Where people live before hospitalization important for discharge planning, reducing readmissions

September 24, 2018, Canadian Medical Association Journal
Credit: CC0 Public Domain

Forty per cent of older adults who leave hospital are discharged to home care or a long-term care facility, which, combined with where they lived before hospitalization, affects their risk of readmission, found a study published in CMAJ (Canadian Medical Association Journal).

These data are important for both health care professionals and policy-makers to improve discharge planning for patients and to reduce readmissions.

"The information from this study will contribute to a better understanding of the extent to which complicated transitions to and from influence readmission among older adults, which is essential for system planning, performance measurement, and the targeting and testing of interventions to improve transitions and reduce readmissions," writes Dr. Andrea Gruneir, Department of Family Medicine, University of Alberta and ICES, with coauthors.

While most research on readmissions focuses on people who are admitted to hospital from the community and who return to the community, this study considers the large number of older adults with more complex pathways across the system.

The large study of 701,527 hospitalized adults over age 65 in Ontario found that 31.5% of people were discharged to home care and 9.5% to long-term care, with 3% newly admitted to long-term care. More than half (53.5%) were women and 40% had five or more chronic conditions. Almost every patient (98%) had visited a doctor at least once during the year before hospital admission, 331,168 (47%) had visited the emergency department and 72,536 (10%) had been admitted.

The authors state that the study "shows that fundamental shortcomings in the health system's ability to meet older adults' needs, particularly those with dementia, manifest as frequent use of acute care, including readmissions, prolonged hospital stays with extended alternate levels of care periods and 'non-acute' reasons for hospital admission."

People who were discharged with home care were the most likely to be readmitted, and when readmitted, 19% were there for two or more weeks and nearly 20% were designated as alternate level of care (ALC), the longest of any group in the study. Conversely, people who were discharged to long-term care (as a new admission) were the least likely to be readmitted, but their first hospital stay was most often for dementia. More than 80% were in hospital for two or more weeks and were designated as ALC, which means they no longer need acute hospital care but can't be discharged as the appropriate level of care required is not available in another setting.

"By contextualizing hospitalization within these care settings, our findings suggest an approach to understanding readmissions as a signal of the health system's preparedness for the ageing population," the authors conclude.

Explore further: Longer hospital stays might reduce readmissions from post-acute care facilities

More information: Andrea Gruneir et al, Care setting and 30-day hospital readmissions among older adults: a population-based cohort study, Canadian Medical Association Journal (2018). DOI: 10.1503/cmaj.180290

Related Stories

Longer hospital stays might reduce readmissions from post-acute care facilities

March 7, 2017
More than 25 percent of Medicare beneficiaries who are admitted to the hospital are sent to a post-acute care facility (a health facility like a rehabilitation or skilled nursing center used instead of a hospital) after being ...

Dementia increases the risk of 30-day readmission to the hospital after discharge

February 23, 2018
About 25 percent of older adults admitted to hospitals have dementia and are at increased risk for serious problems like in-hospital falls and delirium (the medical term for an abrupt, rapid change in mental function). As ...

CU researchers study hospital readmissions from post-acute care facilities

January 15, 2016
Better coordination between hospitals and post-acute care facilities could reduce patient readmission to hospitals and mortality rates, according to a new study of risk factors by researchers from the University of Colorado ...

PCI patients discharged against medical advice twice as likely to be readmitted

July 18, 2018
In a new study, researchers found discharge against medical advice as the strongest predictor of 30-day unplanned readmissions in heart attack patients. While only a small number of patients choose to discharge against medical ...

Hospitals may take too much of the blame for unplanned readmissions

July 12, 2018
A major goal of hospitals is to prevent unplanned readmissions of patients after they are discharged. A new study reveals that the preventability of readmissions changes over time: readmissions within the first week after ...

Hospital readmission rates not accurate measure of care quality

August 22, 2011
Avoidable readmissions after discharge from hospital are fairly uncommon and are not an accurate measure of quality of care, found a study in CMAJ (Canadian Medical Association Journal).

Recommended for you

Juul e-cigarettes pose addiction risk for young users, study finds

October 19, 2018
Teens and young adults who use Juul brand e-cigarettes are failing to recognize the product's addictive potential, despite using it more often than their peers who smoke conventional cigarettes, according to a new study by ...

Self-lubricating latex could boost condom use: study

October 17, 2018
A perpetually unctuous, self-lubricating latex developed by a team of scientists in Boston could boost the use of condoms, they reported Wednesday in the journal Royal Society Open Science.

Engineered enzyme eliminates nicotine addiction in preclinical tests

October 17, 2018
Scientists at Scripps Research have successfully tested a potential new smoking-cessation treatment in rodents.

Nutrition has a greater impact on bone strength than exercise

October 17, 2018
One question that scientists and fitness experts alike would love to answer is whether exercise or nutrition has a bigger positive impact on bone strength.

How healthy will we be in 2040?

October 17, 2018
A new scientific study of forecasts and alternative scenarios for life expectancy and major causes of death in 2040 shows all countries are likely to experience at least a slight increase in lifespans. In contrast, one scenario ...

Study finds evidence of intergenerational transmission of trauma among ex-POWs from the Civil War

October 16, 2018
A trio of researchers affiliated with the National Bureau of Economic Research has found evidence that suggests men who were traumatized while POWs during the U.S. Civil War transmitted that trauma to their offspring—many ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.