Predictors of Rehospitalization in Post-Acute Rehabilitation among Different Ethnic Groups

Abstract

Objectives: Previous research has shown that ethnicity may play a role in increased risk for hospital readmission during a post-acute rehabilitation care (PARC) stay. However, little is known about risk factors influencing discharge status from PARC settings among different ethnic groups. Hence, the aim of our study was to investigate the relationship of individual characteristics (eg, sex, neighborhood quality) and health behavior (use of rehabilitation services) with rehospitalization across ethnic groups of older adult patients who received post-acute rehabilitation for a cardiovascular disease at a skilled nursing facility (SNF). Design: Retrospective study with data extraction from electronic medical records (EMRs) at admission and discharge. Setting: SNF. Participants: The sample consisted of 520 post-acute rehabilitation patients (96 Hispanics, 172 African Americans, and 252 Whites) 60 years or older with an admitting condition of a circulatory-related disease. Measurements: Sociodemographic and health-related variables, and discharge status (rehospitalized or home). Results: For the Hispanic sample, lower community quality was associated with a greater likelihood of being rehospitalized. For African Americans, having no social support, higher levels of admission functional dependency, and shorter length of stay were significantly associated with a higher likelihood of being rehospitalized. For the group of White participants, the following variables emerged as risk factors for rehospitalization: being male, lower admission cognitive functioning, higher levels of admission depressive symptomatology, and shorter length of stay. Conclusions/Implications: Individual characteristics and health behaviors that are risk factors for rehospitalization during a post-acute stay vary across ethnic groups. Hence, the study provides

Scoping review: Social support impacts hospital readmission rates

“…Having people available to help with personal and medical care after discharge was found to decrease the risk of readmission by Ottenbacher et al (2012) and Schwarz and Elman (2003). Other research has conflicting results, reporting no statistical significance between social support and hospital readmissions (Cimarolli et al, 2020;Li et al, 2019). The methods of measurement of social support are inconsistent between studies.…”

“…Although the topic of hospital readmission is often related to the discharge process, only eight of the articles addressed discharge needs, discharge planning or discharge education (Cakir et al, 2017; Cimarolli et al, 2020; Flythe et al, 2017; Li et al, 2019; Navathe et al, 2018; Rubin et al, 2014; Strunin et al, 2007; White et al, 2015). Eleven of the studies addressed assessment or screening of social support, but only five mentioned it as part of the discharge process (Chan et al, 2019; Flythe et al, 2017; Green et al, 2020; Li et al, 2019; Schwarz, 2000).…”

“…(Agtarap et al, 2018; Chan et al, 2019; Dupre et al, 2018; Enguidanos et al, 2015; Flythe et al, 2017; Green et al, 2020; Li et al, 2019; Navathe et al, 2018; Polsook & Aungsuroch, 2020; Rubin et al, 2014; Sokoreli et al, 2019; White et al, 2015). Eleven of the studies only included adults 60 or older (Chan et al, 2019; Cimarolli et al, 2020; Dupre et al, 2018; Enguidanos et al, 2015; Green et al, 2020; Happ et al, 1997; Ottenbacher et al, 2012; Rodríguez‐Artalejo et al, 2006; Schwarz, 2000; Schwarz & Elman, 2003; Sokoreli et al, 2019; Vinson et al, 1990; White et al, 2015). Most participants were white (66.6%) indicating that minority groups were not well represented in the studies related to social support and hospital readmission.…”

“…Some researchers use validated tools to evaluate social support, for example, The Social Provision Scale (Agtarap et al, 2018), The Duke Social Support Scale (Ottenbacher et al, 2012) or The Multidimensional Scale of Perceived Social Support (Chan et al, 2019). Others identify social support based on information found in electronic health records (Cimarolli et al, 2020) or based on patients’ responses to questions (Rodríguez‐Artalejo et al, 2006), lacking a foundation to support to support evaluation. This absence of consistency indicates a gap in the literature related to social support.…”

Instrumental support: A conceptual analysis

“…19 The phrase "someone to look after you" was used instead of identifying a familial or social connection in the context of improving psychological wellbeing 28 and decreasing the risk of readmission. 29 "Friend" was also used to describe the person who would help with health care and medications, 21,27 be present during meetings to talk about discharge planning, 30 or help with managing chronic illness. 25 The term "caregiver" was used in combination with friends and/or family, but was also used alone without any defining characteristics.…”