Controlling Hospital Readmission of Elderly Persons Living at Home

Abstract

A large proportion of hospital stays stem from rapid readmission of elderly patients. These patients represent high cost users of inpatient care. Intervention in the hospital admission-readmission cycle may serve the interests of patients and payors alike. Data collected through comprehensive geriatric assessment can be useful in identifying those patients at high risk of readmission and who might benefit from more intensive in-hospital or post hospital attention. However, risk factors for readmission are largely unknown. We conducted a prospective study of elderly patients admitted to a metropolitan teaching hospital medical service and assessed by a geriatric team, to increase our knowledge of the factors associated with hospital readmissions. The most powerful predictor of hospital readmission within 6 months proved to be prior hospitalization. Attempts to reduce rehospitalizations in elderly patients must focus on those with prior recent hospitalizations.

Prevalence and predictors of healthcare utilization among older people (60+): Focusing on ADL dependency and risk of depression

“…Marcantonio et al (1999) found that the unplanned readmission rate within 30 days after discharge was 11% among patients aged 65 years and older. The association between earlier hospitalization and readmissions has also been explored by for example Kellogg et al (1991). They found that a hospital stay in the 6 21 months preceding the index admission was a significant predictor for readmission (OR=3.3, 95% CI 2.0-5.4).…”

Screening for risk of rehospitalization from home care: Use of the outcomes assessment information set and the probability of readmission instrument

“…OASIS AND P RA / BOWLES AND CATER determined the P ra score. Several investigators have shown the importance of prior hospitalization in predicting the likelihood of future hospitalization (Corrigan & Martin, 1992;Kellogg et al, 1991;Reed et al, 1991;Soeken et al, 1991;Vinson et al, 1990). In the OASIS prior hospitalization results in a lower score than if a patient came from a skilled nursing facility or a rehabilitation facility.…”

“…The identification of patients at risk for poor discharge outcomes such as rehospitalization is an important area of research and of evidence-based practice. Many researchers have identified the characteristics of at-risk patients including age >70, female gender, chronic cardiac or respiratory problems, widowed, cognitive impairment, polypharmacy, poor self-rated health, and long length of stay or complications during a hospital stay (Anderson, Helms, Hanson, & DeVilder, 1999;Berkman, Walker, Bonander, & Holmes, 1992;Bowles, Naylor, & Foust, 2002;Kellogg, Brickner, Conley, & Conroy, 1991;Lagoe, Noetscher, & Murphy, 2001;Leiby & Shupe, 1992;Naylor et al, 1994). The level of dependence in activities of daily living (ADLs) such as mobility, eating, bathing, and feeding is also a predictor of risk of rehospitalization (Redeker & Brassard, 1996;Reed, Buckner, & Pearlman, 1991).…”

“…The level of dependence in activities of daily living (ADLs) such as mobility, eating, bathing, and feeding is also a predictor of risk of rehospitalization (Redeker & Brassard, 1996;Reed, Buckner, & Pearlman, 1991). Prior hospitalization has consistently been a strong predictor of subsequent hospitalization (Corrigan & Martin, 1992;Kellogg et al, 1991;Reed et al, 1991;Soeken, Prescott, Herron, & Creasia, 1991;Vinson, Rich, Sperry, Shah, & McNamara, 1990).…”

Transitions in Health Care Use and Expenditures Among Frail Older Adults by Payor/Provider Type

“…Second, much of the literature on transitions between acute and long term care services has focused exclusively on the most expensive components of the health care system — hospitals and nursing homes 5,6,8,15–17 . Yet Roos and colleagues 16 have demonstrated that not all frail community‐dwelling older people need or use these costly medical services.…”