Addie Middleton1, Brian Downer2, Allen Haas3, Yu-Li Lin3, James E Graham2, Kenneth J Ottenbacher2. 1. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Division of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina. Electronic address: middlja@musc.edu. 2. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas. 3. Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
Abstract
OBJECTIVES: The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions. DESIGN: Retrospective cohort study. SETTING: SNFs and acute care hospitals submitting claims to Medicare. PARTICIPANTS: National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1% were women, and 86.3% were non-Hispanic white. MEASUREMENTS: Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions. RESULTS: The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95% confidence interval [CI] 1.49-1.59); self-care, 1.50 (95% CI 1.44-1.55); and cognition, 1.12 (95% CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663, 9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent. CONCLUSIONS: Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.
OBJECTIVES: The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions. DESIGN: Retrospective cohort study. SETTING: SNFs and acute care hospitals submitting claims to Medicare. PARTICIPANTS: National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1% were women, and 86.3% were non-Hispanic white. MEASUREMENTS: Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions. RESULTS: The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95% confidence interval [CI] 1.49-1.59); self-care, 1.50 (95% CI 1.44-1.55); and cognition, 1.12 (95% CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663, 9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent. CONCLUSIONS:Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.
Authors: Addie Middleton; James E Graham; Yu-Li Lin; James S Goodwin; Janet Prvu Bettger; Anne Deutsch; Kenneth J Ottenbacher Journal: J Gen Intern Med Date: 2016-07-20 Impact factor: 5.128
Authors: Debra Saliba; Joan Buchanan; Maria Orlando Edelen; Joel Streim; Joseph Ouslander; Dan Berlowitz; Joshua Chodosh Journal: J Am Med Dir Assoc Date: 2012-07-15 Impact factor: 4.669
Authors: Mark Toles; Ruth A Anderson; Mark Massing; Mary D Naylor; Eric Jackson; Sharon Peacock-Hinton; Cathleen Colón-Emeric Journal: J Am Geriatr Soc Date: 2014-01-02 Impact factor: 5.562
Authors: Randi E Berkowitz; Zachary Fang; Benjamin K I Helfand; Richard N Jones; Robert Schreiber; Michael K Paasche-Orlow Journal: J Am Med Dir Assoc Date: 2013-04-20 Impact factor: 4.669
Authors: Kenneth J Ottenbacher; Amol Karmarkar; James E Graham; Yong-Fang Kuo; Anne Deutsch; Timothy A Reistetter; Soham Al Snih; Carl V Granger Journal: JAMA Date: 2014-02-12 Impact factor: 56.272
Authors: Jason R Falvey; Robert E Burke; Cari R Levy; Allison M Gustavson; Lisa Price; Jeri E Forster; Jennifer E Stevens-Lapsley Journal: Phys Ther Date: 2019-01-01