Abstract 18757: Access to Routine Care and Risks for 30-Day Readmission in Patients With Cardiovascular Disease

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Abstract

Introduction: Studies have not examined whether patient-reported difficulties in access to routine medical care are associated with rehospitalization in patients with cardiovascular disease (CVD).

Methods: Electronic medical records and a standardized survey were used to examine cardiovascular patients admitted to a large medical center from January 1, 2015 through January 10, 2017 (n=520). All-cause readmission within 30 days of discharge was the primary outcome for analysis. Logistic regression models were used to examine the association between access to care and 30-day readmission while adjusting for patient demographics, socioeconomic status, healthcare utilization, and health status.

Results: Nearly 1-in-6 surveyed patients (15.7%) reported difficulty in accessing routine medical care; and those who were younger, male, non-white, uninsured, with heart failure, and low social support were significantly more likely to report difficulty. Patients who reported difficulty in accessing care had significantly higher rates of 30-day readmission than patients who did not report difficulty (33.3% vs. 17.9%; p=.001); and the risks remained largely unchanged after accounting for nearly two dozen covariates (unadjusted odds ratio [OR]=2.29; 95% CI: 1.46-3.60 vs. adjusted OR=2.17; 95% CI: 1.29-3.66). Risks for readmission were especially high for patients who reported issues with transportation (OR=3.24; 95% CI: 1.28-8.16) and scheduling appointments (OR=3.56; 95% CI: 1.43-8.84), but not for other reasons (OR=1.47; 95% CI: 0.61-3.54).

Conclusion: Cardiovascular patients who reported difficulty in accessing routine care had substantial risks of readmission 30 days after discharge. These findings have important implications for identifying high-risk patients and developing interventions to improve access to routine medical care.

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