Abstract
Dombrowski W, Yoos JL, Neufeld R, Tarshish CY. Factors predicting rehospitalization
of elderly patients in a postacute skilled nursing facility rehabilitation program.
Objective
To examine potential risk factors for rehospitalization of skilled nursing facility
(SNF) rehabilitation patients.
Design
Retrospective review of rehabilitation charts.
Setting
SNF rehabilitation beds (n=114) at a 514-bed urban, academic nursing home that receives
patients from tertiary care hospitals.
Participants
Consecutive rehabilitation patients (n=50) who were rehospitalized during days 4 to
30 of rehabilitation, compared with a matched group of rehabilitation patients (n=50)
who were discharged without rehospitalization.
Interventions
Not applicable.
Main Outcome Measure
Data on potential risk factors were collected: demographics, medical history, conditions
associated with preceding hospitalization, and initial rehabilitation examination
and laboratory values. The clinical conditions precipitating rehospitalizations were
noted.
Results
Sixty-two percent of rehospitalizations were related to complications or recurrence
of the same medical condition that was treated during the preceding hospitalization.
The rehospitalized group had significantly more comorbidities including anemia (P=.001) and malignant solid tumors (P<.001), index hospitalizations involving a gastrointestinal condition (P=.001), needed more assistance with eating (P=.001) and walking (P=.03), and had lower hemoglobin (P=.002) and albumin levels (P<.001). A logistic regression model found that the strongest predictors for rehospitalization
are a history of a malignant solid tumor (odds ratio [OR]=10.10), a recent hospitalization
involving gastrointestinal conditions (OR=4.62), and a low serum albumin level (with
each unit decrease in albumin, the odds of rehospitalization are 4 times greater [OR=.24,
P=.005]).
Conclusions
Comorbid conditions, reasons for index hospitalization, and laboratory values are
associated with an increased risk for rehospitalization. Further studies are needed
to identify high-risk elderly patients and target interventions to minimize rehospitalizations.
Key Words
List of Abbreviations:
ADL (activities of daily living), BI (Barthel Index), CHF (congestive heart failure), OR (odds ratio), SNF (skilled nursing facility)To read this article in full you will need to make a payment
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References
- Overview: Medicare post-acute care since the Balanced Budget Act of 1997.Health Care Financ Rev. 2002; 24: 1-6
- Access to postacute rehabilitation.Arch Phys Med Rehabil. 2007; 88: 1488-1493
- How did Medicare's prospective payment system affect hospitals?.N Engl J Med. 1987; 317: 867-873
- The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage.Inquiry. 1989; 26: 35-47
- Assessing the effectiveness of postacute care rehabilitation.Arch Phys Med Rehabil. 2007; 88: 1500-1504
- Growth and payment adequacy of Medicare postacute care rehabilitation.Arch Phys Med Rehabil. 2007; 88: 1494-1499
- “Quicker and sicker” under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey.Bull Econ Res. 2011; 63: 1-27
- Rehabilitation therapy in skilled nursing facilities: effects of Medicare's new prospective payment system.Health Aff (Millwood). 2003; 22: 214-223
- Skilled nursing facilities: Medicare payments exceed costs for most but not all facilities.http://www.gao.gov/new.items/d03183.pdf(Accessed December 27, 2009)Date: December 2002
- National Health Expenditures Accounts, table 2 Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.(Accessed December 27, 2009)
- Access to postacute nursing home care before and after the BBA.Health Aff (Millwood). 2002; 21: 254-264
- Rehabilitation services after the implementation of the nursing home prospective payment system: differences related to patient and nursing home characteristics.Med Care. 2005; 43: 1109-1115
- Physical rehabilitation following Medicare prospective payment for skilled nursing facilities.Health Serv Res. 2004; 39: 1299-1318
- The impact of the 1997 Balanced Budget Amendment's prospective payment system on patient case mix and rehabilitation utilization in skilled nursing.Gerontologist. 2002; 42: 653-660
- Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure.Circ Heart Fail. 2011; 4: 293-300
- Evaluating readmission rates: how can we improve?.South Med J. 2010; 103: 1079-1083
- 30-day readmissions after coronary artery bypass graft surgery in New York State.JACC Cardiovasc Interv. 2011; 4: 569-576
- Joint replacement and hip fracture readmission rates: impact of discharge destination.PM R. 2010; 2: 806-810
- Minor depression and rehabilitation outcome for older adults in subacute care.J Behav Health Serv Res. 2004; 31: 189-198
- Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community.Arch Phys Med Rehabil. 2004; 85: 1602-1607
- Factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization.J Gerontol A Biol Sci Med Sci. 2009; 64: 1296-1303
