Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury

Pryor

et al. 2019

PM&R

Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC.

Section: Resultsmentioning

confidence: 99%

Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review

Pryor

et al. 2019

PM&R

Archives of Physical Medicine and Rehabilitation

“…Patients discharged to SNF/ICF may be at greater risk of readmission than those discharged to home care. Hammond and colleagues 30 also found discharge to institutional settings was associated with higher hospital readmission rates compared to discharge to home. Discharge to SNF also significantly increased the risk of depression in both men and women post-TBI 31 .…”

Section: Discussionmentioning

confidence: 96%

“…Providing suicidal prevention, home care education, safety or environmental modification to remove unsafe triggers (e.g., drugs) may address such concerns. For ‘circulatory system disease,’ cardiac dysfunction in the first two weeks after TBI was found associated with higher rates of in-hospital mortality 30 . Consistently, our findings suggest that timely intervention in symptoms management and improved compliance with medication for cardiac disease may facilitate the hemodynamic management of TBI and further avoid follow up readmissions 15 .…”

Section: Discussionmentioning

confidence: 99%

Effects of Age and Sex on Hospital Readmission in Traumatic Brain Injury

Karmarkar

Adhikari

et al. 2018

Objective To investigate the impact of age and sex on 30-, 60- and 90-day hospital readmission after acute hospital discharge for individuals with traumatic brain injury (TBI). Design Retrospective cohort study. Setting Acute hospitals and post-acute discharge settings Participants From the 2013 Nationwide Readmissions Database, we retrieved information on 52,877 individuals with diagnosis-related group codes of TBI. We included only those alive at index acute discharge and excluded those discharged with same-day readmission. We divided our sample into four age groups: 18-40, 41-65, 66-75 and 76+ years old. Interventions NA. Main Outcome Measure(s) All-cause hospital readmission. Results Sex differences in 30-, 60- and 90-day hospital readmission were found for all age groups (all p<.05). The largest sex differences in hospital readmission were in the two oldest groups (66-75, 76+). For both sexes, the oldest group (76+) had the highest adjusted 90-day readmission risk [e.g., 90-day readmission: Odds Ratio (OR) = 2.32 (2.01-2.69) for males; OR=1.96 (1.59-2.43) for females]. Among those readmitted within 90 days, the youngest group (18-40 years) had the highest cumulative readmission percent (35% for both sexes) within the first week post-hospital discharge. Conclusion Age and sex were significantly associated with hospital readmission during the first 90 days post-discharge in our TBI sample. Specifically, those aged 66-75 or 76+ had the highest readmission risk over 90 days for both sexes. The findings suggest that clinicians should consider age and sex in discharge planning and for the entire episode of care for the TBI population.

“…5 Previous studies examining rehospitalization and post-acute inpatient rehabilitation have focused on predictors other than the functional domains identified by the IMPACT Act and outcomes other than post-discharge 30-day unplanned rehospitalization. 9,11,[21][22][23][24][25][26] Unplanned rehospitalizations have the potential for improvement 7,27 and are the focus of the current quality improvement policies being developed by CMS and the National Quality Forum. 28 In our national sample of community-dwelling adults who were discharged from post-acute rehabilitation, the overall unadjusted 30-day unplanned rehospitalization rate was 12.0 %.…”

Section: Discussionmentioning

confidence: 99%

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

et al. 2016

BACKGROUND:The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012-2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012-2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42-1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27-1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09-1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3-17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3-8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS:The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.