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Wahyudi ER, Ronoatmodjo S, Setiati S, Besral, Soejono CH, Kuswardhani T, Fitriana I, Marsigit J, Putri SA, Harmany GRT. The risk of rehospitalization within 30 days of discharge in older adults with malnutrition: A meta-analysis. Arch Gerontol Geriatr 2024; 118:105306. [PMID: 38071901 DOI: 10.1016/j.archger.2023.105306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Malnutrition is a global health problem associated with higher rehospitalization risk, subsequently increasing the risks of adverse complications, and mortality in older individuals. Nevertheless, studies investigating this are still scarce, and even fewer reviewed and aggregated. A number of studies have recently assessed the correlation of malnourishment with rehospitalization among older adults. OBJECTIVE/AIM This systematic review and meta-analysis aimed to elaborate the correlation between malnutrition and 30-day rehospitalization in older adults. METHODS Systematic review was conducted on literatures from Cochrane, ScienceDirect, SpringerLink, Oxford Academic, and MEDLINE according to PRISMA Guideline, investigating the correlation of malnutrition in older adults with rehospitalization, using Malnutrition, Older Adults, and Rehospitalization as keywords. Meta-analysis was done using RevMan, with random-effect analysis model. P values of ≤0.05 were considered statistically significant with results reported as risk ratios (RR), mean differences (MD), 95 % confidence intervals (CI) and I2 statistics. RESULTS Seven literatures were analysed, consisting of 19,340 patients aged 65 or older undergoing hospitalization. Subjects were assessed with screening tools to identify malnutrition. Malnourished subjects are compared to others with normal nutrition; in cohort studies with follow-up period ranging from 3 to 16 months. Malnutrition significantly increased the risks of rehospitalization within 30 days (RR 1.73 [95 % CI 1.10-2.72], p = 0.02, I2 = 56 %), overall rehospitalization at all times (RR 1.33 [95 % CI 1.16-1.52], p < 0.0001, I2 = 75 %), and overall mortality (RR 2.66 [95 % CI 1.09-6.50], p = 0.03, I2 = 94 %). CONCLUSION Malnutrition exhibited significant consequences in older patients regarding the rate of rehospitalization and mortality based on this meta-analysis. Further research is highly encouraged to verify this finding.
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Affiliation(s)
- Edy Rizal Wahyudi
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia; Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Sudarto Ronoatmodjo
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia
| | - Siti Setiati
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia; Center of Clinical Epidemiology and Evidence-Based Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia
| | - Besral
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia
| | - Czeresna Heriawan Soejono
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia; Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Tuty Kuswardhani
- Geriatric Division, KSM Department of Internal Medicine, Prof. Ngoerah Hospital, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
| | - Ika Fitriana
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Jessica Marsigit
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Stella Andriana Putri
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia
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Edelstein J, Li CY, Meythaler J, Weaver JA, Graham JE. Inpatient Rehabilitation Facility Ownership Type Yields Mixed Performances on Quality Measures. Arch Phys Med Rehabil 2024; 105:443-451. [PMID: 37907161 PMCID: PMC11006015 DOI: 10.1016/j.apmr.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures. DESIGN Cross-sectional, observational design. SETTING We used 2 Centers for Medicare and Medicare publicly-available, facility-level data sources: (1) IRF compare files and (2) IRF rate setting files - final rule. Data from 2021 were included. PARTICIPANTS The study sample included 1092 IRFs (N=1092). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We estimated the effects of IRF ownership type, defined as for-profit and nonprofit, on 15 IRF-QRP measures using general linear models. Models were adjusted for the following facility-level characteristics: (1) Centers for Medicare and Medicaid census divisions; (2) number of discharges; (3) teaching status; (4) freestanding vs hospital unit; and (5) estimated average weight per discharge. RESULTS Ownership type was significantly associated with 9 out of the fifteen IRF-QRP measures. Nonprofit IRFs performed better with having lower readmissions rates within stay and 30-day post discharge. For-profit IRFs performed better for all the functional measures and with higher rates of returning to home and the community. Lastly, for-profit IRFs spent more per Medicare beneficiary. CONCLUSIONS Ideally, IRF performance would not vary based on ownership type. However, we found that ownership type is associated with IRF-QRP performance scores. We suggest that future studies investigate how ownership type affects patient-level outcomes and the longitudinal effect of ownership type on IRF-QRP measures.
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Affiliation(s)
- Jessica Edelstein
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO.
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Jay Meythaler
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Jennifer A Weaver
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
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Herrmann AA, Chrenka EA, Seth S, Nyamao TM, Niemioja GM, Hanson LR, Hussein HM. Potentially Preventable Readmissions After Acute Inpatient Rehabilitation. Am J Phys Med Rehabil 2023; 102:1014-1019. [PMID: 37104643 DOI: 10.1097/phm.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. DESIGN Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days ( n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls ( n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. RESULTS Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. CONCLUSIONS Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.
