Readmission to an Acute Care Hospital During Inpatient Rehabilitation After Stroke

Herrmann, Amanda A; Chrenka, Ella; Niemioja, Gretchen M; Othman, Sally; Podoll, Katherine; Oie, Annika; Hussein, Haitham M.

doi:10.1097/phm.0000000000001844

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…The PPR group had significantly more medical comorbidities than the control group, and the most common causes for PPRs were infection and inadequate management of chronic conditions, rather than injury or unplanned events. We have noted the association between high burden of medical comorbidities and readmission in two previous studies 7,8 . A recent study that analyzed the risk factors and common causes of PPRs in older patients (mean age = 85 yrs) found similar results, noting that acute heart failure, pulmonary edema, sepsis, pneumonia, and stroke made up common causes for readmissions 3 .…”

Section: Discussionmentioning

confidence: 56%

“…We have noted the association between high burden of medical comorbidities and readmission in two previous studies. 7,8 A recent study that analyzed the risk factors and common causes of PPRs in older patients (mean age = 85 yrs) found similar results, noting that acute heart failure, pulmonary edema, sepsis, pneumonia, and stroke made up common causes for readmissions. 3 In another study by our group that focused on acute care encounters after stroke discharge, postdischarge primary care visit within 1 wk was associated with a decreased need for acute care encounters.…”

Section: Discussionmentioning

confidence: 75%

“…This is similar to our observation in an earlier study of increased number of sedatives and hypnotics in IRF stroke patients who experience unplanned interruption of their rehabilitation stay and readmission to acute care hospital. 7 Although a causal relationship cannot be established, the administration of sedatives and hypnotics could be considered a risk factor for PPR.…”

Section: Discussionmentioning

confidence: 99%

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Potentially Preventable Readmissions after Acute Inpatient Rehabilitation

Herrmann

Chrenka

Seth

et al. 2023

Am J Phys Med Rehabil

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Objective The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. Design Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days (n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls (n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. Results Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. Conclusions Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Potentially Preventable Readmissions after Acute Inpatient Rehabilitation

Herrmann

Chrenka

Seth

et al. 2023

Am J Phys Med Rehabil

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“…12 For those who do resume their daily activities, over 50% still report difficulty at 1 year, which can lead to poor outcomes such as falls and rehospitalization. 13,14 Within the field of rehabilitation, the measurement of functioning has been dominated by measures of capacity. Capacity is defined as what is possible in an ideal situation 15,16 as opposed to the enacted or lived experience, in this case daily participation in the individual's own home environment.…”

Section: Introductionmentioning

confidence: 99%

Differences in Daily Activity Performance Between Inpatient Rehabilitation Facility and Home Among Stroke Survivors

Somerville,

Blenden,

Kretzer

et al. 2024

Neurorehabil Neural Repair

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Background Stroke survivors are one of the largest consumer groups of rehabilitation services. Despite improvement in daily activities while in inpatient rehabilitation, many have difficulty performing daily activities at home after discharge. The difference in performance between a standard clinical context and at home is poorly understood. Objective To better understand differences in activity performance during transition from inpatient rehabilitation facility (IRF) to home, we examined daily activity performance scores from 2 different environments (IRF and home) at the same time point (discharge). Methods This was a cross-sectional analysis using baseline data from a randomized controlled trial. Participants were stroke survivors aged ≥50 who planned to discharge home from the IRF. The Functional Independence Measure and Section GG codes (both converted to International Classification of Functioning, Disability, and Health scores) were conducted per protocol first at home and then in the IRF at discharge (≤3 days apart, order not randomized). Results Among 57 participants, activity scores at home were significantly worse than scores at IRF discharge. Over 40% of participants had discharge scores indicating no-to-mild impairment for shower/tub transfer, walking, and going up/down stairs, while home visit scores indicated moderate-to-complete impairment for those activities. The greatest differences in scores were for shower/tub transfer (median difference 1.5, 95% CI 1.00-2.00) and going up/down stairs (median difference 1.50, 95% CI 1.00-2.00). Conclusion The environment plays an important role in stroke survivors’ functioning at home. Future studies should further examine how the environment impacts activity performance upon returning home following stroke.

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“…Studies on the incidence, causes, and consequences of these transfers remain however limited [5]. Notably, several studies did not focus on unplanned transfers only [6,7], while others included patients admitted to rehabilitation for selected conditions [8][9][10][11][12][13][14][15][16][17], or younger than 65 years [18][19][20], or were performed in skilled nursing facilities and not inpatient rehabilitation setting [21][22][23]. Four studies specifically investigated unplanned transfers from geriatric rehabilitation back to acute care [1][2][3][4], with widely variable rates ranging from 4 to 22%.…”

Section: Introductionmentioning

confidence: 99%

Unplanned transfer to acute care during inpatient geriatric rehabilitation: incidence, risk factors, and associated short-term outcomes

Fernandes,

Bula,

Krief

et al. 2024

BMC Geriatr

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Background Information is scarce on unplanned transfers from geriatric rehabilitation back to acute care despite their potential impact on patients’ functional recovery. This study aimed 1) to determine the incidence rate and causes of unplanned transfers; 2) to compare the characteristics and outcomes of patients with and without unplanned transfer. Methods Consecutive stays (n = 2375) in a tertiary geriatric rehabilitation unit were included. Unplanned transfers to acute care and their causes were analyzed from discharge summaries. Data on patients’ socio-demographics, health, functional, and mental status; length of stay; discharge destination; and death, were extracted from the hospital database. Bi- and multi-variable analyses investigated the association between patients’ characteristics and unplanned transfers. Results One in six (16.7%) rehabilitation stays was interrupted by a transfer, most often secondary to infections (19.3%), cardiac (16.8%), abdominal (12.7%), trauma (12.2%), and neurological problems (9.4%). Older patients (AdjORage≥85: 0.70; 95%CI: 0. 53–0.94, P = .016), and those admitted for gait disorders (AdjOR: 0.73; 95%CI: 0.53–0.99, P = .046) had lower odds of transfer to acute care. In contrast, men (AdjOR: 1.71; 95%CI: 1.29–2.26, P < .001), patients with more severe disease (AdjORCIRS: 1.05; 95%CI: 1.02–1.07, P < .001), functional impairment before (AdjOR: 1.69; 95%CI: 1.05–2.70, P = .029) and at rehabilitation admission (AdjOR: 2.07; 95%CI: 1.56- 2.76, P < .001) had higher odds of transfer. Transferred patients were significantly more likely to die than those without transfer (AdjOR 13.78; 95%CI: 6.46–29.42, P < .001) during their stay, but those surviving had similar functional performance and rate of home discharge at the end of the stay. Conclusion A significant minority of patients experienced an unplanned transfer that potentially interfered with their rehabilitation and was associated with poorer outcomes. Men, patients with more severe disease and functional impairment appear at increased risk. Further studies should investigate whether interventions targeting these patients may prevent unplanned transfers and modify associated adverse outcomes.

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Readmission to an Acute Care Hospital During Inpatient Rehabilitation After Stroke

Cited by 3 publications

References 24 publications

Potentially Preventable Readmissions after Acute Inpatient Rehabilitation

Potentially Preventable Readmissions after Acute Inpatient Rehabilitation

Differences in Daily Activity Performance Between Inpatient Rehabilitation Facility and Home Among Stroke Survivors

Unplanned transfer to acute care during inpatient geriatric rehabilitation: incidence, risk factors, and associated short-term outcomes

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