Citation

Hoyer EH, Needham DM, Miller J, Deutschendorf A, Friedman M, Brotman DJ. Arch. Phys. Med. Rehabil. 2013; 94(10): 1951-1958.

Affiliation

Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD. Electronic address: ehoyer1@jhmi.edu.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.apmr.2013.05.028

PMID

23810355

Abstract

OBJECTIVE: To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. DESIGN: Retrospective cohort study. SETTING: Academic hospital-based CIIRP in Baltimore, MD. Baltimore, MDnterventions: Patients' functional status, the primary exposure variable, was assessed using tertiles of the total Functional Independence Measure (FIM) score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domain. A propensity score, consisting of 25 relevant clinical and demographic variables, were used to adjust for confounding in the analysis. MAIN OUTCOME MEASURES: Readmission to acute care was categorized as: a) readmission before planned discharge from CIIRP, b) readmission within 30 days of discharge from CIIRP, and c) total readmissions (a + b), with total readmissions being the a priori primary outcome. RESULTS: Among 1515 patients, there were 347 total readmissions. Total readmissions was significantly associated with FIM scores, with adjusted odds ratios (OR) and 95% confidence intervals (CI) for lowest and middle FIM tertiles versus highest tertile of 2.6 (1.9-3.7, p<0.001) and 1.7 (1.2-2.4, p=0.002), respectively. There were similar findings for secondary analyses of readmission before planned discharge from CIIRP [3.5 (2.2-5.8, p<0.001) and 2.1 (1.3-3.5, p=0.002)], and a weaker association for readmissions after discharge from CIIRP [1.6 (1.0-2.4, p=0.047) and 1.3 (0.8-1.9, p=0.28)]. The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score. CONCLUSIONS: Functional status on admission to CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.

Language: en