Imperial College London
Alternate

Emeritus ProfessorDerekBell

Faculty of Medicine, School of Public Health

Emeritus Professor in Acute Medicine
 
 
 
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Contact

 

+44 (0)7886 725 212d.bell

 
 
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Assistant

 

Miss Heather Barnes +44 (0)20 3315 8144

 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bottle:2018:10.3310/hsdr06260,
author = {Bottle, A and Honeyford, K and Chowdhury, F and Bell, D and Aylin, P},
doi = {10.3310/hsdr06260},
journal = {Health and Social Care Delivery Research},
pages = {1--84},
title = {Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study},
url = {http://dx.doi.org/10.3310/hsdr06260},
volume = {6},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplannedhospital activity, but our understanding of what drives this is incomplete.Objectives: To model patient, primary care and hospital factors associated with readmission and mortalityfor patients with HF and COPD, to assess the statistical performance of post-discharge emergencydepartment (ED) attendance compared with readmission metrics and to compare all the results for thetwo conditions.Design: Observational study.Setting: English NHS.Participants: All patients admitted to acute non-specialist hospitals as an emergency for HF or COPD.Interventions: None.Main outcome measures: One-year mortality and 30-day emergency readmission following the patient’sfirst unplanned admission (‘index admission’) for HF or COPD.Data sources: Patient-level data from Hospital Episodes Statistics were combined with publicly availablepractice- and hospital-level data on performance, patient and staff experience and rehabilitationprogramme website information.Results: One-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factorspredicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long)index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS andcomorbidities also predicted readmission. Of the practice and hospital factors we considered, only moredoctors per 10 beds [odds ratio (OR) 0.95 per doctor; p < 0.001] was significant for both cohorts for mortality,with staff recommending to friends and family (OR 0.80 per unit increase; p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP; p = 0.004) important for COPD. For readmission,only hospital size [OR per 100 beds = 2.16, 95% confidence interval (
AU  - Bottle,A
AU  - Honeyford,K
AU  - Chowdhury,F
AU  - Bell,D
AU  - Aylin,P
DO  - 10.3310/hsdr06260
EP  - 84
PY  - 2018///
SN  - 2755-0060
SP  - 1
TI  - Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study
T2  - Health and Social Care Delivery Research
UR  - http://dx.doi.org/10.3310/hsdr06260
UR  - https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr06260
UR  - http://hdl.handle.net/10044/1/96188
VL  - 6
ER  -
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