACE index score (a prediction tool) for predicting 30-day all-cause mortality and readmission rates (independently and combined) in South Australian AMI patients who had an angiogram between 2015-6. 4. To conduct a pilot clinical study to determine whether an association exists between a) the quantity and b) the quality of sleep time in hospital and 30-day all-cause unplanned readmission in a South Australian cohort of cardiovascular inpatients. Methods: The thesis employs multiple methodological approaches including a scoping review (Chapter II), ‘big data’ techniques (Chapter III), registry data analysis (Chapter IV) and a prospective clinical observational cohort study (Chapter V). Summary of major findings: Chapter II: The scoping review of contemporary Australian literature found limited literature on the topic of readmissions following hospitalisation for a CVD or condition. Furthermore, it xi found that the methods used in prior studies lacked uniformity and standardisation which was reflected in the large range of readmission rates observed (from 6.3% to 27%, median 13%). Chapter III: The hospital-level analysis of administrative data found that Australian and New Zealand HF inpatients had a 30-day all-cause mortality rate of 10.7% across 392 hospitals and a 30-day all-cause readmission rate of 22.3% across 391 hospitals. Additionally, readmission rates remained stable whilst an overall improvement in the mortality rates were seen over the study period. Chapter IV: Analysis of registry patients found a 30-day unplanned readmission rate of 11.8% and mortality rate of 0.7%. Moreover, the LACE index was a moderate predictor (Cstatistic= 0.62) of readmissions in this cohort and a score ≥10 indicated moderate discriminatory capacity to predict 30-day readmissions. The two variables with the best predictive variables were length of stay and admissions to the emergency department in the prior six months. Chapter V: The clinical study found an association between the quality of sleep in hospital and 30-day all-cause unplanned readmissions as measured by the Pittsburgh Sleep Quality Index. This study also found trends but no statistically significant association between any objective measure of sleep quantity and 30-day all-cause unplanned readmissions. Conclusions This thesis has contributed to the literature by determining the rate of readmission in HF patients, incorporating predictive models into medicine and exploring a hypothesised variable (disrupted sleep) in clinical practice to help reduce the burden of readmissions. It supports the importance of measuring 30-day all-cause unplanned readmissions as an objective, broad, generic measure of hospital care quality and safety, and promotes efforts to improve this outcome.
Advisor: Beltrame, John F.
Tavella, Rosanna
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2019
Keywords: readmissions
cardiovascular disease
patient outcomes
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