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Affiliation(s)
- Amanda A Herrmann
- From the HealthPartners Institute, Bloomington, Minnesota (AAH, EAC, LRH); HealthPartners Neuroscience Center, St Paul, Minnesota (AAH, EAC, SS, TMN, GMN, LRH); Regions Hospital, St Paul, Minnesota (GMN); and University of Minnesota, Minneapolis, Minnesota (HMH)
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Mitsutake S, Ishizaki T, Yano S, Tsuchiya-Ito R, Uda K, Toba K, Ito H. All-Cause Readmission or Potentially Avoidable Readmission: Which Is More Predictable Using Frailty, Comorbidities, and ADL? Innov Aging 2023; 7:igad043. [PMID: 37342490 PMCID: PMC10278982 DOI: 10.1093/geroni/igad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 06/23/2023] Open
Abstract
Background and Objectives Readmission-related health care reforms have shifted their focus from all-cause readmissions (ACR) to potentially avoidable readmissions (PAR). However, little is known about the utility of analytic tools from administrative data in predicting PAR. This study determined whether 30-day ACR or 30-day PAR is more predictable using tools that assess frailty, comorbidities, and activities of daily living (ADL) from administrative data. Research Design and Methods This retrospective cohort study was conducted at a large general acute care hospital in Tokyo, Japan. We analyzed patients aged ≥70 years who had been admitted to and discharged from the subject hospital between July 2016 and February 2021. Using administrative data, we assessed each patient's Hospital Frailty Risk Score, Charlson Comorbidity Index, and Barthel Index on admission. To determine the influence of each tool on readmission predictions, we constructed logistic regression models with different combinations of independent variables for predicting unplanned ACR and PAR within 30 days of discharge. Results Among 16 313 study patients, 4.1% experienced 30-day ACR and 1.8% experienced 30-day PAR. The full model (including sex, age, annual household income, frailty, comorbidities, and ADL as independent variables) for 30-day PAR showed better discrimination (C-statistic: 0.79, 95% confidence interval: 0.77-0.82) than the full model for 30-day ACR (0.73, 0.71-0.75). The other prediction models for 30-day PAR also had consistently better discrimination than their corresponding models for 30-day ACR. Discussion and Implications PAR is more predictable than ACR when using tools that assess frailty, comorbidities, and ADL from administrative data. Our PAR prediction model may contribute to the accurate identification of at-risk patients in clinical settings who would benefit from transitional care interventions.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shohei Yano
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- The Salvation Army Booth Memorial Hospital, Tokyo, Japan
| | - Rumiko Tsuchiya-Ito
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Kazuaki Uda
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenji Toba
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hideki Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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French MA, Keatley E, Li J, Balasubramanian A, Hansel NN, Wise R, Searson P, Singh A, Raghavan P, Wegener S, Roemmich RT, Celnik P. The feasibility of remotely monitoring physical, cognitive, and psychosocial function in individuals with stroke or chronic obstructive pulmonary disease. Digit Health 2023; 9:20552076231176160. [PMID: 37214659 PMCID: PMC10192672 DOI: 10.1177/20552076231176160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Clinical implementation of remote monitoring of human function requires an understanding of its feasibility. We evaluated adherence and the resources required to monitor physical, cognitive, and psychosocial function in individuals with either chronic obstructive pulmonary disease or stroke during a three-month period. Methods Seventy-three individuals agreed to wear a Fitbit to monitor physical function and to complete monthly online assessments of cognitive and psychosocial function. During a three-month period, we measured adherence to monitoring (1) physical function using average daily wear time, and (2) cognition and psychosocial function using the percentage of assessments completed. We measured the resources needed to promote adherence as (1) the number of participants requiring at least one reminder to synchronize their Fitbit, and (2) the number of reminders needed for each completed cognitive and psychosocial assessment. Results After accounting for withdrawals, the average daily wear time was 77.5 ± 19.9% of the day and did not differ significantly between months 1, 2, and 3 (p = 0.30). To achieve this level of adherence, 64.9% of participants required at least one reminder to synchronize their device. Participants completed 61.0% of the cognitive and psychosocial assessments; the portion of assessments completed each month didnot significantly differ (p = 0.44). Participants required 1.13 ± 0.57 reminders for each completed assessment. Results did not differ by disease diagnosis. Conclusions Remote monitoring of human function in individuals with either chronic obstructive pulmonary disease or stroke is feasible as demonstrated by high adherence. However, the number of reminders required indicates that careful consideration must be given to the resources available to obtain high adherence.
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Affiliation(s)
- Margaret A French
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Eva Keatley
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Junyao Li
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care
Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care
Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Wise
- Division of Pulmonary and Critical Care
Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Searson
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
- Department of Materials Science and
Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Anil Singh
- Department of Pulmonary and Critical
Care Medicine, Allegheny Health Network, Pittsburg, PA, USA
| | - Preeti Raghavan
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Stephen Wegener
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Ryan T Roemmich
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
- Kennedy Krieger Institute, Center for Movement Studies, Baltimore, MD, USA
| | - Pablo Celnik
- Department of Physical Medicine and
Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
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Orman ES, Ghabril MS, Desai AP, Nephew L, Patidar KR, Gao S, Xu C, Chalasani N. Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis. Clin Gastroenterol Hepatol 2022; 20:e1426-e1437. [PMID: 34311111 PMCID: PMC8784569 DOI: 10.1016/j.cgh.2021.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions. METHODS We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction. RESULTS A total of 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher Model for End-Stage Liver Disease, discharge with public transportation, and impaired basic activities of daily living and quality-of-life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared with a model including only clinical variables, addition of functional status and quality-of-life variables improved the area under the receiver-operating characteristic curve from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared with clinical variables alone. Compared with a model using electronically available variables only, no models improved prediction when examined with integrated discrimination improvement. CONCLUSIONS PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.
