- •Hospitalizations are an important component of health resource use and there is a need to address readmission rates in Multiple Sclerosis patients.
- •Common medical comorbidities such as neurogenic bladder and ischemic heart disease should be prevented, screened and managed in this population.
- •Patients with progressive disease subtypes and those under “second-line drugs” have a higher and soon after discharge risk of hospital readmission.
- •Efforts to reduce hospitalizations will need to be directed at preventing infections and disease-related complications.
Readmission rate is an important healthcare quality metric and remains a problem in Multiple Sclerosis (MS) patients, nonetheless information about this issue is scarce. We present the first study to estimate hospital readmissions in a MS hospital-based European cohort.
Retrospective cohort study of patients with at least one hospitalization with a primary discharge of MS from August 1, 2009 and July 31, 2015. The primary outcome was hospitalization within 30 days post-discharge (30-DR). The secondary outcomes included length of stay during index and readmission, total hospital readmissions during the study period, predictors and causes of readmission.
Forty-four (41.5%) patients had a hospital readmission during the six years of this study, 11.3% of them 30-DR, mainly due to infections (58.5%). The two most common comorbidities in these patients were neurogenic bladder (47.7%) and ischemic heart disease (18.1%). Progressive MS subtype was the main predictor of 30-DR, even after adjustment for therapy (OR: 6.29; p = 0.016), with an area under the curve of 0.73.
Progressive MS subtypes and “second-line drugs” carry a higher risk of hospital readmission soon after discharge. The impact and cost-effectiveness of strategies to lower readmission rates in MS should be the focus of upcoming studies.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Multiple Sclerosis and Related Disorders
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Hospital admissions and MS: temporal trends and patient characteristics.Am. J. Manag. Care. 2012; 18: 735-742
- Patterns of comorbidity in elderly patients with multiple sclerosis.J. Clin. Epidemiol. 1994; 47: 1127-1132
- All-cause hospitalizations in multiple sclerosis patients.Rev. Neurol. 2019; 68: 229-235
- Dramatically changing rates and reasons for hospitalization in multiple sclerosis.Neurology. 2014; 83: 929-937
- Reducing hospital readmission rates: current strategies and future directions.Annu. Rev. Med. 2014; 65: 471-485
- Interventions to reduce 30-day rehospitalization: a systematic review.Ann. Intern. Med. 2011; 155: 520-528
- European Multiple Sclerosis P. New insights into the burden and costs of multiple sclerosis in Europe: results for Portugal.Mult. Scler. 2017; 23: 143-154
- Reduction in Hospitals’ readmission rates: role of hospital-based skilled nursing facilities.Inquiry. 2019; 5646958018817994
- Thirty-day readmissions in multiple sclerosis: an age and gender-based US national retrospective analysis.Mult. Scler. Relat. Disord. 2019; 31: 41-50
- Does multiple sclerosis-associated disability differ between races?.Neurology. 2006; 66: 1235-1240
- Multiple sclerosis in US minority populations: clinical practice insights.Neurol. Clin. Pract. 2015; 5: 132-142
- Charlson Comorbidities Index.J. Physiother. 2016; 62: 171
- Preventable readmissions and predictors of readmission after subarachnoid hemorrhage.Neurocrit. Care. 2018; 29: 336-343
- Genulf. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines.Mult. Scler. 2007; 13: 915-928
- Cough efficacy is related to the disability status in patients with multiple sclerosis.Respiration. 2008; 76: 311-316
- Comorbidity, socioeconomic status and multiple sclerosis.Mult. Scler. 2008; 14: 1091-1098
- A systematic review of the incidence and prevalence of cardiac, cerebrovascular, and peripheral vascular disease in multiple sclerosis.Mult. Scler. 2015; 21: 318-331
- Multiple sclerosis is associated with an increased risk of acute myocardial infarction.CTRIMS Online Library Marrie R. 2018; 10 (Oct228252): P408
- Resource utilization, costs and treatment patterns of switching and discontinuing treatment of MS patients with high relapse activity.BMC Health Serv. Res. 2013; 13: 131
- Infection risks among patients with multiple sclerosis treated with fingolimod, natalizumab, rituximab, and injectable therapies.JAMA Neurol. 2019;
- Disease-modifying therapies and infectious risks in multiple sclerosis.Nat. Rev. Neurol. 2016; 12: 217-233
- A real-world comparison of relapse rates, healthcare costs and resource use among patients with multiple sclerosis newly initiating subcutaneous interferon beta-1a versus oral disease-modifying drugs.Mult. Scler. J. Exp. Transl. Clin. 2018; 42055217318819031
Published online: July 11, 2020
Accepted: July 11, 2020
Received in revised form: July 6, 2020
Received: February 4, 2020
© 2020 Elsevier B.V. All rights reserved.