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Chang CH, Lopez K, Wasser T, Mei H. Risk factors for readmission of patients with amputation to acute care from inpatient rehabilitation: A retrospective cohort study. PM R 2024; 16:231-238. [PMID: 37584174 DOI: 10.1002/pmrj.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/24/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Amputation is a major condition that requires inpatient rehabilitation. Some research has been conducted to explore the risk factors for readmission of patients from inpatient rehabilitation facilities to acute care hospitals. However, few studies have included patients with amputation in the study population. OBJECTIVE To identify the risk factors for readmission of patients with amputation to acute care hospitals from an inpatient rehabilitation facility. DESIGN Retrospective cohort study. SETTING An acute rehabilitation hospital associated with a community-based tertiary medical center. PATIENTS A retrospective review of 156 independent admissions of 145 patients from June 2019 to July 2022. MAIN OUTCOME MEASURE The study outcome measure was readmission to acute care from an acute rehabilitation unit. RESULTS Of the 156 independent admissions, the readmission rate was 19% (29/156). The most common cause of transfer was incision-site complications (9/29, 31%), including wound infection and wound dehiscence. Patients with amputation readmitted to acute care are more likely to be receiving dialysis (p < .001), have a longer length of stay in acute care before admission to the rehabilitation facility (p = .039), and have a lower Section GG score on admission (p < .001). Age, sex, ethnicity, amputation level, and history of diabetes mellitus were not associated with acute care hospital readmission. The logistic regression model revealed that patients being on dialysis was the only significant risk factor predictive of readmission to acute care (odds ratio [OR] 4.82, p = .006). CONCLUSIONS This study showed that incision-site complications were the most common cause of disruption in inpatient rehabilitation via acute hospital readmission in patients with amputation. Being on dialysis was associated with a higher risk of readmission to acute care hospitals. Based on the results of this study, specific rehabilitation plans might be required for patients with amputation who carry certain risk factors to reduce rehospitalization to the acute care unit.
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Affiliation(s)
- Chin-Hen Chang
- Department of Physical Medicine and Rehabilitation, Reading Hospital, Tower Health System, Reading, Pennsylvania, USA
| | - Kevin Lopez
- Department of Physical Medicine and Rehabilitation, Reading Hospital, Tower Health System, Reading, Pennsylvania, USA
| | - Thomas Wasser
- Consult-Stat: Complete Statistical Service, Wernersville, Pennsylvania, USA
| | - Haiping Mei
- Department of Physical Medicine and Rehabilitation, Reading Hospital, Tower Health System, Reading, Pennsylvania, USA
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Gordon C, Davidson H, Dharmasiri M, Davies T. Factors associated with emergency readmissions after acute stroke: A retrospective audit of two hospitals. J Eval Clin Pract 2023; 29:158-165. [PMID: 35993593 DOI: 10.1111/jep.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Emergency hospital readmissions within 30 days of discharge from hospital are considered a marker for the quality of hospital care, patient experience, the discharge process and integration with community services. This paper describes the frequency and variations in cause of emergency readmissions at 30 and 90 days following discharge after acute stroke from two stroke units. METHODS Retrospective data collection of Hospital Episodes Statistics (HES) and Sentinel Stroke National Audit Programme (SSNAP) of consecutive acute stroke hospital discharges over 24 months from 2017 to 2019 from two specialist stroke units in England. HES data were used to calculate the Charlson comorbidity index (CCI). Covariates were analysed for their association with readmission rate, including: age; gender; CCI; length of stay for first stroke admission; living alone; discharge to a care home; discharge receiving stroke specialist early supported discharge (ESD) rehabilitation and stroke severity as determined by National Institute for Health Stroke Scale on stroke admission. RESULTS From 2017 to 2019 there were 1999 live discharges with a primary diagnosis of stroke. Both hospitals had a trend of increasing readmission rates with increasing stroke severity and comorbidity. Longer length of stroke admission, especially for patients with increasing stroke severity, and patients receiving ESD rehabilitation after discharge reduced 90-day readmissions. This association was stronger at 90 days than at 30 days. Different readmission event rates were found at 30 and 90 days and when events were compared between the two hospitals. CONCLUSION Understanding differences in readmission event rates between hospitals at 30 and 90 days can support local planning of patient needs in the first weeks after stroke discharge and to investigate ways for hospital to reduce the impact of readmission. It is recommended that stroke services use both 30 and 90-day readmissions to inform service evaluation and improvement.
