Functional Status Impairment Is Associated With Unplanned Readmissions

Abstract

Objective: To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. Design: Retrospective cohort study. Setting: Academic hospital-based CIIRP. Participants: Consecutive patients (NZ1515) admitted to a CIIRP between January 2009 and June 2012. Interventions: Patients’ functional status, the primary exposure variable, was assessed using tertiles of the total FIM score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domains. A propensity score, consisting of 25 relevant clinical and demographic variables, was used to adjust for confounding in the analysis. Main Outcome Measures: Readmission to acute care was categorized as (1) readmission before planned discharge from the CIIRP, (2) readmission within 30 days of discharge from the CIIRP, and (3) total readmissions from both groups, with total readmissions being the a priori primary outcome. Results: Among the 1515 patients, there were 347 total readmissions. Total readmissions were significantly associated with FIM scores, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the highest tertile (AORZ2.6; 95% CI, 1.9e3.7; P<.001 and AORZ1.7; 95% CI, 1.2e2.4; PZ.002, respectively). There were similar findings for secondary analyses of readmission before planned discharge from the CIIRP (AORZ3.5; 95% CI, 2.2e5.8; P<.001 and AORZ2.1; 95% CI, 1.3e3.5l PZ.002, respectively), and a weaker association for readmissions after discharge from the CIIRP (AORZ1.6; 95% CI, 1.0e2.4; PZ.047 and AORZ1.3; 95% CI, 0.8e1.9; PZ.28, respectively). The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score. Conclusions: Functional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.

Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey

“…However, the authors concluded that their results, based on data from a single inpatient rehabilitation hospital, needed to be replicated in a nationally representative sample to better understand their findings, scope and generalizability. 22 Our study addresses this gap and corroborates their findings. The magnitude of our estimated effect is, however, lower than theirs (two times vs. three times difference in the odds of readmissions among patients with low and high scores).…”

“…Similarly, Hoyer and colleagues reported that Functional Independence Measures (FIM) (a standard measurement of function in inpatient rehabilitation facilities) motor domains were more highly related to unplanned readmissions than the cognitive domains. 22 Pearson and colleagues found similar results among chronically ill patients using the MOS 36-Item Short-Form Health Survey (SF-36). 33 However, other studies report that mental functioning also 19,41 Further research is needed to understand the interplay between physical and mental components and hospital readmissions.…”

“…Existing literature suggests that lower functional status increases the probability of readmission across different settings and conditions, including the Veterans Health Administration, 19 rehabilitation settings, [20][21][22] and in acute hospitals for heart conditions, [23][24][25][26][27] chronic obstructive pulmonary disease, 15,[28][29][30] burn injuries, 31 and all-cause readmissions. 19,[32][33][34] However, acute care studies have been based on small sample sizes ranging from 45 to 938 patients.…”

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

“…10,23,29 However, in our sample, cognition at discharge exhibited a weaker association with rehospitalization than mobility or self-care. The low prevalence of cognitive dysfunction as measured by the cognitive Figure 1.…”

“…5 Previous studies examining rehospitalization and post-acute inpatient rehabilitation have focused on predictors other than the functional domains identified by the IMPACT Act and outcomes other than post-discharge 30-day unplanned rehospitalization. 9,11,[21][22][23][24][25][26] Unplanned rehospitalizations have the potential for improvement 7,27 and are the focus of the current quality improvement policies being developed by CMS and the National Quality Forum. 28 In our national sample of community-dwelling adults who were discharged from post-acute rehabilitation, the overall unadjusted 30-day unplanned rehospitalization rate was 12.0 %.…”