Observational studyBMC health services research2024
Care fragmentation and readmission mortality and length of stay before and during the COVID-19 pandemic: data from the National Readmissions Database, 2018-2020.
Observational study in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- The Unfinished Journey After Major Surgery: Interhospital Transfer and Care Fragmentation.World journal of surgery · 2026Article
- Implementation Considerations for an Occupational Therapy-Led Mental Health Care Navigation Program for Older Adult Patients.Health services insights · 2026Article
- Diagnostic Entropy as an Administrative Measure of Cross-System Diagnostic Dispersion in Noncommunicable Disease Inpatients: A Methodological Validation Study.Journal of nursing management · 2026Article
- Association Among Fragmented Trauma Care, Mortality, and Major Complications: Optimizing Care for the Injured Beyond the Initial Hospitalization.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- A tri-light warning system for hospitalized COVID-19 patients: Credibility-based risk stratification for future pandemic preparedness.European journal of radiology open · 2024Article
- Estimate the number of lives saved by a SARS-CoV-2 vaccination campaign in six states in the United States with a simple model.IJID regions · 2024Article
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Authors and funding
4 authors.
Funding
Abstract
importanceA quarter of all 30-day readmissions involve fragmented care, where patients return to a different hospital than their original admission; these readmissions are associated with increased in-hospital mortality and longer lengths-of-stay (LOS). The stress on healthcare systems at the beginning of the COVID-19 pandemic could worsen care fragmentation and related outcomes.
objectiveTo compare fragmented readmissions in 2020 versus 2018-2019 and assess whether mortality and LOS in fragmented readmissions differed in the two time periods.
designObservational study
settingNational Readmissions Database (NRD), 2018-2020
participantsAll adults (> 18 y/o) with 30-day readmissions MAIN OUTCOMES AND MEASURES: We examined the percentage of fragmented readmissions over 2018-2020. Using unadjusted and adjusted logistic and linear regressions, we estimated the associations between fragmented readmissions and in-hospital mortality and LOS.
results24.0-25.7% of readmissions in 2018-2020 and 27.3%-31.0% of readmissions for COVID-19 were fragmented. 2018-2019 fragmented readmissions were associated with 18-20% higher odds of in-hospital mortality compared to nonfragmented readmissions. Fragmented readmissions for COVID-19 were associated with an 18% increase in in-hospital mortality (AOR 1.18, 95% CI 1.12, 1.24). The LOS of fragmented readmissions in March-November 2018-2019 were on average 0.81 days longer, while fragmented readmissions between March-November of 2020 were associated with a 0.88-1.03 day longer LOS. CONCLUSIONS AND RELEVANCE: A key limitation is that the NRD does not contain information on several patient/hospital-level factors that may be associated with the outcomes of interest. We observed increased fragmentation during COVID-19, but its impact on in-hospital mortality and LOS remained consistent with previous years.
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