Hospital readmission in persons with stroke following postacute inpatient rehabilitation

Kenneth Ottenbacher, J. E. Graham, A. J. Ottenbacher, J. Lee, Soham Al Snih al snih, Amol Karmarkar, Timothy Reistetter, G. V. Ostir

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background. Readmission is an important quality indicator following acute care hospitalization. We examined factors associated with hospital readmission in persons with stroke following postacute inpatient rehabilitation. Methods. Prospective cohort study including 674 persons with stroke who received rehabilitation at 11 facilities located in eight states and the District of Columbia. Measures included hospital readmission within 3 months of discharge, sociodemographic characteristics, length of stay, primary payment source, comorbidities, stroke type, standardized assessments of motor and cognitive function, depressive symptoms, and social support. Results. Mean age was 71.5 years (SD = 10.5). Twenty-five percent of patients reported high depressive symptoms. Overall, 18% (n = 122) of the sample was rehospitalized. Univariate analyses showed that people who were rehospitalized were more likely (p < .05) to be non-Hispanic white, married, demonstrate less functional independence at discharge, experience longer lengths of stay in rehabilitation, and report more depressive symptoms and lower social support. In the fully adjusted multivariable hierarchical generalized linear model, motor functional status (OR = 0.98, 95% CI 0.96 - 0.99), depressive symptoms (OR = 1.80, 95% CI 1.06 - 3.05), and social support (OR = 2.28, 95% CI 1.29 - 4.03) remained statistically significant. In addition, a minority-by-depressive symptoms interaction term also reached statistical significance. Conclusion. Functional status, depressive symptoms, and social support were important predictors of hospital readmission. These variables are not included in most administrative data sets. Future research to develop useful risk-adjustment models for rehospitalization following postacute inpatient rehabilitation services should include large diverse samples and explore practical sources for additional meaningful information.

Original languageEnglish (US)
Pages (from-to)875-881
Number of pages7
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume67 A
Issue number8
DOIs
StatePublished - Aug 2012

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Patient Readmission
Inpatients
Rehabilitation
Stroke
Depression
Social Support
Length of Stay
Risk Adjustment
Cognition
Comorbidity
Linear Models
Hospitalization
Cohort Studies
Prospective Studies

Keywords

  • Disability
  • Outcomes
  • Postacute
  • Quality indicators

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology
  • Medicine(all)

Cite this

Hospital readmission in persons with stroke following postacute inpatient rehabilitation. / Ottenbacher, Kenneth; Graham, J. E.; Ottenbacher, A. J.; Lee, J.; Al Snih al snih, Soham; Karmarkar, Amol; Reistetter, Timothy; Ostir, G. V.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 67 A, No. 8, 08.2012, p. 875-881.

Research output: Contribution to journalArticle

Ottenbacher, Kenneth ; Graham, J. E. ; Ottenbacher, A. J. ; Lee, J. ; Al Snih al snih, Soham ; Karmarkar, Amol ; Reistetter, Timothy ; Ostir, G. V. / Hospital readmission in persons with stroke following postacute inpatient rehabilitation. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2012 ; Vol. 67 A, No. 8. pp. 875-881.
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AU - Karmarkar, Amol

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N2 - Background. Readmission is an important quality indicator following acute care hospitalization. We examined factors associated with hospital readmission in persons with stroke following postacute inpatient rehabilitation. Methods. Prospective cohort study including 674 persons with stroke who received rehabilitation at 11 facilities located in eight states and the District of Columbia. Measures included hospital readmission within 3 months of discharge, sociodemographic characteristics, length of stay, primary payment source, comorbidities, stroke type, standardized assessments of motor and cognitive function, depressive symptoms, and social support. Results. Mean age was 71.5 years (SD = 10.5). Twenty-five percent of patients reported high depressive symptoms. Overall, 18% (n = 122) of the sample was rehospitalized. Univariate analyses showed that people who were rehospitalized were more likely (p < .05) to be non-Hispanic white, married, demonstrate less functional independence at discharge, experience longer lengths of stay in rehabilitation, and report more depressive symptoms and lower social support. In the fully adjusted multivariable hierarchical generalized linear model, motor functional status (OR = 0.98, 95% CI 0.96 - 0.99), depressive symptoms (OR = 1.80, 95% CI 1.06 - 3.05), and social support (OR = 2.28, 95% CI 1.29 - 4.03) remained statistically significant. In addition, a minority-by-depressive symptoms interaction term also reached statistical significance. Conclusion. Functional status, depressive symptoms, and social support were important predictors of hospital readmission. These variables are not included in most administrative data sets. Future research to develop useful risk-adjustment models for rehospitalization following postacute inpatient rehabilitation services should include large diverse samples and explore practical sources for additional meaningful information.

AB - Background. Readmission is an important quality indicator following acute care hospitalization. We examined factors associated with hospital readmission in persons with stroke following postacute inpatient rehabilitation. Methods. Prospective cohort study including 674 persons with stroke who received rehabilitation at 11 facilities located in eight states and the District of Columbia. Measures included hospital readmission within 3 months of discharge, sociodemographic characteristics, length of stay, primary payment source, comorbidities, stroke type, standardized assessments of motor and cognitive function, depressive symptoms, and social support. Results. Mean age was 71.5 years (SD = 10.5). Twenty-five percent of patients reported high depressive symptoms. Overall, 18% (n = 122) of the sample was rehospitalized. Univariate analyses showed that people who were rehospitalized were more likely (p < .05) to be non-Hispanic white, married, demonstrate less functional independence at discharge, experience longer lengths of stay in rehabilitation, and report more depressive symptoms and lower social support. In the fully adjusted multivariable hierarchical generalized linear model, motor functional status (OR = 0.98, 95% CI 0.96 - 0.99), depressive symptoms (OR = 1.80, 95% CI 1.06 - 3.05), and social support (OR = 2.28, 95% CI 1.29 - 4.03) remained statistically significant. In addition, a minority-by-depressive symptoms interaction term also reached statistical significance. Conclusion. Functional status, depressive symptoms, and social support were important predictors of hospital readmission. These variables are not included in most administrative data sets. Future research to develop useful risk-adjustment models for rehospitalization following postacute inpatient rehabilitation services should include large diverse samples and explore practical sources for additional meaningful information.

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