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Affiliation(s)
- Eric S Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Marwan S Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kavish R Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chenjia Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
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Edelstein J, Walker R, Middleton A, Reistetter T, Gary KW, Reynolds S. Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions. Am J Occup Ther 2022; 76:23119. [PMID: 34964838 DOI: 10.5014/ajot.2022.048678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. OBJECTIVE To evaluate how acute occupational therapy service delivery factors affect readmission risk. DESIGN Cross-sectional, retrospective study. SETTING Single academic medical center. PARTICIPANTS Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. RESULTS Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). CONCLUSIONS AND RELEVANCE For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy's role in the U.S. quality-focused health care system.
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Affiliation(s)
- Jessica Edelstein
- Jessica Edelstein, PhD, OTR/L, is Occupational Therapy Postdoctoral Fellow, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, Edelstein was Occupational Therapist, Department of Rehabilitation, Froedtert Hospital, Milwaukee, WI, and PhD Student, Virginia Commonwealth University, Richmond, VA;
| | - Rebekah Walker
- Rebekah Walker, PhD, is Associate Professor, Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, and Associate Director, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Addie Middleton
- Addie Middleton, PhD, DPT, is Clinician Scientist, New England Geriatric Research and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA
| | - Timothy Reistetter
- Timothy Reistetter, PhD, OTR, FAOTA, is Associate Dean of Research and Professor, School of Health Professions, Department of Occupational Therapy, University of Texas Health Science Center at San Antonio
| | - Kelli Williams Gary
- Kelli Williams Gary, PhD, MPH, OTR/L, is Associate Professor, Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond
| | - Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
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Edelstein J, Middleton A, Walker R, Reistetter T, Reynolds S. Impact of Acute Self-Care Indicators and Social Factors on Medicare Inpatient Readmission Risk. Am J Occup Ther 2022; 76:23120. [PMID: 34964839 DOI: 10.5014/ajot.2022.049084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Readmissions are costly for Medicare and are associated with poor patient outcomes. OBJECTIVE To determine whether two domains relevant to acute occupational therapy practice-self-care status and social factors-were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP). DESIGN Cross-sectional, retrospective study. SETTING Single academic medical center. PARTICIPANTS Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses. RESULTS No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia. CONCLUSIONS AND RELEVANCE The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.
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Affiliation(s)
- Jessica Edelstein
- Jessica Edelstein, PhD, OTR/L, is Occupational Therapy Postdoctoral Fellow, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, Edelstein was Occupational Therapist, Department of Rehabilitation, Froedtert Hospital, Milwaukee, WI, and PhD Student, Virginia Commonwealth University, Richmond;
| | - Addie Middleton
- Addie Middleton, PhD, DPT, is Clinician Scientist, New England Geriatric Research and Clinical Center, U.S Department of Veterans Affairs Boston Healthcare System, Boston, MA
| | - Rebekah Walker
- Rebekah Walker, PhD, is Associate Professor, Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, and Associate Director, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Timothy Reistetter
- Timothy Reistetter, PhD, OTR, FAOTA, is Associate Dean of Research and Professor, School of Health Professions, Department of Occupational Therapy, University of Texas Health Science Center at San Antonio
| | - Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
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Falvey J, Bade MJ, Forster JE, Stevens-Lapsley JE. Poor Recovery of Activities-of-Daily-Living Function Is Associated With Higher Rates of Postsurgical Hospitalization After Total Joint Arthroplasty. Phys Ther 2021; 101:pzab189. [PMID: 34339513 PMCID: PMC8565313 DOI: 10.1093/ptj/pzab189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/10/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Medicare beneficiaries are increasingly using home health (HH) as the first postacute care setting after hospital discharge following total joint arthroplasty (TJA). Yet, prior research has shown that changes in payment models for TJA may negatively influence functional outcomes for Medicare beneficiaries. The purpose of this study was to evaluate the impact of poor functional outcomes during an HH episode of care on hospitalization risk for older recipients of TJA. METHODS For this study, 5822 Medicare beneficiaries who underwent elective TJA and subsequently participated in HH care following hospital discharge were identified using Medicare hospitalizations records and HH claims. Recovery of activities-of-daily-living (ADL) function was evaluated using patient assessment data completed at HH admission and discharge from the Medicare Outcomes and Assessment Information Set (OASIS). Hospitalization outcomes were captured from Medicare hospital claims. Cox proportional hazards regression was used to evaluate the hazard ratio for hospitalization after HH discharge. RESULTS The 5822 Medicare beneficiaries who received a TJA and subsequently were discharged to HH were evaluated (n = 3989 [68.6%] following total knee replacement, n = 1883 [31.4%]) following total hip replacement). Nearly 9% (n = 534) of patients did not improve their ability to perform ADLs during the HH episode; this lack of improvement was associated with a more than 2-fold increase in hospital readmission rate following HH discharge (2.3% vs 4.9%). In adjusted models, there was a significant 77% increase (hazard ratio = 1.77; 95% CI = 1.14-2.74) in hospitalization risk during the 90-day postsurgical period. CONCLUSION Poor recovery of ADL function in HH settings following TJA is strongly associated with elevated risk of future hospitalizations. IMPACT Medicare beneficiaries who fail to make substantive improvements in basic ADL function during HH care episodes following TJA may need intensive monitoring from interdisciplinary team members across the continuum of care, especially during transitions from home care to outpatient care. LAY SUMMARY An increasing number of patients receive home health care after joint replacement surgery, but outcomes after home health are unclear. These findings suggest that improvements in basic tasks such as walking or bathing are associated with a lower likelihood of hospitalization.
