Hospital Readmission From Post-Acute Care Facilities: Risk Factors, Timing, and Outcomes

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• 作者：Robert E. Burke ; MD ; MS^a ; ^b ; ^{Robert.Burke5@va.gov" class="auth_mail" title="E-mail the corresponding author} ; Emily A. Whitfield ; PhD^a ; David Hittle ; PhD^c ; Sung-joon Min ; PhD^c ; Cari Levy ; MD ; PhD^a ; ^c ; Allan V. Prochazka ; MD ; MSc^a ; ^b ; Eric A. Coleman ; MD ; MPH^c ; Robert Schwartz ; MD^d ; Adit A. Ginde ; MD ; MPH^e
• 关键词：Post-acute care ; readmission ; care transition
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：17
• 期：3
• 页码：249-255
• 全文大小：625 K

文摘

Hospital discharges to post-acute care (PAC) facilities have increased rapidly. This increase may lead to more hospital readmissions from PAC facilities, which are common and poorly understood. We sought to determine the risk factors and timing for hospital readmission from PAC facilities and evaluate the impact of readmission on patient outcomes.

Design

Retrospective analysis of Medicare Current Beneficiary Survey (MCBS) from 2003–2009.

Setting

The MCBS is a nationally representative survey of beneficiaries matched with claims data.

Participants

Community-dwelling beneficiaries who were hospitalized and discharged to a PAC facility for rehabilitation.

Intervention/Exposure

Potential readmission risk factors included patient demographics, health utilization, active medical conditions at time of PAC admission, and PAC characteristics.

Measurements

Hospital readmission during the PAC stay, return to community residence, and all-cause mortality.

Results

Of 3246 acute hospitalizations followed by PAC facility stays, 739 (22.8%) included at least 1 hospital readmission. The strongest risk factors for readmission included impaired functional status (HR 4.78, 95% CI 3.21–7.10), markers of increased acuity such as need for intravenous medications in PAC (1.63, 1.39–1.92), and for-profit PAC ownership (1.43, 1.21–1.69). Readmitted patients had a higher mortality rate at both 30 days (18.9% vs 8.6%, P < .001) and 100 days (39.9% vs 14.5%, P < .001) even after adjusting for age, comorbidities, and prior health care utilization (30 days: OR 2.01, 95% CI 1.60–2.54; 100 days: OR 3.79, 95% CI 3.13–4.59).

Conclusions

Hospital readmission from PAC facilities is common and associated with a high mortality rate. Readmission risk factors may signify inadequate transitional care processes or a mismatch between patient needs and PAC resources.