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How Comorbidities Co-Occur in Readmitted Hip Fracture Patients: From Bipartite Networks to Insights for Post-Discharge Planning.

Bhavnani SK, Dang B, Visweswaran S, Divekar R, Tan A, Karmarkar A, Ottenbacher K - AMIA Jt Summits Transl Sci Proc (2015)

Bottom Line: A network-wide analysis revealed nine patient/comorbidity co-clusters, of which two had a significantly different proportion of cases compared to the rest of the data.This counter-intuitive result suggests that HFx patients with more serious comorbidities may have better follow-up that reduces the risk of 30-day readmission, whereas those with specific relatively less-serious comorbidities may have less stringent follow-up resulting in unanticipated incidents that precipitate readmission.These analyses reveal the strengths and limitations of bipartite networks for identifying hypotheses for complex phenomena related to readmissions, with the goal of improving follow-up care for patients with specific combinations of comorbidities.

View Article: PubMed Central - PubMed

Affiliation: Inst. for Translational Sciences, Inst. for Human Infections and Immunity, Univ. of Texas Medical Branch, Galveston, TX.

ABSTRACT
Although a majority of 30-day readmissions of hip-fracture (HFx) patients in the elderly are caused by non-surgical complications, little is known about which specific combinations of comorbidities are associated with increased risk of readmission. We therefore used bipartite network analysis to explore the complex associations between 70 comorbidities (defined by hierarchal condition categories as critical in this population) and (a) cases consisting of all 2,316 HFx patients without hospital complications in the 2010 Medicare claims database who were re-admitted within 30 days of discharge, and (b) controls consisting of an equal number of matched HFx patients who were not readmitted for at least 90 days since discharge. A network-wide analysis revealed nine patient/comorbidity co-clusters, of which two had a significantly different proportion of cases compared to the rest of the data. A cluster-specific analysis of the most significant co-cluster revealed that a pair of comorbidities (Renal Failure and Diabetes with no Complications) within the co-cluster had significantly higher risk of 30-day readmission, whereas another pair of comorbidities (Renal Failure and Diabetes with Renal or Peripheral Circulatory Manifestations), despite having a relatively more serious comorbidity, did not confer a higher risk. This counter-intuitive result suggests that HFx patients with more serious comorbidities may have better follow-up that reduces the risk of 30-day readmission, whereas those with specific relatively less-serious comorbidities may have less stringent follow-up resulting in unanticipated incidents that precipitate readmission. These analyses reveal the strengths and limitations of bipartite networks for identifying hypotheses for complex phenomena related to readmissions, with the goal of improving follow-up care for patients with specific combinations of comorbidities.

No MeSH data available.


Related in: MedlinePlus

Bipartite network of only Cluster-1 showing the four comorbidities (black triangles), which were associated with a majority of the patients. Patients with both Renal Failure, and Diabetes w/o Complications had a significantly higher risk of 30-day readmission compared to either alone with respect to the other comorbidities in this cluster. This relationship was also significant when considering all the patients in the full network.
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f2-2092233: Bipartite network of only Cluster-1 showing the four comorbidities (black triangles), which were associated with a majority of the patients. Patients with both Renal Failure, and Diabetes w/o Complications had a significantly higher risk of 30-day readmission compared to either alone with respect to the other comorbidities in this cluster. This relationship was also significant when considering all the patients in the full network.

Mentions: As shown in Figure 2, Cluster-1 had four comorbidities (Renal Failure, Diabetes w/o Complication, Diabetes w/Renal or Peripheral Circulatory Manifestation, and Dialysis Status) that were connected to the majority (97.6%) of the patients within the cluster, and which had the four highest node degrees (total number of coincident edges). Because Cluster-1 had the highest significance of all the clusters, and the above four comorbidities were highly connected to a majority of the patients, we analyzed the odds ratio (OR) and significance for all combinations of these four comorbidities with respect to the other comorbidities in Cluster-1. The results revealed that only the combination of Renal Failure and Diabetes w/o Complications compared to either alone (with no other comorbidities) conferred high risk (OR=1.54, 95% CI=1.13–2.08, FDR adjusted p=0.017), whereas all other combinations did not. For example, even though Diabetes w/Renal or Peripheral Circulatory Manifestation and Dialysis constitute high risk for complications, they were not associated with significantly higher OR of readmission in any combination. Finally, the association between Renal Failure and Diabetes w/o Complications also conferred high risk (OR=1.54, 95% CI=1.01–2.36, p=0.044) when considering all 69 comorbidities in the entire network.


