Association of impaired functional status at hospital discharge and subsequent rehospitalization

Abstract

OBJECTIVE To determine whether functional status near the time of discharge from acute care hospitalization is associated with acute care readmission. PATIENTS AND METHODS Retrospective cohort study of 9405 consecutive patients admitted from an acute care hospital to an inpatient rehabilitation facility between July 1, 2006 and December 31, 2012. Patients’ functional status at admission to the rehabilitation facility was assessed by the Functional Independence Measure (FIM) score, and divided into low, middle, or high functional status. The main outcome was readmission to an acute care hospital within 30 days of acute care discharge (for all patients and by subgroup according to diagnostic group: medical, orthopedic, or neurologic). RESULTS There were 1182 (13%) readmissions. FIM score was significantly associated with readmission, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for low and middle versus high FIM score category of 3.0 (2.5-3.6; P < 0.001) and 1.5 (95% CI: 1.3-1.8; P < 0.001), respectively. This relationship between FIM score and read-mission held across diagnostic category. Medical patients with low functional status had the highest readmission rate (OR: 29%; 95% CI: 25%-32%) and an adjusted OR for readmission of 3.2 (95% CI: 2.4-4.3, P < 0.001) compared to medical patients with high FIM scores. CONCLUSIONS AND RELEVANCE For patients admitted to an acute inpatient rehabilitation facility, functional status near the time of discharge from an acute care hospital is strongly associated with acute care readmission, particularly for medical patients with greater functional impairments. Reducing functional status decline during acute care hospitalization may be an important strategy to lower readmissions.

Functional Status Outperforms Comorbidities in Predicting Acute Care Readmissions in Medically Complex Patients

“…Of the 26 distinct readmission models examined in a 2011 systematic review, only eight models considered functional status as a predictor variable, and only two studies ultimately included overall health and functional status, activities of daily living dependence, and mobility in their final models. 6 In a recent single-center study of medical patients, Hoyer et al (2014) found that functional status at the time of acute care discharge was a significant predictor of 30-day acute care readmission, where lowest-functioning patients had the highest rates of readmission (OR 29 %, 95 % CI 25-32 %). 21 Coupled with our findings that the presence of medical comorbidities does not further improve the prediction of readmission risk, these studies suggest that emphasis on functional status will enhance national readmission models, and interventions aimed at improving function may impact readmission rates.…”

“…FIM scores upon IRF admission have been used in previous research as a proxy for acute care discharge functional status. 21 …”

“…However, the UDSMR dataset is one of the largest national datasets with available functional data, and functional data was collected at the time of IRF admission, thereby serving as a reasonable surrogate of functional status at the time of acute care discharge. 21 Nonetheless, future work is needed to examine and test these findings in the acute care setting.…”

“…Furthermore, there is increasing recognition that a standardized inpatient assessment tool is necessary to improve the discharge planning process and transitions to post-acute care. 12 Models predicting readmission in the stroke, [13][14][15][16][17][18] burn, 19 cancer, 20 and general inpatient rehabilitation populations 21 have identified functional status as an important predictor of hospital readmission. Limitations of prior work include small and single-center study designs, narrowly defined patient populations, and defining readmissions beyond the 30-day period.…”

Capsule Comment on Harrison et al., Assessing the Impact of Nurse Post-Discharge Telephone Calls on 30-day Hospital Readmission Rates

“…This ability to answer the telephone is reminiscent of the relationship between lower hospital readmission rates and more favorable 6-minute walk test results in heart failure patients 4 and global assessments of functional status performed in rehabilitation facilities. 5 The ability to answer the phone emerged as a functional status proxy predicting both hospital readmission and the "success" of the program. The phone call itself had no effect.…”