MC03
Association of 30-Day Continuity of Care with Outcomes in Multiple Sclerosis

Thursday, May 31, 2018
Exhibit Hall A (Nashville Music City Center)
Kanika Sharma, MD , Neurology, University of Iowa, Iowa City, IA
Yubo Gao, PhD , Medicine, University of Iowa, Iowa City, IA
Junlin Liao, PhD , Surgery, University of Iowa, Iowa City, IA
John A Kamholz, MD, PhD , Neurology, University of Iowa, Iowa City, IA
Frank R Bittner, DO , Neurology, University of Iowa, Iowa City, IA
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Background:

Fragmentation of care is known to impact outcomes. Given that most hospitals do not share clinical data electronically, emergency department(ED) evaluation in different hospitals rarely involves clinical information exchange or shared patient management. Patients with multiple sclerosis (MS) require multi-disciplinary care, therefore lack of familiarity can pose hurdles to efficient care.

Objectives:

With no literature existing on the impact of continuity of care on outcomes in patients with MS, we investigate the association of continuity of care with discharge disposition, length of hospital stay (LOS) and charges following 30-day readmission.

Methods:

Using an all-payer cohort derived from the National Readmission Database, adult patients discharged following an index admission for MS (ICD-9-CM code 340) were tracked to identify those incurring a 30-day readmission via utilizing ED services. We defined “continuity of care” as patients presenting to the ED of original (index) hospital from which they were first discharged 30 days prior. Likewise, patients re-admitted to other hospitals were labelled to have received “fragmented” care. Using multivariable regression techniques (generalized estimating equations accounting for clustering of outcomes by hospitals and propensity score matching), the association of continuity of care with discharge disposition, LOS and hospital charges (inflation adjusted to represent October 2017 dollar value) were investigated.

Results:

Overall, 1581 eligible patients with MS were readmitted within 30-day following index discharge. Of these, 1399 (88.5%) patients were readmitted utilizing the ED services; 1057(75.6%) were readmitted to the same hospital while 342(24.4%) were to other centers. Patients readmitted to same hospitals had relatively lower proportion of discharge to rehabilitation facility(24.5% vs 25.7%; p=0.648), lower mean LOS(5.2 vs 6.1 days; p=0.001) and hospital charges ($40,798 vs $51,380; p=0.008). In a multivariable analysis controlled for confounders, patients receiving continuity of care (readmitted to same hospitals) compared to those with fragmented care (readmitted to other hospitals) were significantly associated with lower marginal LOS (-1.0 day; p=0.028) and marginal hospital charges (18.1% lower; p=0.001).  

Conclusions:

The study underscores the potential significance of continuity of care in reducing hospital stay and economic burden (charges) in MS patients that will witness readmission within 30-days following index discharge.