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Affiliation(s)
- Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Michael J Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeri E Forster
- Rocky Mountain Regional Veterans Affairs Medical Center, Mental Illness Research, Education, and Clinical Center, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Veterans Affairs Eastern Colorado Geriatric Research, Education and Clinical Center, Aurora, Colorado, USA
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Tennison JM, Rianon NJ, Manzano JG, Munsell MF, George MC, Bruera E. Thirty-day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation. Cancer Med 2021; 10:6199-6206. [PMID: 34313031 PMCID: PMC8446558 DOI: 10.1002/cam4.4154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate the 30‐day hospital readmission rate, reasons, and risk factors for patients with cancer who were discharged to home setting after acute inpatient rehabilitation. Design, Setting, and Participants This was a secondary retrospective analysis of participants in a completed prospective survey study that assessed the continuity of care and functional safety concerns upon discharge and 30 days after discharge in adults. Patients were enrolled from September 5, 2018, to February 7, 2020, at a large academic quaternary cancer center with National Cancer Institute Comprehensive Cancer Center designation. Main Outcomes and Measures Thirty‐day hospital readmission rate, descriptive summary of reasons for readmissions, and statistical analyses of risk factors related to readmission. Results Fifty‐five (21%) of the 257 patients were readmitted to hospital within 30 days of discharge from acute inpatient rehabilitation. The reasons for readmissions were infection (20, 7.8%), neoplasm (9, 3.5%), neurological (7, 2.7%), gastrointestinal disorder (6, 2.3%), renal failure (3, 1.1%), acute coronary syndrome (3, 1.1%), heart failure (1, 0.4%), fracture (1, 0.4%), hematuria (1, 0.4%), wound (1, 0.4%), nephrolithiasis (1, 0.4%), hypervolemia (1, 0.4%), and pain (1, 0.4%). Multivariate logistic regression modeling indicated that having a lower locomotion score (OR = 1.29; 95% CI, 1.07–1.56; p = 0.007) at discharge, having an increased number of medications (OR = 1.12; 95% CI, 1.01–1.25; p = 0.028) at discharge, and having a lower hemoglobin at discharge (OR = 1.31; 95% CI, 1.03–1.66; p = 0.031) were independently associated with 30‐day readmission. Conclusion and Relevance Among adult patients with cancer discharged to home setting after acute inpatient rehabilitation, the 30‐day readmission rate of 21% was higher than that reported for other rehabilitation populations but within the range reported for patients with cancer who did not undergo acute inpatient rehabilitation. Research is needed to determine the rates of and risk factors for 30‐day hospital readmission after acute inpatient cancer rehabilitation to understand the nature of this problem and to decrease costs associated with readmissions. Among adult patients with cancer discharged to a home setting after acute inpatient rehabilitation, the 30‐day readmission rate of 21% was higher than that reported for other rehabilitation populations but within the range reported for patients with cancer who did not undergo acute inpatient rehabilitation. Cancer rehabilitation patients may have unique risk factors for readmission.
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Affiliation(s)
- Jegy M Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nahid J Rianon
- Department of Family & Community Medicine and Joan & Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Houston Health Science Center, Houston, TX, USA
| | - Joanna G Manzano
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina C George
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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Knox S, Downer B, Haas A, Ottenbacher KJ. Mobility and Self-Care are Associated With Discharge to Community After Home Health for People With Dementia. J Am Med Dir Assoc 2021; 22:1493-1499.e1. [PMID: 33476569 PMCID: PMC8496773 DOI: 10.1016/j.jamda.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES A priority health outcome for patients, families, and the Centers for Medicare & Medicaid Services (CMS) is a patient's ability to return home and remain in the community without adverse events following discharge from post-acute care services. Successful discharge to community (DTC) is defined as being discharged to the community and not experiencing a readmission or death within 30 days of discharge. The objective of this study was to determine the association between patient factors and successful DTC after home health for individuals with Alzheimer's disease and related dementias (ADRD). DESIGN This retrospective study derived data from 100% national CMS data files from October 1, 2016, through September 30, 2017. SETTINGS AND PARTICIPANTS Criteria from the Home Health Quality Reporting program were used to identify a cohort of 790,439 Medicare home health beneficiaries, 143,164 (18.0%) with ADRD. MEASURES Successful DTC rates with associated 95% confidence intervals (CIs) were calculated for each patient characteristic. Multilevel logistic regression was used to estimate the relative risk (RR) of successful DTC after home health, by ADRD diagnosis, mobility, self-care, caregiver support, and medication management, adjusted for patient demographics and clinical characteristics. RESULTS Overall, 79.4% of beneficiaries had a successful DTC. Beneficiaries with ADRD had a significantly lower odds of successful DTC than those without ADRD (RR=0.947, 95% CI=0.944-0.950). This association remained significant after adjustment for caregiver support, assistance with medications, independence in mobility, and level of self-care. Greater need for caregiver support, greater need for assistance with medications, greater dependence in mobility, and greater self-care dependence were all associated with decreased risk of successful DTC. CONCLUSIONS AND IMPLICATIONS Older adults with ADRD receiving home health had decreased RR of successful DTC. To have a successful DTC, older adults with ADRD need sufficient support from caregivers and independence in functioning.
