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  • Study Looks at Readmission Hazards, Offsets Among Adults With Debility

    Among individuals admitted for inpatient rehabilitation, patients who are admitted for debility—a significant decline in functional mobility and/or activities of daily living—are among the most likely to be readmitted within 30 days. Now a new study takes a closer look at just how those readmissions play out, and what factors are related to the greatest risk of readmission within that group.

    In the February issue of Physical Therapy (PTJ), APTA's research journal, researchers share their findings from an analysis of more than 45,000 records of Medicare beneficiaries who were admitted to a hospital for debility, and then later discharged to the community between 2006 and 2009. Authors of the study tracked these patients to uncover rates of readmission within 90 days, and any factors that would put some at higher risk for readmission than others. The records covered 1,199 facilities.

    What they found was that 1 in 3 patients were readmitted within 90 days, with more than half of those readmissions (56%) occurring in the first month after discharge—19% of the total. That 30-day readmission rate was not as high as the 23%-24% reported among Medicare beneficiaries in skilled nursing facilities, but authors point out that their study focuses on patients readmitted to the community after discharge from inpatient rehabilitation rather than after discharge from acute care.

    In terms of risks for a return to the hospital, researchers found that certain comorbidities—specifically congestive heart failure, renal failure, and chronic pulmonary disease—were among the top reasons associated with readmission. "These generally prevalent conditions have implications for developing and targeting hospital readmission reduction programs for patients with debility," authors write.

    There were positive signs when it came to the effect of inpatient rehabilitation. Researchers found that higher scores on the Functional Independence Measure (FIM) at discharge correlated to a decreased risk of readmission. That decrease amounted to a 2% lower risk of readmission within the first 2 weeks of discharge for every 1 point increase in FIM, with the rate dropping to a 1%-per-point relationship for readmission at 1 month. The protective effects of the higher FIM scores seemed to fall off at the 2 month mark, authors note. Of the FIM items associated with the greatest impact on readmission, walk/wheelchair and stair locomotion, lower body dressing, eating, and bowel and bladder control topped the list.

    The average age of patients in the study was 80.8 years. The study group was majority female (60.1%), non-Hispanic white (86.4%), not married (56.2%), and living with others prior to acute hospitalization (61.8%).

    Authors believe that while more study is needed, their findings around readmission hazards can inform health care providers, particularly in the ways patients with debility are evaluated and monitored after discharge.

    "These considerations are relevant to discharge planning and transition of care from inpatient rehabilitation to community," authors write. "Patients with debility who have lower motor function and comorbid conditions associated with increased readmission hazard should be monitored for functional trajectory and medical stability during inpatient rehabilitation and post-discharge. Optimizing independence levels for motor function during inpatient rehabilitation is an important consideration for reducing hospital readmissions."

    Lead author of the study was Rebecca Galloway, PT, PhD. The article appears in the concluding issue of a 3-issue PTJ series focusing on health services research. Current and past editions of PTJ are available for free to APTA members.

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