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August 28, 2018BMC GeriatricsOpen Access

Causes and correlates of 30 day and 180 day readmission following discharge from a Medicine for the Elderly Rehabilitation unit

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Population

3,984 older patients discharged from a single inpatient rehabilitation facility, mean age 84.1 years, 39.7%…

Design

Cohort

Follow-up

180 days

Authors

LHLloyd D HughesNHS TaysideMWMiles D. WithamUniversity of Leeds

Discussion

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Implication

Readmission predictors differ by timing after geriatric rehab discharge; leaves open targeted prevention strategies pending prospective validation.

Key Points

  • To identify the clinical causes and baseline predictors of 30-day and 180-day acute hospital readmission among older adults following discharge from an inpatient rehabilitation facility.
  • Analyzed routinely collected, linked electronic clinical data from 3,984 patients (mean age 84.1 years, 39.7% male) admitted to a single inpatient rehabilitation unit over a 13-year period.
  • Evaluated baseline variables including Barthel functional scores, length of stay, comorbidities, and discharge medications alongside diagnostic hospital episode statistics.
  • Performed univariate and multivariable Cox proportional hazards regression to detect independent predictors of 30-day and 180-day readmission.
  • Overall readmission occurred in 5.6% of patients (n = 222) at 30 days and 23.2% (n = 926) at 180 days, with the majority returning for diagnoses different from their index admission (only 26.6% at 30 days and 21.1% at 180 days shared index diagnoses).
  • Most frequent readmission diagnoses were chest infections, falls/immobility, and stroke at 30 days, compared to falls/immobility, cancer, and chest infections at 180 days.
  • In multivariable Cox models, older age, male sex, longer initial stay, and heart failure predicted both 30- and 180-day readmission; discharge directly to a personal home independently predicted 30-day readmission, whereas cancer, prior myocardial infarction, and chronic obstructive pulmonary disease predicted 180-day readmission.

Structured PICO

P
Population
3,984 older patients discharged from a single inpatient rehabilitation facility, mean age 84.1 years, 39.7% male.
O
Outcome
Readmission to acute care facilities within 30 and 180 days of dischargehard clinical

Most readmissions of older people after discharge from inpatient rehabilitation occur for different reasons than the original admission, with heart failure being a significant predictor of both 30- and 180-day readmission.

Cite This Study

Hughes et al. (2018) studied this question.

synapsesocial.com/papers/6a7009d4e36a167817e1c2c9https://doi.org/10.1186/s12877-018-0883-3

Topics

HFrEF treatmentHeart failureHeart failure hospitalization
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Also Consider

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  1. 1Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients2013 · 560 citations
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