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Affiliation(s)
- Sara Knox
- Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA.
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Allen Haas
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
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12
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Mitsutake S, Ishizaki T, Tsuchiya‐Ito R, Furuta K, Hatakeyama A, Sugiyama M, Toba K, Ito H. Association of cognitive impairment severity with potentially avoidable readmissions: A retrospective cohort study of 8897 older patients. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12147. [PMID: 33816752 PMCID: PMC8012240 DOI: 10.1002/dad2.12147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Understanding the association between cognitive impairment severity and potentially avoidable readmissions (PARs) in older patients may facilitate the identification of at-risk individuals who would benefit from readmission prevention measures. METHODS This retrospective cohort study was conducted using claims data linked with routinely collected cognitive impairment assessment results from a general acute care hospital in Tokyo, Japan. Patients were 65 years or age or older who were discharged from the subject hospital to home or a facility between July 2016 and September 2018. RESULTS A multivariable logistic regression analysis adjusted for covariates showed that the odds of PARs within 90 days to the subject hospital for patients with moderate and severe cognitive impairment were 1.418 times (95% confidence interval: 1.005-2.002) and 2.212 times (95% confidence interval: 1.206-4.058) higher, respectively, that for patients with normal cognition. DISCUSSION Older inpatients with later-stage cognitive impairment may represent a suitable target population for transitional care programs aimed at reducing readmissions.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research TeamTokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Tatsuro Ishizaki
- Human Care Research TeamTokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Rumiko Tsuchiya‐Ito
- Human Care Research TeamTokyo Metropolitan Institute of GerontologyTokyoJapan
- Research DepartmentInstitute for Health Economics and PolicyTokyoJapan
| | - Ko Furuta
- Department of PsychiatryTokyo Metropolitan Geriatric HospitalTokyoJapan
| | - Akira Hatakeyama
- Dementia Support CenterTokyo Metropolitan Geriatric HospitalTokyoJapan
| | - Mika Sugiyama
- Research Team for Promoting Independence of the ElderlyTokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Kenji Toba
- Tokyo Metropolitan Geriatric Hospital and Institute of GerontologyTokyoJapan
| | - Hideki Ito
- Tokyo Metropolitan Geriatric Hospital and Institute of GerontologyTokyoJapan
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13
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Kerminen HM, Jäntti PO, Valvanne JNA, Huhtala HSA, Jämsen ERK. Risk factors of readmission after geriatric hospital care: An interRAI-based cohort study in Finland. Arch Gerontol Geriatr 2021; 94:104350. [PMID: 33516078 DOI: 10.1016/j.archger.2021.104350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify risk factors for readmission after geriatric hospital care. METHODS A retrospective cohort study of 1,167 community-dwelling patients aged ≥70 years who were hospitalised in two geriatric hospitals and discharged to their homes over a three-year period. We combined the results of the interRAI-post acute care instrument (interRAI-PAC) with hospital discharge records. Factors associated with readmissions within 90 days following discharge were analysed using logistic regression analysis. RESULTS The patients' mean age was 84.5 (SD 6.2) years, and 71% (n = 827) were women. The 90-day readmission rate was 29.5%. The risk factors associated with readmission in the univariate analysis were as follows: age, admission from home vs. acute care hospital, Alzheimer's disease, unsteady gait, fatigue, unstable conditions, Activities of Daily Living Hierarchy Scale (ADLH) score, Cognitive Performance Scale (CPS) score, body mass index (BMI), frailty index, bowel incontinence, hearing difficulties, and poor self-rated health. In the multivariable analysis, age of ≥90 years, ADLH ≥1, unsteady gait, BMI <25 or ≥30 kg/m 2 , and frailty remained as risk factors for readmission. Surgical operation during the treatment period was associated with a lower readmission risk. CONCLUSIONS AND IMPLICATIONS InterRAI-PAC performed upon admission to geriatric hospitals revealed patient-related risk factors for readmission. Based on the identified risk factors, we recommend that the patient's functional ability, activities of daily living (ADL) needs, and individual factors underlying ADL disability, as well as nutritional and mobility problems should be carefully addressed and managed during hospitalization to diminish the risk for readmission.
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Affiliation(s)
- Hanna M Kerminen
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland.
| | - Pirkko O Jäntti
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland
| | - Jaakko N A Valvanne
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland
| | - Heini S A Huhtala
- Tampere University, Faculty of Social Sciences, P.O. Box 100, 33014, Tampere University, Finland
| | - Esa R K Jämsen
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland
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14
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Li CY, Karmarkar A, Kuo YF, Haas A, Ottenbacher KJ. Impact of Self-Care and Mobility on One or More Post-Acute Care Transitions. J Aging Health 2020; 32:1325-1334. [PMID: 32501126 PMCID: PMC7718286 DOI: 10.1177/0898264320925259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To investigate the association between functional status and post-acute care (PAC) transition(s). Methods: Secondary analysis of 2013-2014 Medicare data for individuals aged ≥66 years with stroke, lower extremity joint replacements, and hip/femur fracture discharged to one of three PAC settings (inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies). Functional scores were co-calibrated into a 0-100 scale across settings. Multilevel logistic regression was used to test the partition of variance (%) and the probability of PAC transition attributed to the functional score in the initial PAC setting. Results: Patients discharged to inpatient rehabilitation facilities with higher function were less likely to use additional PAC. Function level in an inpatient rehabilitation facility explained more of the variance in PAC transitions than function level while in a skilled nursing facility. Discussion: The function level affected PAC transitions more for those discharged to an inpatient rehabilitation facility than to a skilled nursing facility.
