Objective: To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. Design: Retrospective cohort study. Setting: Academic hospital-based CIIRP. Participants: Consecutive patients (NZ1515) admitted to a CIIRP between January 2009 and June 2012. Interventions: Patients’ functional status, the primary exposure variable, was assessed using tertiles of the total FIM score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domains. A propensity score, consisting of 25 relevant clinical and demographic variables, was used to adjust for confounding in the analysis. Main Outcome Measures: Readmission to acute care was categorized as (1) readmission before planned discharge from the CIIRP, (2) readmission within 30 days of discharge from the CIIRP, and (3) total readmissions from both groups, with total readmissions being the a priori primary outcome. Results: Among the 1515 patients, there were 347 total readmissions. Total readmissions were significantly associated with FIM scores, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the highest tertile (AORZ2.6; 95% CI, 1.9e3.7; P<.001 and AORZ1.7; 95% CI, 1.2e2.4; PZ.002, respectively). There were similar findings for secondary analyses of readmission before planned discharge from the CIIRP (AORZ3.5; 95% CI, 2.2e5.8; P<.001 and AORZ2.1; 95% CI, 1.3e3.5l PZ.002, respectively), and a weaker association for readmissions after discharge from the CIIRP (AORZ1.6; 95% CI, 1.0e2.4; PZ.047 and AORZ1.3; 95% CI, 0.8e1.9; PZ.28, respectively). The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score. Conclusions: Functional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.

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Key Points Question Is the Johns Hopkins Community Health Partnership, a broad care coordination program inclusive of acute care and community interventions, associated with improved health outcomes? Findings This quality improvement study found that the community intervention was associated with a statistically significant reduction in admissions, readmissions, and emergency department visits for Medicaid, but the utilization results were mixed for the acute care intervention. In terms of cost of care, there were statistically significant cost savings totaling $113.3 million. Meaning A care coordination model in an urban academic center environment can be associated with improved outcomes, including substantial cost reduction.

PAL and TG care coordination interventions were associated with lower rates of 30-day readmission. Our findings underscore the importance of determining the appropriate intervention for the hardest-to-reach patients, who are also at the highest risk of being readmitted.

OBJECTIVE Hospital discharge summaries can provide valuable information to future providers and may help to prevent hospital readmissions. We sought to examine whether the number of days to complete hospital discharge summaries is associated with 30‐day readmission rate. PATIENTS AND METHODS This was a retrospective cohort study conducted on 87,994 consecutive discharges between January 1, 2013 and December 31, 2014, in a large urban academic hospital. We used multivariable logistic regression models to examine the association between days to complete the discharge summary and hospital readmissions while controlling for age, gender, race, payer, hospital service (gynecology–obstetrics, medicine, neurosciences, oncology, pediatrics, and surgical sciences), discharge location, length of stay, expected readmission rate in Maryland based on diagnosis and illness severity, and the Agency for Healthcare Research and Quality Comorbidity Index. Days to complete the hospital discharge summary—the primary exposure variable—was assessed using the 20th percentile (>3 vs ≤3 days) and as a continuous variable (odds ratio expressed per 3‐day increase). The main outcome was all‐cause readmission to any acute care hospital in Maryland within 30 days. RESULTS Among the 87,994 patients, there were 14,248 (16.2%) total readmissions. Discharge summary completion >3 days was significantly associated with readmission, with adjusted odds ratio (OR) (95% confidence interval [CI]) of 1.09 (1.04 to 1.13, P = 0.001). We also found that every additional 3 days to complete the discharge summary was associated with an increased adjusted odds of readmission by 1% (OR: 1.01, 95% CI: 1.00 to 1.01, P < 0.001). CONCLUSION Longer days to complete discharge summaries were associated with higher rates of all‐cause hospital readmissions. Timely discharge summary completion time may be a quality indicator to evaluate current practice and as a potential strategy to improve patient outcomes. Journal of Hospital Medicine 2016;11:393–400. 2016 Society of Hospital Medicine