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Affiliation(s)
- Clare Gordon
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK
| | - Hannah Davidson
- Royal Bournemouth Hospital, University Hospitals Dorset, Bournemouth, Dorset, UK
| | - Michelle Dharmasiri
- Royal Bournemouth Hospital, University Hospitals Dorset, Bournemouth, Dorset, UK
| | - Tanya Davies
- Royal Bournemouth Hospital, University Hospitals Dorset, Bournemouth, Dorset, UK
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Plys E, Beam R, Boxer RS, Portz JD. Behavioral Health Services with Short-Stay Residents in Skilled Nursing Facilities: A Qualitative Study of Clinicians and Administrators. Clin Gerontol 2022; 45:1189-1200. [PMID: 34128773 PMCID: PMC8671564 DOI: 10.1080/07317115.2021.1937425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The perspectives of professionals involved in behavioral health (BH) services with short-stay residents in skilled nursing facilities (SNFs) are rarely captured in the literature. This study examines the real-world experiences of BH clinicians and administrators in post-acute/subacute care units in SNFs. METHODS This qualitative study used semi-structured interviews with 18 clinicians (e.g., psychologists and social workers) and five administrators (e.g., directors of social services or BH company executives) involved in BH services with short-stay SNF residents. Interviews were recorded, transcribed, and analyzed by two independent coders using conventional thematic content analysis. RESULTS Three themes emerged from the data: (1) BH needs are high among short-stay residents and families during post-acute care transitions; (2) BH services offer multiple unique opportunities to enhance post-acute/subacute care in SNFs; and (3) barriers to providing optimal BH care exist at multiple levels and require action from BH clinicians and stakeholders. CONCLUSIONS Variability in clinician roles and barriers to optimized care suggest the need for future research targeting best practices and implementation strategies for BH services with short-stay SNF residents. CLINICAL IMPLICATIONS Results identified multiple ways in which BH services may enhance resident, family, and staff outcomes, as well as the milieu in SNFs.
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
| | | | | | - Jennifer D. Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
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Yin S, Paratz J, Cottrell M. Re-admission following discharge from a Geriatric Evaluation and Management Unit: identification of risk factors. AUST HEALTH REV 2022; 46:421-425. [PMID: 35710459 DOI: 10.1071/ah21357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo establish independent factors that influence the likelihood of re-admission within 30 days of discharge from a Geriatric Evaluation and Management Unit.MethodsAn observational prospective cohort design using clinical data extracted from the medical charts of eligible patients discharged from a tertiary public hospital Geriatric Evaluation and Management Unit between July 2017 and April 2019. Binary logistic regression was undertaken to determine variables that increased the likelihood of hospital re-admission (dependent variable).ResultsA total of 367 patients were eligible for inclusion, with 69 patients re-admitted within 30 days of discharge. Univariate analysis demonstrated significant differences between groups (re-admission vs non-re-admission) with respect to Charlson Comorbidity Index (CCI) (7.4 [2.4] vs 6.3 [2.2], P = 0.001), Clinical Frailty Scale (CFS) (5.6 [1.1] vs 5.2 [1.34], P = 0.02), and documented malnourishment (36.2% vs 23.6%, P = 0.04). All three variables remained significant when entered into the regression model (X2 = 25.095, P < 0.001). A higher score for the CFS (OR 1.3; 95% CI 1.03-1.64; P = 0.03) and CCI (OR 1.2; 95% CI 1.06-1.33; P = 0.004), and documented malnourishment (OR 1.92; 95% CI 1.06-3.47; P = 0.03) were all independent factors that increased the likelihood of patient re-admission within 30 days of discharge.ConclusionsThis study supports the formal inclusion of the CCI and CFS into routine practice in Geriatric Evaluation and Management Units. The inclusion of the measures can help inform future discharge planning practices. Clinicians should use malnourishment status, CCI and CFS to identify at risk patients and target discharge planning interventions accordingly.