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Affiliation(s)
- Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-1142
| | - Amol Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-0137
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Public Health, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-1148
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-0177
| | - Allen Haas
- Department of Preventive Medicine & Public Health, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-1148
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-0137
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd. Galveston, TX 77555-0177
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15
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Ifejika NL, Bhadane M, Cai CC, Watkins JN, Grotta JC. Characteristics of Acute Stroke Patients Readmitted to Inpatient Rehabilitation Facilities: A Cohort Study. PM R 2020; 13:479-487. [PMID: 32737961 DOI: 10.1002/pmrj.12462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reducing acute care readmissions from inpatient rehabilitation facilities (IRFs) is a healthcare reform goal. Stroke patients have higher acute readmission rates and persistent impairments, warranting second IRF hospitalization consideration. OBJECTIVE To provide evidence-based information to justify IRF readmission for patients with post-stroke impairments. MAIN OUTCOME MEASURE Variables that increase the likelihood of a second IRF hospitalization. DESIGN Retrospective cohort study. SETTING Seven-center rehabilitation network. PARTICIPANTS Stroke patients, readmitted to acute care, who returned or did not return to an in-network IRF between 1 October 2014-31 December 2017(n = 380). INTERVENTIONS Univariable analyses (Returned/Did Not Return to IRF) described demographics, stroke type and risk factors. Between group differences in readmission causes, motor impairments and functional independence measure (FIM) scores were examined. Return to IRF logistic regression model included variables with P < .1. Odds ratio and 95% CI were calculated; Relative risk was calculated for categorical variables. P < .05 equaled statistical significance. RESULTS One hundred ninety-two stroke patients returned to IRF, 188 did not. Returned to IRF patients were younger (60.6 vs. 66 years; P < .001), sustained hemorrhagic strokes (22.4 vs. 14.2%; P = .01), had lower cardiac disease prevalence (41.7 vs. 55.3%; P = .008) or non-Medicare insurance (59.9 vs. 39.4%; P < .001). Did Not Return to IRF patients had higher admission and discharge motor and total FIM scores. Per point decrease in discharge FIM, second IRF hospitalization odds increased 4% (OR 1.04; 95% CI 1.01-1.07; P = .02). Hemorrhagic stroke patients had 33% increased odds or a 15% higher relative risk of second IRF hospitalization than patients with ischemic stroke [OR 1.33; 95% CI 1.21-1.47; RR 1.15; 95% CI 1.1-1.2; P < .001]. Non-Medicare insurance was associated with 39% increased odds or a 20% higher relative risk of second IRF hospitalization than Medicare [OR 1.39; 95% CI 1.01-1.92; RR 1.2, 95% CI 1.006-1.404; P = .04). CONCLUSIONS Hemorrhagic stroke, non-Medicare insurance or lower discharge FIM score during the first IRF hospitalization predict a second IRF stay. Further work is needed to establish the validity of within IRF stay readmission measures.
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Affiliation(s)
- Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, TX.,Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas, TX.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, TX
| | - Minal Bhadane
- Department of Optometry, University of Houston, Houston, Texas, TX
| | - Chunyan C Cai
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, Texas, TX
| | | | - James C Grotta
- Stroke Research and Mobile Stroke Unit, Memorial Hermann Hospital - Texas Medical Center, Houston, Texas, TX
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16
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Freburger JK, Chou A, Euloth T, Matcho B. Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia. JAMA Netw Open 2020; 3:e2012979. [PMID: 32886119 PMCID: PMC7489809 DOI: 10.1001/jamanetworkopen.2020.12979] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Pneumonia often leads to functional decline during and after hospitalization and is a leading cause of hospital readmissions. Physical and occupational therapists help improve functional mobility and may be of help in this population. OBJECTIVE To evaluate whether use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. DESIGN, SETTING, AND PARTICIPANTS This cohort study included the electronic health records and administrative claims data of 30 746 adults discharged alive with a primary or secondary diagnosis of pneumonia or influenza-related conditions from January 1, 2016, to March 30, 2018. Patients were treated at 12 acute care hospitals in a large health care system in western Pennsylvania. Data for this study were analyzed from September 2019 through March 2020. EXPOSURES Number of physical and occupational therapy visits during the acute care stay categorized as none, low (1-3), medium (4-6), or high (>6). MAIN OUTCOMES AND MEASURES Outcomes were 30-day hospital readmission or death. Generalized linear mixed models were estimated to examine the association of therapy use and outcomes, controlling for patient demographic and clinical characteristics. Subgroup analyses were conducted for patients older than 65 years, for patients with low functional mobility scores, for patients discharged to the community, and for patients discharged to a post-acute care facility (ie, skilled nursing or inpatient rehabilitation facility). RESULTS Of 30 746 patients, 15 507 (50.4%) were men, 26 198 (85.2%) were White individuals, and the mean (SD) age was 67.1 (17.4) years. The 30-day readmission rate was 18.4% (5645 patients), the 30-day death rate was 3.7% (1146 patients), and the rate of either outcome was 19.7% (6066 patients). Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98). The association was stronger in the subgroup with low functional mobility and in individuals discharged to a community setting. CONCLUSIONS AND RELEVANCE In this study, the number of therapy visits received was inversely associated with the risk of readmission or death. The association was stronger in the subgroups of patients with greater mobility limitations and those discharged to the community.
