Shubing Cai1, Sijiu Wang2, Dana B Mukamel3, Thomas Caprio4, Helena Temkin-Greener2. 1. Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY. Electronic address: Shubing_cai@urmc.rochester.edu. 2. Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY. 3. iTEQC Research Program, Medicine-Division of General Internal Medicine, University of California, Irvine, CA. 4. Department of Medicine, University of Rochester School of Medicine, Rochester, NY.
Abstract
OBJECTIVES: To explore profiles of obese residents who receive post-acute care in nursing homes (NHs) and to assess the relationship between obesity and hospital readmissions and how it is modified by individual comorbidities, age, and type of index hospitalizations. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Medicare fee-for-service beneficiaries who were newly admitted to free-standing US NHs after an acute inpatient episode between 2011 and 2014 (N = 2,323,019). MEASURES: The Minimum Data Set 3.0 were linked with Medicare data. The outcome variable was 30-day hospital readmission from an NH. Residents were categorized into 3 groups based on their body mass index (BMI): nonobese, mildly obese, moderate-to-severely obese. We tested the relationship between obesity and 30-day readmissions by fixed-effects logit models and stratified analyses by the type of index hospitalization and residents' age. RESULTS: Forty percent of the identified residents were admitted after a surgical episode, and the rest were admitted after a medical episode. The overall relationship between obesity and readmissions suggested that obesity was associated with higher risks of readmission among the oldest old (≥85 years) residents but with lower risks of readmission among the youngest group (65-74 years). After accounting for individual co-covariates, the association between obesity and readmissions among the oldest old residents became weaker; the adjusted odds ratio was 1.061 (P = .049) and 1.004 (P = .829) for moderate-to-severely obese patients with surgical and medical index hospitalizations, respectively. The protective effect of obesity among younger residents reduced after adjusting for covariates. CONCLUSIONS/RELEVANCE: The relationship between obesity and hospital readmission among post-acute residents could be affected by comorbidities, age, and the type of index hospitalization. Further studies are also warranted to understand how to effectively measure NH quality outcomes, including hospital readmissions, so that policies targeting at quality improvement can successfully achieve their goals without unintended consequences.
OBJECTIVES: To explore profiles of obese residents who receive post-acute care in nursing homes (NHs) and to assess the relationship between obesity and hospital readmissions and how it is modified by individual comorbidities, age, and type of index hospitalizations. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Medicare fee-for-service beneficiaries who were newly admitted to free-standing US NHs after an acute inpatient episode between 2011 and 2014 (N = 2,323,019). MEASURES: The Minimum Data Set 3.0 were linked with Medicare data. The outcome variable was 30-day hospital readmission from an NH. Residents were categorized into 3 groups based on their body mass index (BMI): nonobese, mildly obese, moderate-to-severely obese. We tested the relationship between obesity and 30-day readmissions by fixed-effects logit models and stratified analyses by the type of index hospitalization and residents' age. RESULTS: Forty percent of the identified residents were admitted after a surgical episode, and the rest were admitted after a medical episode. The overall relationship between obesity and readmissions suggested that obesity was associated with higher risks of readmission among the oldest old (≥85 years) residents but with lower risks of readmission among the youngest group (65-74 years). After accounting for individual co-covariates, the association between obesity and readmissions among the oldest old residents became weaker; the adjusted odds ratio was 1.061 (P = .049) and 1.004 (P = .829) for moderate-to-severely obesepatients with surgical and medical index hospitalizations, respectively. The protective effect of obesity among younger residents reduced after adjusting for covariates. CONCLUSIONS/RELEVANCE: The relationship between obesity and hospital readmission among post-acute residents could be affected by comorbidities, age, and the type of index hospitalization. Further studies are also warranted to understand how to effectively measure NH quality outcomes, including hospital readmissions, so that policies targeting at quality improvement can successfully achieve their goals without unintended consequences.
Authors: Hilal Maradit Kremers; Sue L Visscher; Walter K Kremers; James M Naessens; David G Lewallen Journal: J Bone Joint Surg Am Date: 2014-05-07 Impact factor: 5.284
Authors: Helena Temkin-Greener; Sijiu Wang; Thomas Caprio; Dana B Mukamel; Shubing Cai Journal: J Am Med Dir Assoc Date: 2020-07-04 Impact factor: 4.669