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Affiliation(s)
- Sally Yin
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Level 2 Ned Handlon Building, Herston, Brisbane, Qld 4029, Australia
| | - Jennifer Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Level 8, UQ Centre for Clinical Research (UQCCR), Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Level 2 Ned Handlon Building, Herston, Brisbane, Qld 4029, Australia
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Roberts MH, Mapel DW, Ganvir N, Dodd MA. Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes. Int J Chron Obstruct Pulmon Dis 2022; 17:701-717. [PMID: 35411140 PMCID: PMC8994612 DOI: 10.2147/copd.s348714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Rationale Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s) Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods This was an observational cohort study using Health and Retirement Study data (2006–2018) of community living individuals ages 50–64 and ≥65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results The study included 18,979 survey observations for age 50–64, and 24,162 age ≥65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50–64 (95% CI: 3.8–5.9% vs 0.7–1.3%) and age ≥65 (95% CI: 11.9–14.3% vs 5.6–6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50–64 years). These measures identify patients with increased risk of poor outcomes.
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Affiliation(s)
- Melissa H Roberts
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
- Correspondence: Melissa H Roberts, College of Pharmacy, The University of New Mexico, 2502 Marble Ave, Albuquerque, NM, 87106, USA, Tel +1 505 925 0953, Fax +1 505 272 6749, Email
| | - Douglas W Mapel
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
- Northern Arizona Pulmonary Associates/Critical Care Consultants of Arizona, Flagstaff, AZ, USA
| | - Nikhil Ganvir
- Department of Economics, The University of New Mexico, Albuquerque, NM, USA
| | - Melanie A Dodd
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
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Stuck AK, Mangold JM, Wittwer R, Limacher A, Bischoff-Ferrari HA. Ability of 3 Frailty Measures to Predict Short-Term Outcomes in Older Patients Admitted for Post-Acute Inpatient Rehabilitation. J Am Med Dir Assoc 2021; 23:880-884. [PMID: 34687605 DOI: 10.1016/j.jamda.2021.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the ability of 3 commonly used frailty measures to predict short-term clinical outcomes in older patients admitted for post-acute inpatient rehabilitation. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Consecutive patients (n = 207) admitted to a geriatric inpatient rehabilitation facility. METHODS Frailty on admission was assessed using a frailty index, the physical frailty phenotype, and the Clinical Frailty Scale (CFS). Predictive capacity of the frailty instruments was analyzed for (1) nonhome discharge, (2) readmission to acute care, (3) functional decline, and (4) prolonged length of stay, using multivariate logistic regression models and receiver operating characteristic (ROC) curves. RESULTS The number of patients classified as frail was 91 (44.0%) with the frailty index, 134 (64.7%) using the frailty phenotype, and 151 (73.0%) with the CFS. The 3 frailty measures revealed acceptable discriminatory accuracy for nonhome discharge (area under the curve ≥ 0.7) but differed in their predictive ability: the adjusted odds ratio (OR) for nonhome discharge was highest for the CFS [6.2, 95% confidence interval (CI) 1.8-21.1], compared to the frailty index (4.1, 95% CI 2.0-8.4) and the frailty phenotype (OR 2.9, 95% CI 1.2-6.6). For the other outcomes, discriminatory accuracy based on ROC tended to be lower and predictive ability varied according to frailty measure. Readmission to acute care from inpatient rehabilitation was predicted by all instruments, most pronounced by the frailty phenotype (OR 5.4, 95% CI 1.6-18.8) and the frailty index (OR 2.5, 95% CI 1.1-5.6), and less so by the CFS (OR 1.4, 95% CI 0.5-3.8). CONCLUSIONS AND IMPLICATIONS Frailty measures may contribute to improved prediction of outcomes in geriatric inpatient rehabilitation. The choice of the instrument may depend on the individual outcome of interest and the corresponding discriminatory ability of the frailty measure.
