Factors Predicting Rehospitalization of Elderly Patients in a Postacute Skilled Nursing Facility Rehabilitation Program

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• 作者：Wen Dombrowski ; MD^a ; ; Jessica L. Yoos ; MA^b ; Richard Neufeld ; MD^a ; Chaim Y. Tarshish ; PhD^b
• 关键词：Delivery of health care ; Episodes of care ; Hospital readmissions ; Rehabilitation ; Rehabilitation outcome ; Subacute care
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2012
• 出版时间：October 2012
• 年：2012
• 卷：93
• 期：10
• 页码：1808-1813
• 全文大小：224 K

文摘

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.