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Affiliation(s)
- Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aileen Chou
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracey Euloth
- University of Pittsburgh Medical Center Rehabilitation Services, Pittsburgh, Pennsylvania
| | - Beth Matcho
- University of Pittsburgh Medical Center Rehabilitation Services, Pittsburgh, Pennsylvania
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17
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Chan EY, Samsudin SA, Lim YJ. Older patients’ perception of engagement in functional self-care during hospitalization: A qualitative study. Geriatr Nurs 2020; 41:297-304. [DOI: 10.1016/j.gerinurse.2019.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022]
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18
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Carroll NW, Hall AG, Feldman S, Thirumalai M, Wade JT, Rimmer JH. Enhancing Transitions From Rehabilitation Patient to Wellness Participant for People With Disabilities: An Opportunity for Hospital Community Benefit. Front Public Health 2020; 8:105. [PMID: 32322569 PMCID: PMC7156537 DOI: 10.3389/fpubh.2020.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Pressure is increasing on not-for-profit hospitals to demonstrate that they provide sufficient benefit to the community to justify their tax-exempt status. Many industry observers have suggested that this community benefit should address unmet medical needs within the community, deficits in the social determinants of health, or health disparities within communities. We argue that one area of clear unmet need is assistance in helping bridge the transition that people with disabilities (PWD) must make from rehabilitation patient to wellness participant. Programs to bridge this transition are necessary because many PWD struggle to identify strategies to maintain and maximize their own well-being after discharge from the healthcare system. As a result, PWD have worse health outcomes than non-disabled individuals. To address these needs, we propose hospitals take a leading role in establishing new, community-based efforts to provide PWD with benefits that will support their effort to self-manage health. Hospitals are well-suited to lead the creation of these programs because of the important role they play in providing services to PWD and because of their ability to bring together multiple stakeholders required to make supportive programs sustainable.
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Affiliation(s)
- Nathan W Carroll
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson G Hall
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sue Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jamie Tinker Wade
- Spain Rehabilitation Center, University of Alabama at Birmingham Hospital, Birmingham, AL, United States
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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19
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Kushner DS, Strasser DC. Stroke Inpatient Rehabilitation Team Conferences: Leadership and Structure Improve Patient Outcomes. J Stroke Cerebrovasc Dis 2020; 29:104622. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022] Open
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20
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Function and Caregiver Support Associated With Readmissions During Home Health for Individuals With Dementia. Arch Phys Med Rehabil 2020; 101:1009-1016. [PMID: 32035139 DOI: 10.1016/j.apmr.2019.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the association between mobility, self-care, cognition, and caregiver support and 30-day potentially preventable readmissions (PPR) for individuals with dementia. DESIGN This retrospective study derived data from 100% national Centers for Medicare and Medicaid Services data files from July 1, 2013, through June 1, 2015. PARTICIPANTS Criteria from the Home Health Claims-Based Rehospitalization Measure and the Potentially Preventable 30-Day Post Discharge Readmission Measure for the Home Health Quality Reporting Program were used to identify a cohort of 118,171 Medicare beneficiaries. MAIN OUTCOME MEASURE The 30-day PPR rates with associated 95% CIs were calculated for each patient characteristic. Multilevel logistic regression was used to study the relationship between mobility, self-care, caregiver support, and cognition domains and 30-day PPR during home health, adjusting for patient demographics and clinical characteristics. RESULTS The overall rate of 30-day PPR was 7.6%. In the fully adjusted models, patients who were most dependent in mobility (odds ratio [OR], 1.59; 95% CI, 1.47-1.71) and self-care (OR, 1.73; 95% CI, 1.61-1.87) had higher odds for 30-day PPR. Patients with unmet caregiving needs had 1.11 (95% CI, 1.05-1.17) higher odds for 30-day PPR than patients whose caregiving needs were met. Patients with cognitive impairment had 1.23 (95% CI, 1.16-1.30) higher odds of readmission than those with minimal to no cognitive impairment. CONCLUSIONS Decreased independence in mobility and self-care tasks, unmet caregiver needs, and impaired cognitive processing at admission to home health are associated with risk of 30-day PPR during home health for individuals with dementia. Our findings indicate that deficits in mobility and self-care tasks have the greatest effect on the risk for PPR.