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Affiliation(s)
- Anna K Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Joel M Mangold
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rachel Wittwer
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Heike A Bischoff-Ferrari
- Department of Aging Medicine, University Hospital Zurich, Zurich, Switzerland; Centre on Aging and Mobility, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
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Plys E, Morrow CD, Portz JD, Jones CD, Piper C, Boxer RS. Psychological interventions with older adults during inpatient postacute rehabilitation: A systematic review. Rehabil Psychol 2021; 66:233-247. [PMID: 34472922 PMCID: PMC8622202 DOI: 10.1037/rep0000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Older adults in inpatient postacute care settings report high rates of depression and anxiety. Psychological interventions address these symptoms through educational, cognitive, behavioral, relaxation, and/or psychosocial approaches. The purpose of this study was to systematically evaluate the quality of existing literature on psychological interventions for depression and/or anxiety among older adults during an inpatient postacute care stay. Method: Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Google Scholar were searched for key concepts. Studies were included that (a) sampled skilled nursing facility or inpatient rehabilitation facility patients, (b) evaluated a psychological intervention, (c) measured depression and/or anxiety symptoms before and after interventions, and (d) had a mean or median age of 65+. Two raters assessed articles for inclusion and risk of bias. Results: Search strategies identified 7,506 articles for screening; nine met inclusion criteria. Included studies varied by study design, intervention type, and methodological quality. Only one study had low overall risk of bias. Four studies demonstrated preliminary treatment benefits for depression symptoms; none reported benefits for anxiety symptoms. Conclusions: Most of the included studies were limited by small sample size and high risk of bias. Thus, currently, there is insufficient evidence to support the effectiveness of psychological interventions for depression or anxiety among older adults during an inpatient postacute care stay. The authors offer a detailed discussion of methodological limitations, empirical gaps, and future directions to develop this body of literature. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine
| | - Cynthia D Morrow
- Health Systems Management and Policy, Colorado School of Public Health
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System
| | - Christi Piper
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente of Colorado
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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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Kitamura M, Izawa KP, Ishihara K, Yaekura M, Nagashima H, Yoshizawa T, Okamoto N. Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction. Heart Vessels 2020; 36:509-517. [PMID: 33123778 DOI: 10.1007/s00380-020-01718-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama, 700-0804, Japan
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Masakazu Yaekura
- Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan
| | - Takashi Yoshizawa
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Nobuhiro Okamoto
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
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Hospitalized Adults With Intellectual and Developmental Disabilities: Confronting Challenges. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Kitamura M, Izawa KP, Yaekura M, Mimura Y, Ikeda Y, Nagashima H, Brubaker PH. Relationship among Activities of Daily Living, Nutritional Status, and 90 Day Readmission in Elderly Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245068. [PMID: 31842307 PMCID: PMC6950285 DOI: 10.3390/ijerph16245068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients. Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method. Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) (p = 0.03), hemoglobin (p = 0.047), GNRI (p = 0.02) and motor-FIM (p = 0.007) were significantly different between the readmission (n = 31) and non-readmission (n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study’s cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower (p = 0.002) in the group with GNRI <92 and motor FIM <75. Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Kokura Rehabilitation College, Kitakyushu, Kitakyushu 800-0206, Japan;
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: ; Tel.: +81-78-796-4566
| | - Masakazu Yaekura
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Yumi Mimura
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Yuichi Ikeda
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Peter H. Brubaker
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
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Physical Therapist Determination of Discharge Disposition in the Acute Care Setting. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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King L, Harrington A, Linedale E, Tanner E. A mixed methods thematic review: Health-related decision-making by the older person. J Clin Nurs 2018; 27:e1327-e1343. [PMID: 29322576 DOI: 10.1111/jocn.14261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To undertake a mixed methods thematic literature review that explored how elderly adults approached decision-making in regard to their health care following discharge. BACKGROUND A critical time for appropriate health decisions occurs during hospital discharge planning with nursing staff. However, little is known how the 89% of elderly living at home make decisions regarding their health care. Research into older adults' management of chronic conditions emerges as an important step to potentially encourage symptom monitoring, prevent missed care and detect deterioration. All should reduce the risk of hospital re-admission. DESIGN A mixed methods thematic literature review was undertaken. The structure followed the PRISMA reporting guidelines for systematic reviews recommended by the EQUATOR network. METHODS PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus online databases were searched using keywords, inclusion and exclusion criteria. References drawn from relevant publications, identified by experts and published between 1995 and 2017 were also considered. Twenty-five qualitative, quantitative and mixed methods studies and reviews were critically appraised (CASP 2013) before inclusion in the review. Analysis of each study's findings was undertaken using Braun and Clarke's (2006) steps to identify major themes and sub-themes. RESULTS Four main themes associated with health-related decision-making in the elderly were identified: "the importance of maintaining independence," "decision making style," "management of conditions at home" and "discharge planning." CONCLUSION Health care decision preferences in the elderly emerged as highly complex and influenced by multiple factors. Development of a tool to assess these components has been recommended. RELEVANCE TO CLINICAL PRACTICE Nurses play a vital role in exploring and understanding the influence that maintaining independence has with each patient. This understanding provides an initial step toward development of a tool to assist collaboration between patients and healthcare professionals involved in their care.
