Table 1.
Studies with Mortality as an Outcome
| Source | Location | Number of patients | Study population | Definition of care fragmentation | Mortality follow-up period | Ottawa bias assessment | Findings |
|---|---|---|---|---|---|---|---|
| Jia 200722 | Florida | 1818 | Veterans Health Administration (VHA) patients diagnosed with acute stroke | VHA + Medicare, VHA + Medicaid, Triple (VHA + Medicare and Medicaid) | 1 year after discharge | Fair |
VHA-Medicare AOR 1.6 (1.0–2.4) VHA-Medicaid AOR 2.8 (1.0–7.4) Triple AOR 1.0 (0.5–2.0) |
| Wolinsky 200723 | USA | 1522 | Male veterans > 70 | Veterans who self-reported use of both VHA and Medicare (dual use) for inpatient hospitalizations | 9-year mortality | Fair | AHR 1.56 (1.12–2.17) |
| Staples 201424 | Toronto, Canada | 198,149 | All adult patients readmitted to one of 21 acute care hospitals in the Toronto area | Readmission to a hospital different than the one they were discharged from | 30 days | Good |
OR 1.26 (1.23–1.30) AOR 1.06 (1.02–1.10) |
| Saunders 201425 | USA | 6752 | Medicare patients undergoing abdominal aortic aneurysm (AAA) repair | Readmission to a different hospital than the one where the surgery was performed | In-hospital and 30-day mortality | Good |
In-hospital: not reported (per data use agreement) but non-significant 30 days: OR 0.95 (0.56–1.62) |
| Glebova 201426 | Maryland | 115 | Patients undergoing thoracic and thoracoabdominal aneurysm repair, 2002–2013 | Readmission to a different hospital than the one where the surgery was performed | Mortality during readmission, at 30 days, 1 year, 5 years, until last follow-up | Good |
Non-fragmented vs. fragmented During readmission: 14% (1) vs. 0 30 days: 0 vs. 0 1 year: 43% (3) vs. 8% (2) (p = 0.05) At final follow-up: 43% (3) vs. 15% (4) (p = 0.11) |
| Tsai 201527 | USA (Medicare) | 93,062 | Patients with coronary artery bypass graft, pulmonary lobectomy, endovascular aneurysm repair, open AAA repair, colectomy, total hip replacement with a 30-day readmission | Readmission to a different hospital than the one where the surgery was performed | 30-day mortality | Good |
Risk and hospital adjusted: OR 1.41 (1.31–1.52) Distance-adjusted: OR 1.48 (1.37–1.59) |
| Brooke 201518 | USA (Medicare) | 1,111,046 | Patients undergoing one of 12 major operations* readmitted within 30 days, 2001–2011 | Readmission to a different hospital than the one where the surgery was performed | 90-day mortality | Good | Pooled AOR (Ref: fragmented readmission) 0.74 (0.66–0.83) |
| Pak 201528 | New York State | 2338 | Patients discharged from one of 100 New York State Hospitals following radical cystectomy between 2009 and 2012 with 30 or 90-day readmissions | Readmission to a different hospital than the one where the surgery was performed | 30- and 90-day mortality | Good |
30 days OR 3.62 (1.52–8.57) 90 days OR 5.66 (2.63–12.2) |
| Luu 201629 | USA (Surveillance Epidemiology, and End Results Program [SEER]-Medicare) | 3399 | Patients who had colon cancer surgery who were readmitted within 30 days of discharge, 2000–2009 | Readmission to a different hospital than the one where the surgery was performed |
Long-term mortality colon-cancer specific mortality 90-day mortality (all-cause and cancer-specific) |
Good |
Long-term mortality: HR 1.04 (95% CI 0.87–1.12) Colon cancer-specific mortality: 1.09 (95% CI 0.77–1.51) 90-day mortality: 1.18 (95% CI 1.02–1.38) |
| Mays 201630 | Chicago, IL | 780 | Patients with recurrent diabetic ketoacidosis, 2006–2012 | Readmission to a different hospital than the patient was discharged from | Mortality during study period | Good | NR but non-significant in adjusted models |
| Zheng 201631 | California (State Inpatient Database [SID]) | 9233 | Patients with major cancer surgery† readmitted within 30 days, 2004–2011 | Readmission to a different hospital than the one where the surgery was performed | In-hospital mortality | Good |
Adjusted for patient and hospital characteristics: 1.31 (1.03–1.66) Adjusted for diagnoses: 1.24 (0.98–1.58) |
| Kothari 201620 | California and Florida | 2996 | Patients who underwent orthotopic liver transplant readmitted within the first year, 2006–2011 | Readmission to a hospital other than where surgery was performed | 30-day mortality after readmission | Good | OR 1.75 (1.16 to 2.65) |
| Justiniano 201719 | New York State | 20,016 | Patients readmitted within 30 days, 2004–2014 | Readmission to a different hospital than where surgery was performed ± under the care of a different physician | 1-year survival (excluding initial 30-day mortality) | Good | HR 1.57 (1.17–2.11) |
| Stitzenberg 201732 | USA (SEER-Medicare) | 7903 | Patients with cancer‡ who underwent extirpative surgery, 2001–2007 | Readmission to a different hospital than the one where the surgery was performed | 90-day mortality | Good | HR 1.15 (1.10–1.19) |
| Hua 201733 | New York State | 26,947 | Mechanically ventilated intensive care unit patients re-hospitalized within 30 days at NY state hospitals between 2008 and 2013 | Readmission to a different hospital than the patient was discharged from | In-hospital mortality | Good | ARR 1.11 (1.03–1.20) |
| McAlister 201712 | Canada | 39,368 | Patients with heart failure readmitted within 30 days, 2004–2013 | Readmission to a different hospital than the patient was discharged from | In-hospital mortality | Good |
OR 0.89 (0.82–0.96) *Reference was fragmented group |
| Graboyes 201715 | California | 561 | Patients readmitted within 30 days of a head and neck cancer surgery, 2008–2010 | Readmission to a hospital other than where surgery was performed | In-hospital mortality | Good | OR 2.1 (1.04–4.26) |
| Burke 201811 | USA (National Readmissions Database [NRD]) | 2,722,821 | Patients readmitted within 30 days in 2013 | Readmission to a different hospital than the patient was discharged from | In-hospital mortality | Good |
OR 1.14 (1.10–1.18) AOR 1.21 (1.17–1.25) |
*Open AAA repair, infra-inguinal arterial bypass, aorto-bifemoral bypass, coronary artery bypass surgery, esophagectomy, colectomy, pancreatectomy, cholecystectomy, ventral hernia repair, craniotomy, hip or knee replacement
†Esophagectomy, gastrectomy, pancreatectomy, hepatectomy, proctectomy, lung resection
‡Bladder, esophagus, lung, pancreas cancer