Abstract
Objective
To examine the association between cocalibrated functional scores across post-acute
care settings and the subsequent risk of hospital readmission.
Design
Retrospective cohort study.
Setting and Participants
We analyzed 781,021 fee-for-service Medicare beneficiaries discharged to either inpatient
rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home health
agencies (HHA) after an acute hospital stay for stroke (N = 143,277), lower extremity
joint replacements (512,577), and hip/femur fracture (125,167) between January 1,
2013, and August 31, 2014.
Measures
Functional items from IRF-PAI, MDS, and OASIS were categorized into self-care and
mobility domains. We cocalibrated admission functional scores across post-acute settings
and divided scores into 4 functional levels using quartiles (Q1-Q4, with Q4 representing
the most independent function). The primary outcomes were 30-day and 90-day hospital
readmissions (yes/no) after an initial post-acute stay.
Results
Patients who were more dependent in self-care and mobility at the initial post-acute
setting were significantly more likely to experience hospital readmission [eg, hazard
ratios of 30-day readmission in stroke: 1.54 (95% confidence interval [CI] 1.47-1.61),
1.18 (95% CI 1.14-1.23), and 1.12 (95% CI 1.08-1.16) for Q1, Q2 and Q3, compared to
Q4]. We found similar results for risk of 90-day hospital readmission across impairment
conditions.
Conclusions and Implications
Patients who were more functionally dependent at the initial post-acute setting had
a higher risk to readmit to the hospitals after discharging from the post-acute setting
for 30 and 90 days, compared with patients who were more functionally independent.
This finding is consistent across impairment conditions and post-acute settings. Future
research should determine effective strategies of maintaining and facilitating functional
performance across post-acute settings to optimize long-term patient outcomes.
Keywords
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Article info
Publication history
Published online: August 30, 2021
Footnotes
This study was funded, in part, by the National Institutes of Health (P2CHD065702, R01HD069443, K01HD086290, K01HD101589) and the Claude D. Pepper Older Americans Independence Center Award at the University of Texas Medical Branch, funded by the National Institute on Aging (P30-AG024832).
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