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Affiliation(s)
- Lindy King
- College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ann Harrington
- College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ecushla Linedale
- College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Elizabeth Tanner
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Nursing and School of Medicine, Baltimore, MD, USA
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Middleton A, Graham JE, Ottenbacher KJ. Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries. Arch Phys Med Rehabil 2018; 99:1067-1076. [PMID: 28583465 PMCID: PMC5712486 DOI: 10.1016/j.apmr.2017.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions. DESIGN Retrospective cohort study. SETTING Inpatient rehabilitation facilities submitting claims to Medicare. PARTICIPANTS National cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1±7.6 years. Most were women (59.7%) and white (84.5%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES (1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions. RESULTS The overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3-3.5) versus 6.9% (95% CI, 6.7-7.1), mobility: 3.3% (95% CI, 3.2-3.4) versus 7.2% (95% CI, 7.0-7.4), and cognition: 3.5% (95% CI, 3.4-3.6) versus 6.2% (95% CI, 6.0-6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67-.74), mobility: .64 (95% CI, .61-.68), and cognition: .84 (95% CI, .80-.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%). CONCLUSIONS Functional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.
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Affiliation(s)
- Addie Middleton
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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Lee DCA, Williams C, Lalor AF, Brown T, Haines TP. Hospital readmission risks in older adults following inpatient subacute care: A six-month follow-up study. Arch Gerontol Geriatr 2018; 77:142-149. [PMID: 29763856 DOI: 10.1016/j.archger.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND High rates of unplanned hospital readmissions are a burden on healthcare systems and individuals. This study examined factors at, and after initial hospital discharge and their associations with unplanned hospital readmission for older adults up to six months post-discharge from subacute care. METHODS Older subacute care patients were surveyed prior to discharge, and assessed monthly post-discharge for six months. Data included the Geriatric Depression Scale, Phone-Fitt sub-scales, Friendship Scale, modified Lubben Social Network Scale, unplanned hospital readmission, self-reported physical capacity and falls in the last month were collected. Regression analyses were used to examine relationships between unplanned hospital readmission and variables that may predispose this outcome. RESULTS Participants (n = 311) completed the baseline assessment. N = 218 (70%) completed all at six-month post-discharge. Eighty-nine (29%) participants shared 143 readmissions. Those with cancer history (adjusted OR [95% CI]) (1.97 [1.15, 3.39]), neurological disease other than stroke (2.95 [1.32, 6.57]) and dependence on others to assist in bending tasks (1.94 [1.14, 3.29]) at initial discharge were associated with readmission within six months post-discharge. Those who fell in the last month (adjusted OR [robust 95% CI]) (2.28 [1.43, 3.64]), being less physical active (0.98 [0.96, 0.99]), and dependence on others in moving around residence (2.63 [1.37, 5.06]) after initial discharge were associated with a readmission in the next month within six months post-discharge. CONCLUSION Trials investigating the effectiveness of strategies to reduce falls, build physical capacity, increase physical activity level, and connection with health care services after discharge to prevent readmission are warranted.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), Moorooduc Highway, Frankston, Victoria 3199, Australia.
| | - Cylie Williams
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia; Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), Moorooduc Highway, Frankston, Victoria 3199, Australia
| | - Aislinn F Lalor
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), Moorooduc Highway, Frankston, Victoria 3199, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), Moorooduc Highway, Frankston, Victoria 3199, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), Moorooduc Highway, Frankston, Victoria 3199, Australia
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Pergolotti M, Lavery J, Reeve BB, Dusetzina SB. Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region. Am J Occup Ther 2018; 72:7202205050p1-7202205050p9. [PMID: 29426383 DOI: 10.5014/ajot.2018.023796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps. METHOD This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs. RESULTS Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12-14 visits. DISCUSSIO . Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium.
