Functional Status is Associated with 30-day Potentially Preventable Hospital Readmissions following Inpatient Rehabilitation among Aged Medicare Fee-for-Service Beneficiaries

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Addie Middleton, James E. Graham, Kenneth J. Ottenbacher
ObjectiveTo determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.DesignRetrospective cohort study.SettingInpatient rehabilitation facilities submitting claims to Medicare.ParticipantsNational cohort of 371,846 inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013-2014. The average age was 79.1 (SD, 7.6) years. A majority were female (59.7%) and non-Hispanic white (84.5%).InterventionsNot applicable.Main Outcome Measures1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions following inpatient rehabilitation and 2) primary diagnoses for readmissions.ResultsThe overall rate of any 30-day hospital readmission following inpatient rehabilitation was 12.4% (N=46,265) and the overall rate of potentially preventable readmissions was 5.0% (N=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates (95% CI) for the highest vs. lowest quartiles within each functional domain were as follows: self-care: 3.4% (3.3-3.5) vs 6.9% (6.7-7.1); mobility: 3.3% (3.2-3.4) vs 7.2% (7.0-7.4); cognition 3.5% (3.4-3.6) vs 6.2% (6.0-6.4). Similarly, adjusted odds ratios were as follows: self-care: 0.70 (0.67-0.74); mobility: 0.64 (0.61-0.68); cognition: 0.84 (0.80-0.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).ConclusionsFunctional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.



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