IMPROVING DECISION-MAKING AND OUTCOMES IN TRANSITIONS TO POST-ACUTE CARE FACILITIES

摘要

The number of older adults discharged to post-acute care (PAC) facilities after hospitalization is increasing rapidly, but their clinical course is uncertain. We sought to identify prognostic factors linked to outcomes of older adults discharged to PAC using a retrospective analysis of the 2003–2009 Medicare Current Beneficiary Survey (MCBS), a nationally-representative survey of Medicare recipients matched with claims data. Community-dwelling adults age 65 and older who were hospitalized and discharged to a PAC facility were included. The primary outcome was a composite of events representing failure to return to the community, including death, readmission to the hospital, or remaining in a PAC facility 100 days post-hospital discharge. Of 1416 eligible patients, 510 (35.9%) did not return to the community. In multivariable analysis, the most important factors included the presence of dyspnea (OR 1.46; 95% CI 1.09–1.96), cognitive impairment (1.12; 1.02–1.24), use of antipsychotics (1.10; 1.04–1.17), number of physician visits in the PAC facility (1.09; 1.03–1.14), index hospital length of stay (1.02 per day; 1.01–1.03), PAC facility length of stay (0.99 per day; 0.98–0.99), and better functional status (0.80; 0.75–0.85). The c-statistic was 0.694. More than one-third of older adults discharged to PAC facilities are readmitted, die, or remain in the PAC facility 100 days post-discharge. Several factors that influence these outcomes may be modifiable. Their predictive value is similar to most readmission prediction models, which have been successfully used to target interventions to high-risk groups. These findings may serve as a starting point for better informing decision-making and improving outcomes.