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Association of Function, Symptoms, and Social Support Reported in Standardized Outpatient Clinic Questionnaires with Subsequent Hospital Discharge Disposition and 30-day Readmissions

  • Tamra Keeney
    Correspondence
    Corresponding author. Tamra Keeney, DPT, PhD, Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston MA, 02114
    Affiliations
    Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA

    Center for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA

    Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI
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  • Minji K. Lee
    Affiliations
    Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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  • Jeffrey R. Basford
    Affiliations
    Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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  • Andrea Cheville
    Affiliations
    Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN

    Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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      Abstract

      Objective

      To determine whether patient-reported information, routinely collected in an outpatient setting, is associated with readmission within 30 days of discharge and/or the need for post-acute care following a subsequent hospital admission.

      Design

      Retrospective Cohort Study. Six domains of patient-reported information collected in the outpatient setting (psychological distress, respiratory symptoms, musculoskeletal pain, family support, mobility, and activities of daily living (ADLs)) were linked to electronic health record (EHR) hospitalization data. Mixed effects logistic regression models with random intercepts were used to identify the association between the 6 domains and outcomes.

      Setting

      Outpatient clinics and hospitals in a Midwestern health system

      Participants

      7,671 patients who were hospitalized 11,445 times between May 2004 and May 2014.

      Intervention

      none

      Main Outcome Measures

      30-day hospital readmission and discharge home versus facility.

      Results

      Domains were significantly associated with 30-day readmission and placement in a facility. Specifically, mobility (OR: 1.30; 95% CI: 1.16, 1.46), ADLs (1.27; 1.13, 1.42), respiratory symptoms (1.26; 1.12, 1.41), and psychological distress (1.20; 1.07, 1.35) had the strongest associations with 30-day readmission. The ADL (2.52; 2.26, 2.81), mobility (2.35; 2.10, 2.63), family support (2.28; 1.98, 2.62), and psychological distress (1.38; 1.25, 1.52) domains had the strongest associations with discharge to an institution.

      Conclusions

      Patient-reported function, symptoms, and social support routinely collected in outpatient clinics are associated with future 30-day readmission and discharge to an institutional setting. Whether these data can be leveraged to guide interventions to address patient needs and improve outcomes requires further research.

      Keywords

      List of abbreviations:

      CHF (congestive heart failure), COPD (chronic obstructive pulmonary disease), CAD (coronary artery disease), PNA (pneumonia), EHRs (electronic health records), CVI (Current Visit Information), MIRT (Multidimensional Item Response Theory), ADL (activities of daily living), PROM (patient-reported outcome measure), ROS (review of systems)
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