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

Morandi, Alessandro; Bellelli, Giuseppe; Vasilevskis, Eduard E.; Turco, Renato; Guerini, Fabio; Torpilliesi, Tiziana; Speciale, Salvatore; Emiliani, V; Gentile, Simona; Schnelle, John F.; Trabucchi, Marco

doi:10.1016/j.jamda.2013.03.013

Cited by 104 publications

(96 citation statements)

References 45 publications

(51 reference statements)

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“…This study needs to be considered in light of its limitations stemming from the use of administrative data, which cannot capture all potential risk factors for severe dysglycemia and readmission, including clinical information (e.g., hemoglobin A 1c ), 31 frailty, 32 social support, and socioeconomic factors. We classified hospitalizations on the basis of principal discharge diagnoses, which may underestimate the incidence of severe dysglycemia by capturing only primary dysglycemic events rather than severe dysglycemia precipitated by another potentially unrelated illness.…”

Section: Discussionmentioning

confidence: 99%

Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

et al. 2017

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BACKGROUND: Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management. OBJECTIVE: To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia. DESIGN: Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U.S. PARTICIPANTS: Adults ≥18 years of age with diabetes, discharged from a hospital between January 1, 2009, and December 31, 2014 (N = 342,186). MAIN MEASURES: Principal diagnoses and risk factors for 30-day unplanned readmissions, subset as being for severe dysglycemia vs. all other causes. KEY RESULTS: We analyzed 594,146 index hospitalizations among adults with diabetes: mean age 68.2 years (SD, 13.0), 52.9% female, and 67.8% white. The all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for index hospitalization (5.5%) and readmission (8.9%). Severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified) and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger patient age, severe dysglycemia at index or prior hospitalization, and the Diabetes Complications Severity Index (DCSI) were the strongest risk factors predisposing patients to severe dysglycemia vs. other readmissions. Prior episodes of severe dysglycemia and the DCSI were also independent risk factors for other-cause readmissions, irrespective of the cause of the index hospitalization.CONCLUSIONS: Adults with diabetes are hospitalized and readmitted for a wide range of health conditions, and hospitalizations for severe hypoglycemia and hyperglycemia remain common, with high rates of recurrence. Severe dysglycemia is most likely to occur among younger patients with multiple diabetes complications and prior history of such events.

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Section: Discussionmentioning

confidence: 99%

Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

et al. 2017

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“…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 %.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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BACKGROUND:The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012-2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012-2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42-1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27-1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09-1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3-17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3-8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS:The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

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“…In a study by A. Morandi [23] a score in the Barthel index of 56 points or less is associated to greater risk. In our study, the Barthel index is on average 1.9 points greater in patients who are readmitted.…”

Section: Resultsmentioning

confidence: 95%

Evaluation of the impact of clinical, functional and social factors on the readmission of patients with pluripathologies

Coronado-Vázquez¹,

Casto²,

Martínez³

et al. 2016

JARH

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PURPOSE:Hospital readmissions of patients with pluripathologies is frequent and costly. This study describes the impact of patients' pluripathologies, functional capacity and social complexity on readmissions during a 12-month period following hospital discharge. METHODS: A prospective cohort study. Monthly monitoring of 111 patients over 12 months in Hospital of Riotinto. The primary endpoint was readmission rate. Predictive variables: age, gender, hospitalizations the year before, illnesses that define the pluripathology, medication prescribed on discharge, social situation (Gijón Scale), functional state (Barthel) and cognitive impairment (Pfeiffer). RESULTS: Readmissions accounted for 21.6% of the patients surveyed. Of those readmitted, the mean age was lower than those who did not return to hospital (75.4 vs.79.6) (p=0.031), the average amount of medication prescribed greater (10.5 vs.8.7) (p=0.014), the Barthel score higher (52.5 vs.50.6) and the Gijón value lower (13.8 vs.14.6), but no results was significant. The mean survival time (without readmission) was 310.9 days (95% CI, 289.4-332.5). Category B (chronic renal disease and vasculitis) and F (diabetes with microangiopathy and artery disease) had a lower average survival time (X 2 =7.02; p=0.008) (X 2 =7.07; p=0.008).The readmission risk was hazard ratio (HR) = 3.13 (95% CI, 1.37-7.14) for category B, and HR = 3.38 (95% CI, for category F. CONCLUSIONS:There is a high proportion of readmissions among patients with pluripathologies in the year following discharge from hospital. The greater risk occurs in patients with chronic renal insufficiency and diabetes with microvascular complications. Factors that can be modified are polymedication and the proper control of patients' diabetes.

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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

Cited by 104 publications

References 45 publications

Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events

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

Evaluation of the impact of clinical, functional and social factors on the readmission of patients with pluripathologies

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