- The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities.Arch Phys Med Rehabil. 2005; 86: 373-379
- Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke.J Am Geriatr Soc. 2000; 48: 1389-1397
- Association between delirium resolution and functional recovery among newly admitted postacute facility patients.J Gerontol A Biol Sci Med Sci. 2006; 61: 204-208
- Health status and functional status in relationship to nursing home subacute rehabilitation program outcomes.Am J Phys Med Rehabil. 2002; 81: 373-379
- Outcomes of nonagenarian patients after rehabilitation following hip fracture surgery.J Am Med Dir Assoc. 2012; 13 (Epub 2011 Mar 17): 81.e1-81.e5
- Depression in older patients admitted for postacute nursing home rehabilitation.J Am Geriatr Soc. 2005; 53: 1017-1022
- Therapy use and discharge outcomes for elderly nursing home residents.Gerontologist. 2000; 40: 587-595
- Institutionalized patients with hip fractures: characteristics associated with returning to community dwelling.J Gen Intern Med. 1990; 5: 298-303
- Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities.Med Care. 2000; 38: 1119-1130
- Outcomes of rehabilitation services for nursing home residents.Arch Phys Med Rehabil. 2003; 84: 1129-1136
- Prediction of follow-up living setting in patients with lower limb joint replacement.Arch Phys Med Rehabil. 2002; 81: 471-477
- Predicting follow-up living setting in patients with stroke.Arch Phys Med Rehabil. 2002; 83: 764-770
- Precipitants of emergency room visits and acute hospitalization in short-stay Medicare nursing home residents.J Am Geriatr Soc. 2002; 50: 223-229
- Do hemoglobin and creatinine clearance affect hospital readmission rates from a skilled nursing facility heart failure rehabilitation unit?.J Am Med Dir Assoc. 2008; 9: 194-198
- The outcomes of patients newly admitted to nursing homes after hip fracture.Am J Public Health. 1994; 84: 1281-1286
- Outcomes of older people admitted to postacute facilities with delirium.J Am Geriatr Soc. 2005; 53: 963-969
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 60: 1418-1428
- Posthospital care transitions: patterns, complications, and risk identification.Health Serv Res. 2004; 39: 1449-1465
- Recurrent readmissions in medical patients: a prospective study.J Hosp Med. 2011; 6: 61-67
- Prospective comparison of 6 comorbidity indices as predictors of 1-year post-hospital discharge institutionalization, readmission, and mortality in elderly individuals.J Am Med Dir Assoc. 2012; 13 (Epub 2011 Jan 8): 272-278
- Recovery of activities of daily living in older adults after hospitalization for acute medical illness.J Am Geriatr Soc. 2008; 56: 2171-2179
- Measuring prognosis and case mix in hospitalized elders.J Gen Intern Med. 1997; 12: 203-208
- New walking dependence associated with hospitalization for acute medical illness: incidence and significance.J Gerontol A Biol Sci Med Sci. 1998; 53: M307-M312
- Functional outcomes of acute medical illness and hospitalization in older persons.Arch Intern Med. 1996; 156: 645-652
- A Data Book: Healthcare spending and the Medicare program, Post-acute care.http://www.medpac.gov/chapters/Jun09DataBookSec9.pdf(Accessed December 27, 2009)Date: June 2009
- Bouncing-back: rehospitalization in patients with complicated transitions in the first thirty days after hospital discharge for acute stroke.Home Health Care Serv Q. 2007; 26: 37-55
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- Barthel Index for stroke trials: development, properties, and application.Stroke. 2011; 42: 1146-1151
- Re-admissions following hip fracture surgery.Ann R Coll Surg Engl. 2009; 91: 591-595
- Frequency and diagnoses associated with 7- and 30-day readmission of skilled nursing facility patients to a nonteaching community hospital.J Am Med Dir Assoc. 2011; 12: 195-203
- Preventing the rebound: improving care transition in hospital discharge processes.Aust Health Rev. 2010; 34: 445-451
- Care home versus hospital and own home environments for rehabilitation of older people.Cochrane Database Syst Rev. 2008; (CD003164)
- Preliminary evaluation of a convalescence cardiac unit for older patients as a model of “transitional facility” from hospital to home.J Am Med Dir Assoc. 2001; 2: 302-304
- Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project.J Am Geriatr Soc. 2011; 59: 745-753
- What is palliative care.(Accessed April 10, 2010)
- Should I hospitalize my resident with nursing home-acquired pneumonia?.J Am Med Dir Assoc. 2005; 6: 327-333
- Policy options to improve discharge planning and reduce rehospitalization.JAMA. 2011; 305: 302-303
- The revolving door of rehospitalization from skilled nursing facilities.Health Aff (Millwood). 2010; 29: 57-64
- Reducing unnecessary hospitalizations: apple pie!.J Am Med Dir Assoc. 2009; 10: 595-596
- Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs.J Am Geriatr Soc. 2010; 58: 627-635
Article info
Publication history
Published online: May 02, 2012
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Jun 15, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
