Table 1.
Patient characteristics
| Patient characteristics | Medication adherencea
|
P-valueb | |||||
|---|---|---|---|---|---|---|---|
| Low (N=94) | Intermediate (N=141) | High (N=150) | |||||
| Unplanned readmission, n (%) | 0.020 | ||||||
| Not readmitted | 75 | (79.8%) | 113 | (80.1%) | 136 | (90.7%) | |
| Readmitted | 19 | (20.2%) | 28 | (19.9%) | 14 | (9.3%) | |
| Age, median (Q1, Q3) | 68.0 | (56, 78) | 67.0 | (56, 80) | 69.0 | (59, 81) | 0.66 |
| Female, n (%) | 50 | (53.2%) | 70 | (49.6%) | 70 | (46.7%) | 0.61 |
| Ethnicity, n (%) | 0.61 | ||||||
| Hispanic | 8 | (8.5%) | 15 | (10.6%) | 11 | (7.3%) | |
| Non-Hispanic | 86 | (91.5%) | 126 | (89.4%) | 139 | (92.7%) | |
| Race, n (%) | 0.047 | ||||||
| Asian | 6 | (6.4%) | 6 | (4.3%) | 13 | (8.7%) | |
| Black or African American | 30 | (31.9%) | 30 | (21.3%) | 23 | (15.3%) | |
| White | 58 | (61.7%) | 103 | (73.0%) | 111 | (74.0%) | |
| Others | 0 | (0.0%) | 2 | (1.4%) | 3 | (2.0%) | |
| Marital status, n (%) | 0.049 | ||||||
| Divorced or legally separated | 12 | (12.8%) | 15 | (10.6%) | 12 | (8.0%) | |
| Married, significant other or domestic partner | 30 | (31.9%) | 69 | (48.9%) | 81 | (54.0%) | |
| Single | 29 | (30.9%) | 32 | (22.7%) | 28 | (18.7%) | |
| Widowed | 23 | (24.5%) | 25 | (17.7%) | 29 | (19.3%) | |
| Primary insurance, n (%) | 0.86 | ||||||
| HMO | 9 | (9.6%) | 17 | (12.1%) | 13 | (8.7%) | |
| Medi-Cal | 1 | (1.1%) | 2 | (1.4%) | 3 | (2.0%) | |
| Medicare | 73 | (77.7%) | 104 | (73.7%) | 109 | (72.7%) | |
| PPO | 10 | (10.6%) | 15 | (10.6%) | 23 | (15.3%) | |
| Self-pay/others | 1 | (1.1%) | 3 | (2.1%) | 2 | (1.3%) | |
| Source of index admission, n (%) | 0.34 | ||||||
| Home | 91 | (96.8%) | 130 | (92.2%) | 145 | (96.7%) | |
| MD office | 2 | (2.1%) | 5 | (3.5%) | 3 | (2.0%) | |
| Transfer from another facility | 1 | (1.1%) | 6 | (4.3%) | 2 | (1.3%) | |
| Type of index admission, n (%) | 0.76 | ||||||
| Elective | 2 | (2.1%) | 2 | (1.4%) | 4 | (2.7%) | |
| Emergency | 92 | (97.9%) | 139 | (98.6%) | 146 | (97.3%) | |
| Discharge from an oncology service, n (%) | 10 | (10.6%) | 27 | (19.1%) | 21 | (14.0%) | 0.18 |
| Length of stay of the index admission, median (Q1, Q3) | 5.0 | (3.0, 7.0) | 5.0 | (3.0, 8.0) | 5.0 | (3.0, 8.0) | 0.59 |
| Number of hospital admissions in the past year, median (Q1, Q3) | 1.0 | (0.0, 3.0) | 1.0 | (0.0, 2.0) | 1.0 | (0.0, 2.0) | 0.07 |
| Number of PTA medications, median (Q1, Q3) | 20.0 | (16, 27) | 20.0 | (15, 25) | 20.0 | (16, 24) | 0.74 |
| Number of procedures during index admission, median (Q1, Q3) | 2.0 | (1.0, 4.0) | 2.0 | (1.0, 4.0) | 2.0 | (1.0, 4.0) | 0.91 |
| Hemoglobin level at discharge, median (Q1, Q3) | 10.7 | (9.3, 12.1) | 10.6 | (9.3, 11.8) | 10.7 | (9.6, 12.0) | 0.38 |
| Serum sodium level at discharge, median (Q1, Q3) | 138.0 | (135, 140) | 138.0 | (135, 141) | 138.0 | (136, 141) | 0.52 |
| Serum creatinine level at discharge, median (Q1, Q3) | 1.0 | (0.8, 2.0) | 1.1 | (0.8, 1.8) | 1.0 | (0.8, 1.6) | 0.18 |
| Primary diagnosis on admission, n (%) | 0.46 | ||||||
| Arrhythmia | 3 | (3.2%) | 2 | (1.4%) | 6 | (4.0%) | |
| Asthma/COPD | 6 | (6.4%) | 3 | (2.1%) | 5 | (3.3%) | |
| Bleeding | 3 | (3.2%) | 4 | (2.8%) | 8 | (5.4%) | |
| Bronchitis/pneumonia | 4 | (4.3%) | 4 | (2.8%) | 9 | (6.0%) | |
| Diabetes mellitus | 5 | (5.3%) | 4 | (2.8%) | 3 | (2.0%) | |
| Heart failure | 11 | (11.7%) | 17 | (12.1%) | 12 | (8.0%) | |
| Hypertension | 6 | (6.4%) | 2 | (1.4%) | 1 | (0.7%) | |
| Infection | 13 | (13.8%) | 31 | (22.0%) | 27 | (18.0%) | |
| Ischemic heart disease | 3 | (3.2%) | 10 | (7.1%) | 12 | (8.0%) | |
| Malignant neoplasm | 2 | (2.1%) | 6 | (4.3%) | 6 | (4.0%) | |