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21
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Mitsutake S, Ishizaki T, Tsuchiya-Ito R, Uda K, Teramoto C, Shimizu S, Ito H. Associations of Hospital Discharge Services With Potentially Avoidable Readmissions Within 30 Days Among Older Adults After Rehabilitation in Acute Care Hospitals in Tokyo, Japan. Arch Phys Med Rehabil 2020; 101:832-840. [PMID: 31917197 DOI: 10.1016/j.apmr.2019.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the associations of 3 major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions (PARs) within 30 days in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. DESIGN Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. SETTING Acute care hospitals. PARTICIPANTS Patients who underwent rehabilitation and were discharged to home (N=31,247; mean age in years ± SD, 84.1±5.7) between October 2013 and July 2014. INTERVENTIONS None. MAIN OUTCOME MEASURE 30-day PAR. RESULTS Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI], 0.805-1.151) for discharge planning, 1.060 (95% CI, 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI, 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P<.001), and the odds of 30-day PAR among patients with a higher number (median or higher) of rehabilitation units were 2.031 times higher than those of patients with a lower number (below median) (P<.001). Also, the odds of 30-day PAR among patients with a higher Hospital Frailty Risk Score (median or higher) were 1.252 times higher than those of patients with a lower score (below median) (P=.001). CONCLUSIONS The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Rumiko Tsuchiya-Ito
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Dia Foundation for Research on Aging Societies, Tokyo, Japan
| | - Kazuaki Uda
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chie Teramoto
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hideki Ito
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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22
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Middleton A, Downer B, Haas A, Knox S, Ottenbacher KJ. Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Home Health Care. Med Care 2019; 57:145-151. [PMID: 30531524 PMCID: PMC6358180 DOI: 10.1097/mlr.0000000000001047] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Beginning in 2019, home health agencies' rates of potentially preventable hospital readmissions over the 30 days following discharge will be publicly reported. OBJECTIVES Our primary objective was to determine the association between patients' functional status at discharge from home health care and 30-day potentially preventable readmissions. A secondary objective was to identify the most common conditions resulting in potentially preventable readmissions. DESIGN This was a retrospective cohort study. PARTICIPANTS A total of 1,510,297 Medicare fee-for-service beneficiaries discharged from home health care in 2013-2015. Average age was 75.9 (SD, 10.9) years, 60.0% were female, and 84.2% non-Hispanic white. MEASUREMENTS Thirty-day potentially preventable readmissions following home health discharge. Functional status measures included mobility, self-care, and impaired cognition. RESULTS The overall rate of 30-day potentially preventable readmissions was 2.6% (N=39,452), which accounted for 40% of all 30-day readmissions. After adjusting for sociodemographic and clinical characteristics, the odds ratios for the most dependent score quartile versus the most independent was 1.58 [95% confidence interval (CI), 1.53-1.63] for mobility and 1.65 (95% CI, 1.59-1.69) for self-care. The odds ratios for impaired versus intact cognition was 1.21 (95% CI, 1.18-1.24). The 5 most common conditions resulting in a potentially preventable readmission were congestive heart failure (23.6%), septicemia (16.7%), bacterial pneumonia (9.8%), chronic obstructive pulmonary disease (9.4%), and renal failure (7.5%). CONCLUSIONS Functional limitations at discharge from home health are associated with increased risk for potentially preventable readmissions. Future research is needed to determine whether improving functional independence decreases the risk for potentially preventable readmissions following home health care.
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Affiliation(s)
- Addie Middleton
- Division of Physical Therapy, Medical University of South Carolina, Charleston, SC
| | | | - Allen Haas
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Sara Knox
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA
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23
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Falvey JR, Burke RE, Levy CR, Gustavson AM, Price L, Forster JE, Stevens-Lapsley JE. Impaired Physical Performance Predicts Hospitalization Risk for Participants in the Program of All-Inclusive Care for the Elderly. Phys Ther 2019; 99:28-36. [PMID: 30602041 PMCID: PMC6314329 DOI: 10.1093/ptj/pzy127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medicaid spending on the Program of All-Inclusive Care for the Elderly (PACE) has grown rapidly over the last 5 years. Reducing hospitalization rates is a major goal for PACE. However, there is a paucity of research evaluating the relationship between impaired physical performance and hospitalizations in PACE. OBJECTIVE This study tested whether physical therapist-assessed physical performance, measured by the Short Physical Performance Battery (SPPB), can be used to identify participants in PACE at risk for all-cause hospitalizations or potentially avoidable hospitalizations (PAH). DESIGN This was a retrospective cohort study of 1093 participants in PACE facilities in the Denver, Colorado, area. METHODS Data were acquired from linked electronic medical record data and hospitalization claims. Unadjusted and adjusted Cox proportional hazards regression models were used to evaluate the relationship between SPPB scores and the probabilities of both all-cause hospitalizations and PAH. RESULTS The unadjusted likelihood of hospitalization increased with greater physical performance impairment (for SPPB scores ≥8/12: 12.2%; for SPPB scores of 4/12 to 7/12: 15.7%; for SPPB scores <4/12: 21.1%). Compared with participants with SPPB scores ≥8/12, participants with SPPB scores <4/12 had nearly double the unadjusted hazard for hospitalization (hazard ratio = 1.99; 95% CI = 1.34-2.96). In adjusted Cox regression models, participants with SPPB scores <4/12 remained significantly more likely to be hospitalized (hazard ratio = 1.87; 95% CI = 1.24-2.84). Similar relationships were observed for PAH. LIMITATIONS The use of data from a single network of PACE facilities might limit generalizability to states with different Medicaid guidelines. CONCLUSIONS The findings suggest that impaired physical performance is an independent risk factor for hospitalization among participants in PACE. These findings could help guide the development of PACE program modifications for measuring and intervening on impairments in physical function.
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Affiliation(s)
- Jason R Falvey
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora; and Yale University, School of Medicine, Division of Geriatrics, New Haven, Connecticut
| | - Robert E Burke
- Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Cari R Levy
- Rocky Mountain Regional Veterans Affairs Medical Center
| | - Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, and Rocky Mountain Regional Veterans Affairs Medical Center
| | | | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, and Rocky Mountain Regional Veterans Affairs Medical Center, Mental Illness, Research, Education, and Clinical Center
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO 80045 (USA); and Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, Colorado,Address all correspondence to Dr Stevens-Lapsley at:
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