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.
Keywords
List of abbreviations:
ADRD (Alzheimer disease and related dementias), CMS (Centers for Medicare and Medicaid Services), ICD-9 (International Classification of Diseases, 9th Revision), OASIS (Outcome and Assessment Information Set), OR (odds ratio), PPR (potentially preventable readmissions)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: February 05, 2020
Footnotes
Supported by the National Institutes of Health (grant nos. R01HD069443 , P2CHD065702 , K01AG058789 , U54GM104941 ), National Institute of Aging (grant no. K01AG058789), and the Foundation for Physical Therapy’s Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