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Affiliation(s)
- Mackenzi Pergolotti
- Mackenzi Pergolotti, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Services, Colorado State University, Fort Collins; . At the time of this research, she was Postdoctoral Fellow, Cancer Care Quality Training Program, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jessica Lavery
- Jessica Lavery, MS, is Assistant Research Biostatistician, Memorial Sloan Kettering Cancer Center, New York, NY. At the time of this research, she was Graduate Assistant, Department of Statistics and Operation Research, University of North Carolina at Chapel Hill
| | - Bryce B Reeve
- Bryce B. Reeve, PhD, is Professor, Department of Population Health Sciences, and Director, Health Measurement Center, Duke University Medical Center, Durham, NC. At the time of this research, he was Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Stacie B Dusetzina
- Stacie B. Dusetzina, PhD, is Assistant Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Frailty in a Post-Acute Care Population: A Scoping Review. PM R 2018; 10:1211-1220. [PMID: 29550407 DOI: 10.1016/j.pmrj.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/25/2022]
Abstract
Frailty is a complex and growing phenomenon facing health care providers throughout the continuum of care. Frailty is not well understood in post-acute care (PAC) settings. The purpose of this scoping review was to summarize current evidence of frailty impact on outcomes and frailty mitigation initiatives in PAC. Three major publication databases were searched from January 2000 to June 2017 that identified 18 articles specifically addressing frailty in PAC. Three themes were identified: scales used to measure frailty, factors that led to an adverse outcome or diagnosis of frailty, and interventions to address frailty in PAC. Scales used to measure frailty were dominated by physical factors and scarce on nutrition and social support. Functional decline, grip strength, gait speed, polypharmacy, and nutrition were identified in the studies as factors that identify frailty and are associated with poor outcomes. All these frailty characteristics compromise patients' ability to benefit from rehabilitation, which further establishes the importance of PAC providers to identify, prevent, and treat frailty. Intervention studies had mixed outcomes, suggesting a need for further development in this area. The findings of this scoping review highlight the need for a comprehensive multidimensional assessment of frailty risks in PAC. LEVEL OF EVIDENCE: IV.
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Friebel R, Hauck K, Aylin P, Steventon A. National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016. BMJ Open 2018. [PMID: 29530912 PMCID: PMC5857687 DOI: 10.1136/bmjopen-2017-020325] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess trends in 30-day emergency readmission rates across England over one decade. DESIGN Retrospective study design. SETTING 150 non-specialist hospital trusts in England. PARTICIPANTS 23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016. PRIMARY AND SECONDARY OUTCOMES We examined emergency admissions that occurred within 30 days of discharge from hospital ('emergency readmissions') as a measure of healthcare quality. Presented are overall readmission rates, and disaggregated by the nature of the indexed admission, including whether it was elective or emergency, and by clinical health condition recorded. All rates were risk-adjusted for patient age, gender, ethnicity, socioeconomic status, comorbidities and length of stay. RESULTS The average risk-adjusted, 30-day readmission rate increased from 6.56% in 2006/2007 to 6.76% (P<0.01) in 2012/2013, followed by a small decrease to 6.64% (P<0.01) in 2015/2016. Emergency readmissions for patients discharged following elective procedures decreased by 0.13% (P<0.05), whereas those following emergency admission increased by 1.27% (P<0.001). Readmission rates for hip or knee replacements decreased (-1.29%; P<0.001); for acute myocardial infarction (-0.04%; P<0.49), stroke (+0.62%; P<0.05), chronic obstructive pulmonary disease (+0.41%; P<0.05) and heart failure (+0.15%; P<0.05) remained stable; and for pneumonia (+2.72%; P<0.001), diabetes (+7.09%; P<0.001), cholecystectomy (+1.86%; P<0.001) and hysterectomy (+2.54%; P<0.001) increased. CONCLUSIONS Overall, emergency readmission rates in England remained relatively stable across the observation period, with trends of slight increases contained post 2012/2013. However, there were large variations in trends across clinical areas, with some experiencing marked increases in readmission rates. This highlights the need to better understand variations in outcomes across clinical subgroups to allow for targeted interventions that will ensure highest standards of care provided for all patients.