| Pancreatitis | 3 | (3.2%) | 4 | (2.8%) | 7 | (4.7%) | |
| Renal failure | 4 | (4.3%) | 8 | (5.7%) | 9 | (6.0%) | |
| Venous thromboembolism | 1 | (1.1%) | 2 | (1.4%) | 5 | (3.3%) | |
| Othersc | 30 | (31.9%) | 44 | (31.2%) | 40 | (26.7%) | |
| Primary diagnosis at 30-day readmission, n (%) | 0.42 | ||||||
| Arrhythmia | 1 | (5.3%) | 0 | (0.0%) | 0 | (0.0%) | |
| Asthma/COPD | 2 | (10.5%) | 0 | (0.0%) | 0 | (0.0%) | |
| Bleeding | 0 | (0.0%) | 1 | (3.6%) | 0 | (0.0%) | |
| Bronchitis/pneumonia | 0 | (0.0%) | 1 | (3.6%) | 1 | (7.1%) | |
| Diabetes mellitus | 0 | (0.0%) | 2 | (7.1%) | 1 | (7.1%) | |
| Heart failure | 1 | (5.3%) | 3 | (10.7%) | 1 | (7.1%) | |
| Hypertension | 2 | (10.5%) | 0 | (0.0%) | 0 | (0.0%) | |
| Infection | 4 | (21.1%) | 8 | (28.6%) | 8 | (57.1%) | |
| Ischemic heart diseases | 1 | (5.3%) | 1 | (3.6%) | 0 | (0.0%) | |
| Malignancy | 0 | (0.0%) | 1 | (3.6%) | 0 | (0.0%) | |
| Pancreatitis | 2 | (10.5%) | 2 | (7.1%) | 0 | (0.0%) | |
| Venous thromboembolism | 0 | (0.0%) | 2 | (7.1%) | 0 | (0.0%) | |
| Othersd | 6 | (31.6%) | 7 | (25.0%) | 3 | (21.4%) | |
| Comorbidity, n (%) | |||||||
| Atrial fibrillation | 34 | (36.2%) | 53 | (37.6%) | 62 | (41.3%) | 0.68 |
| COPD | 17 | (18.1%) | 20 | (14.2%) | 17 | (11.3%) | 0.33 |
| Diabetes mellitus | 43 | (45.7%) | 58 | (41.1%) | 68 | (45.3%) | 0.71 |
| Ischemic heart diseases | 43 | (45.7%) | 52 | (36.9%) | 55 | (36.7%) | 0.30 |
| Heart failure | 39 | (41.5%) | 53 | (37.6%) | 52 | (34.7%) | 0.56 |
| Malignant neoplasm | 13 | (13.8%) | 20 | (14.2%) | 18 | (12.0%) | 0.84 |
Notes:
For the assessment of medication adherence, we used MMAS-4. Use of the ©MMAS is protected by the US and International copyright laws. Permission for use is required. A license agreement is available from Donald E Morisky, MMAS Research (MORISKY), 294 Lindura Court, Las Vegas, NV 89135-1415; dmorisky@gmail.com © 2007 Donald E Morisky. All rights reserved. MMAS, Morisky Medication Adherence Scale, and Morisky are the trademarks of Donald E Morisky and may be used only with permission.
For categorical variables, we used chi-square tests. For nonnormally distributed variables, we used the two-sided Kruskal–Wallis rank sum test.
Other diagnoses at admission included anemia, bile duct obstruction, arthritis, calculus, cervical spondylosis, cholangitis, fluid overload, fracture, complications of transplanted organ, complications of implanted device, constipation, degeneration of lumber or lumbosacral intervertebral disk, dehydration, dementia, dislocation of prosthetic joint, disorder of autonomic nervous system, displacement of cervical intervertebral disk, electrolyte imbalance, encephalopathy, epilepsy, fecal impaction, gastritis, gastromy complications, gout, hallucinations, headache, hemiplegia, inguinal hernia with obstruction, intestinal obstruction, migraine, orthostatic hypotension, osteoarthrosis, pain, poisoning, pressure ulcer, prosthetic joint repair, sickle-cell crisis, spasm of muscle, sprain of neck, systemic lupus erythematosus, systemic sclerosis, psychosis, ulcerative colitis, and vascular insufficiency of intestine.
Other diagnoses at 30-day readmission included acute vascular insufficiency of intestine, altered mental status, cerebral infarction, electrolyte imbalance, fracture, hemiplegia, hepatic encephalopathy, complications due to renal dialysis device, hypersensitivity angitis, fall, pain, and unspecified disorder of stomach and duodenum.
Abbreviations: COPD, chronic obstructive pulmonary disease; HMO, Health Maintenance Organization; MD, Doctor of Medicine; MMAS-4, 4-item Morisky Medication Adherence Scale; PPO, Preferred Provider Organization; PTA, prior to admission.