Factors Predicting Rehospitalization of Elderly Patients in a Postacute Skilled Nursing Facility Rehabilitation Program

Dombrowski, Wen; Yoos, Jessica L.; Neufeld, Richard R.; Tarshish, Chaim

doi:10.1016/j.apmr.2012.04.018

Cited by 31 publications

(26 citation statements)

References 54 publications

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“…Indeed, the majority of the investigations have studied readmissions among patients leaving the hospital for home, 13,20–22 and three studies reported readmissions from the SNFs. 9,10,23 This is the first study, to the best of our knowledge, to report rehospitalization and risk factor data from in hospital PAC rehabilitation facilities.…”

Section: Discussionmentioning

confidence: 98%

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Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy, Functional Status, and Length of Stay

Morandi

Bellelli

Vasilevskis

et al. 2013

Journal of the American Medical Directors Association

104

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Objectives Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients admitted to in-hospital rehabilitation facilities after an acute hospitalization. Setting In-hospital Rehabilitation and Aged Care Unit Design Retrospective cohort study Participants Elderly patients ≥65 years admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June 2011. Measurements The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of the above-mentioned risk factors for time to event within the 30-day follow-up. Results Among 2,735 patients, with a median age of 80 years (Interquartile Range 74–85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (Hazard Ratio [HR], 3.94; 95% Confidence Interval, 1.62–9.54; P=.002) and a significant decline in functional status (56 points or more at the Barthel Index) compared to the month prior to hospital admission (HR 2.67, 95% CI: 1.35–5.27; P=.005). Additionally, a length of stay in the acute hospital ≥13 days carried a 2 fold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39–5.10); P=.003). Conclusions The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared to the month prior to acute hospital admission and hospital length of stay are important risk factors.

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Section: Discussionmentioning

confidence: 98%

“…A second study 10 found that a history of a malignant solid tumor, a recent hospitalization involving gastrointestinal diseases and a low serum albumin level were associated with an increased risk for 30-day unplanned rehospitalization from a SNF.…”

Section: Introductionmentioning

confidence: 97%

Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy, Functional Status, and Length of Stay

Morandi

Bellelli

Vasilevskis

et al. 2013

Journal of the American Medical Directors Association

104

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“…15 Dombrowski et al examined 50 patients consecutively admitted to a skilled nursing facility; a history of malignant solid tumors, recent hospitalizations for gastrointestinal conditions, and low serum albumin were associated with 30-day rehospitalizations. 16 As a novel approach, we selected any first AT, independent of final hospital admission, as an outcome because transfers to an emergency department might expose, per se, negative health consequences and increase the burden and costs for the healthcare system. Moreover, including events of AT that did not result in an admission, might capture less severe AT determinants and, in turn, potentially avoidable AT.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Unplanned Transfers to Acute General Hospitals From an Intermediate Care and Rehabilitation Geriatric Facility

Colprim

Inzitari

2014

Journal of the American Medical Directors Association

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“…Other researchers recommend providing discharged patients with a personal health record to help guide outpatient providers (Koehler et al, 2009), giving patients specific instructions about medicines and their health records, following through with home visits, and improving coordination of services and information flow between providers in hospitals and in the community, especially those providers who are in long term services (Deschodt et al, 2011;Dombrowski, Yoos, Neufeld, & Tarshish, 2012;Hansen, Young, Hinami, Leung, & Williams, 2011;Phillips, Wright, Kern, et al, 2004). However, even when a multidisciplinary team approach is employed, lack of communication within the team can lead to poor discharge outcomes (Bauer, Fitzgerald, Haesler, & Manfrin, 2009).…”

Section: Downloaded By [Chulalongkorn University] At 13:02 03 Januarymentioning

confidence: 95%

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Chapin

Chandran

Sergeant

et al. 2014

Social Work in Health Care

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Discharges from the hospital to community-based settings are more difficult for older adults when there is lack of communication, resource sharing, and viable partnerships among service providers in these settings. The researchers captured the perspectives of three different groups of participants from hospitals, independent living centers, and Area Agencies on Aging, which has rarely been done in studies on discharge planning. Findings include identification of barriers in the assessment and referral process (e.g., timing of discharge, inattention to client goals, lack of communication and partnerships between hospital discharge planners and community providers), and strategies for overcoming these barriers. Implications are discussed including potential for Medicaid and Medicare cost reductions due to fewer re-hospitalizations.

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Factors Predicting Rehospitalization of Elderly Patients in a Postacute Skilled Nursing Facility Rehabilitation Program

Cited by 31 publications

References 54 publications

Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy, Functional Status, and Length of Stay

Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy, Functional Status, and Length of Stay

Incidence and Risk Factors for Unplanned Transfers to Acute General Hospitals From an Intermediate Care and Rehabilitation Geriatric Facility

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

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