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Affiliation(s)
- Rocco Friebel
- School of Public Health, Imperial College London, London, UK
- Data Analytics, The Health Foundation, London, UK
| | - Katharina Hauck
- School of Public Health, Imperial College London, London, UK
| | - Paul Aylin
- School of Public Health, Imperial College London, London, UK
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Mitsutake S, Ishizaki T, Teramoto C, Tsuchiya-Ito R, Shimizu S, Ito H. [The associations between readmission within 30 days and the medical institute factors among older patients receiving home medical care]. Nihon Ronen Igakkai Zasshi 2018; 55:612-623. [PMID: 30542027 DOI: 10.3143/geriatrics.55.612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To improve preventive strategies for readmission within 30 days after discharge among older patients receiving home medical care services, we examined the associations between readmission within 30 days and the medical institute factors among patients over 75 years of age. METHODS All patients over 75 years of age receiving home medical care services and who had been admitted to hospital or clinic and discharged between September 2013 and July 2014 in Tokyo, Japan, were participants of this study (n=7,213). The primary outcome was readmission within 30 days after discharge. We performed generalized estimating equations (GEEs) using a model with logit link and binominal sampling distribution to examine the associations of sociodemographic variables, the prevalence of chronic diseases and medical institute factors with readmission within 30 days. RESULTS Approximately 11.2% of the patients receiving home medical care services who had been discharged were readmitted within 30 days after discharge. Men, cancer patients, and emergency admission were positively associated with readmission within 30 days according to the GEEs. The rate of readmission within 30 days was lower in patients receiving home medical care services at home care support clinics/hospitals after discharge (adjusted odds ratio [aOR] = 0.205, p value < 0.001) and in patients discharged from hospitals with over 200 beds (aOR = 0.447, p value < 0.001, vs. clinics) than in others. CONCLUSION Home care support clinics/hospitals, which can provide home medical care services around the clock, may help reduce the rate of readmission within 30 days.
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Affiliation(s)
| | | | - Chie Teramoto
- Tokyo Metropolitan Institute of Gerontology
- Graduate School of Medicine, University of Tokyo
| | - Rumiko Tsuchiya-Ito
- Tokyo Metropolitan Institute of Gerontology
- Dia foundation for research on Ageing Societies
| | | | - Hideki Ito
- Tokyo Metropolitan Institute of Gerontology
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Relationship between Activities of Daily Living and Readmission within 90 Days in Hospitalized Elderly Patients with Heart Failure. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7420738. [PMID: 29201912 PMCID: PMC5671682 DOI: 10.1155/2017/7420738] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/07/2017] [Accepted: 09/11/2017] [Indexed: 12/15/2022]
Abstract
Aims To examine the relationship between activities of daily living (ADL) and readmission within 90 days and assess the cutoff value of ADL to predict readmission in hospitalized elderly patients with heart failure (HF). Methods This cohort study comprised 589 consecutive patients with HF aged ≥65 years, who underwent cardiac rehabilitation from May 2012 to May 2016 and were discharged home. We investigated patients' characteristics, basic attributes, and ADL (motor and cognitive Functional Independence Measure [FIM]). We analyzed the data using the unpaired t-test, χ2 test, Cox proportional hazard model, receiver operating characteristic (ROC) curve, and Kaplan-Meier method. Results Of 589 patients, 113 met the criteria, and they were divided into the nonreadmission (n = 90) and readmission groups (n = 23). Age, body mass index, New York Heart Association class, hemoglobin level, and motor FIM score were significantly different between the two groups (p < 0.05). The body mass index (hazard ratio [HR]: 0.87; p < 0.05) and motor FIM score (HR: 0.94; p < 0.01) remained statistically significant. The cutoff value for the motor FIM score determined by ROC curve analysis was 74.5 points (area under the curve = 0.78; p < 0.001). Conclusion The motor FIM score in elderly patients with HF was an independent predictor of rehospitalization within 90 days.
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Fu JB, Raj VS, Guo Y. A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes. PM R 2017; 9:S324-S334. [PMID: 28942907 PMCID: PMC5736373 DOI: 10.1016/j.pmrj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult-based inpatient rehabilitation, and improved communication and coordination with oncology teams.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030(∗).
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation and Levine Cancer Institute, Charlotte, NC(†)
| | - Ying Guo
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡)
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Morisawa T, Ueno K, Fukuda Y, Kanazawa N, Kawaguchi H, Zaiki R, Fuzisaki H, Yoshioka H, Sasaki M, Iwata K, Koyama T, Kitai T, Furukawa Y, Takahashi T. Significance of sequential cardiac rehabilitation program through inter-hospital cooperation between acute care and rehabilitation hospitals in elderly patients after cardiac surgery in Japan. Heart Vessels 2017; 32:1220-1226. [DOI: 10.1007/s00380-017-0983-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 04/21/2017] [Indexed: 11/27/2022]
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