Key result
Weekly homecare >120 minutes is linked to ~80% higher 30-day readmission risk vs no homecare.
Why the study?
Older adults admitted to an emergency department who depend on homecare may face particular challenges regarding readmission and mortality, but the impact of pre-admission homecare amount remained unclear.
Does receiving homecare prior to admission increase the risk of readmission or mortality within 30 days of a short ED admission in older adults?
Cohort (n=80,517)
Yes
Does receiving homecare prior to admission increase the risk of readmission or mortality within 30 days of a short ED admission in older adults?
Odds Ratio: 1.8 (95% CI 1.7–1.9)
Absolute Event Rate: 21% vs 13%
p-value: p=<0.001
Older adults receiving homecare prior to a short ED admission, particularly those receiving >2 hours a week, are at significantly increased risk of 30-day readmission and mortality.
May flag homecare recipients for closer post-ED surveillance; leaves open whether homecare volume marks or drives readmission risk.
BACKGROUND: Older adults admitted to an emergency department (ED) who are dependent on homecare may be especially challenged with respect to readmission and mortality. This study aimed to assess whether receiving homecare prior admission was associated with readmission or mortality within 30 days of a short ED admission and to explore whether the amount of homecare received was associated with an increased risk of readmission or mortality. METHODS: This nationwide register-based cohort study included patients aged 65 or above who were admitted to an ED at any Danish hospital from 1 December 2016 to 30 November 2017 and discharged within 48 h. Data were extracted from national registers through Statistics Denmark. Homecare was categorized into groups; patients without homecare and three groups according to the amount of homecare received per week. Logistic regression analyses were used to explore the association between the four homecare groups and outcomes, readmissions and mortality. RESULTS: In total, 80,517 patients (51% female, median age 75 years) were included in the study. Overall, 64,886 patients without homecare, 15,631 (19%) patients received homecare (64% female, median age 83 years), of which 4938 patients received homecare ≤30 min, 4033 received > 30 min to ≤120 min and 6660 received > 120 min per week. The risk of readmission and mortality increased concurrently with the minutes of homecare received: Patients receiving homecare > 120 min per week had the highest odds ratios (ORs) for readmission within 30 days (OR 1.8 95% CI: 1.7-1.9) and mortality within 30 days (OR 4.5 95% CI: 4.1-4.9) compared with patients without homecare. CONCLUSION: Receiving homecare was associated with an increased risk of readmission and death following a short ED admission. Collaboration between the ED and primary health care sector in relation to rehabilitation and end-of-life care is essential to improve quality of care for older adults who receive homecare, particularly those receiving homecare > 2 h a week, because of their increased risk of readmission and mortality.
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Elkjær et al. (2021) conducted a cohort in Older adults admitted to an emergency department (ED) and discharged within 48 hours (n=80,517). Homecare (> 120 min per week) vs. No homecare was evaluated on Readmission within 30 days of discharge (OR 1.8, 95% CI 1.7-1.9, p=<0.001). Receiving more than 120 minutes of homecare per week was associated with an increased risk of readmission within 30 days following a short ED admission compared to no homecare (OR 1.8).
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