How Comorbidities Co-Occur in Readmitted Hip Fracture Patients: From Bipartite Networks to Insights for Post-Discharge Planning.

Bhavnani SK, Dang B, Visweswaran S, Divekar R, Tan A, Karmarkar A, Ottenbacher K - AMIA Jt Summits Transl Sci Proc (2015)

Bipartite network of only Cluster-1 showing the four comorbidities (black triangles), which were associated with a majority of the patients. Patients with both Renal Failure, and Diabetes w/o Complications had a significantly higher risk of 30-day readmission compared to either alone with respect to the other comorbidities in this cluster. This relationship was also significant when considering all the patients in the full network.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4525217&req=5

f2-2092233: Bipartite network of only Cluster-1 showing the four comorbidities (black triangles), which were associated with a majority of the patients. Patients with both Renal Failure, and Diabetes w/o Complications had a significantly higher risk of 30-day readmission compared to either alone with respect to the other comorbidities in this cluster. This relationship was also significant when considering all the patients in the full network.
Mentions: As shown in Figure 2, Cluster-1 had four comorbidities (Renal Failure, Diabetes w/o Complication, Diabetes w/Renal or Peripheral Circulatory Manifestation, and Dialysis Status) that were connected to the majority (97.6%) of the patients within the cluster, and which had the four highest node degrees (total number of coincident edges). Because Cluster-1 had the highest significance of all the clusters, and the above four comorbidities were highly connected to a majority of the patients, we analyzed the odds ratio (OR) and significance for all combinations of these four comorbidities with respect to the other comorbidities in Cluster-1. The results revealed that only the combination of Renal Failure and Diabetes w/o Complications compared to either alone (with no other comorbidities) conferred high risk (OR=1.54, 95% CI=1.13–2.08, FDR adjusted p=0.017), whereas all other combinations did not. For example, even though Diabetes w/Renal or Peripheral Circulatory Manifestation and Dialysis constitute high risk for complications, they were not associated with significantly higher OR of readmission in any combination. Finally, the association between Renal Failure and Diabetes w/o Complications also conferred high risk (OR=1.54, 95% CI=1.01–2.36, p=0.044) when considering all 69 comorbidities in the entire network.

Bottom Line: A network-wide analysis revealed nine patient/comorbidity co-clusters, of which two had a significantly different proportion of cases compared to the rest of the data.This counter-intuitive result suggests that HFx patients with more serious comorbidities may have better follow-up that reduces the risk of 30-day readmission, whereas those with specific relatively less-serious comorbidities may have less stringent follow-up resulting in unanticipated incidents that precipitate readmission.These analyses reveal the strengths and limitations of bipartite networks for identifying hypotheses for complex phenomena related to readmissions, with the goal of improving follow-up care for patients with specific combinations of comorbidities.

View Article: PubMed Central - PubMed

Affiliation: Inst. for Translational Sciences, Inst. for Human Infections and Immunity, Univ. of Texas Medical Branch, Galveston, TX.

ABSTRACT
Although a majority of 30-day readmissions of hip-fracture (HFx) patients in the elderly are caused by non-surgical complications, little is known about which specific combinations of comorbidities are associated with increased risk of readmission. We therefore used bipartite network analysis to explore the complex associations between 70 comorbidities (defined by hierarchal condition categories as critical in this population) and (a) cases consisting of all 2,316 HFx patients without hospital complications in the 2010 Medicare claims database who were re-admitted within 30 days of discharge, and (b) controls consisting of an equal number of matched HFx patients who were not readmitted for at least 90 days since discharge. A network-wide analysis revealed nine patient/comorbidity co-clusters, of which two had a significantly different proportion of cases compared to the rest of the data. A cluster-specific analysis of the most significant co-cluster revealed that a pair of comorbidities (Renal Failure and Diabetes with no Complications) within the co-cluster had significantly higher risk of 30-day readmission, whereas another pair of comorbidities (Renal Failure and Diabetes with Renal or Peripheral Circulatory Manifestations), despite having a relatively more serious comorbidity, did not confer a higher risk. This counter-intuitive result suggests that HFx patients with more serious comorbidities may have better follow-up that reduces the risk of 30-day readmission, whereas those with specific relatively less-serious comorbidities may have less stringent follow-up resulting in unanticipated incidents that precipitate readmission. These analyses reveal the strengths and limitations of bipartite networks for identifying hypotheses for complex phenomena related to readmissions, with the goal of improving follow-up care for patients with specific combinations of comorbidities.

No MeSH data available.


Related in: MedlinePlus