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. 2018 Sep 24;190(38):E1124-E1133.
doi: 10.1503/cmaj.180290.

Care setting and 30-day hospital readmissions among older adults: a population-based cohort study

Andrea Gruneir  1 , Kinwah Fung  2 , Hadas D Fischer  2 , Susan E Bronskill  2 , Dilzayn Panjwani  2 , Chaim M Bell  2 , Irfan Dhalla  2 , Paula A Rochon  2 , Geoff Anderson  2
Affiliations

Care setting and 30-day hospital readmissions among older adults: a population-based cohort study

Andrea Gruneir et al. CMAJ. .

Abstract

Background: Despite the fact that many older adults receive home or long-term care services, the effect of these care settings on hospital readmission is often overlooked. Efforts to reduce hospital readmissions, including capacity planning and targeting of interventions, require clear data on the frequency of and risk factors for readmission among different populations of older adults.

Methods: We identified all adults older than 65 years discharged from an unplanned medical hospital stay in Ontario between April 2008 and December 2015. We defined 2 preadmission care settings (community, long-term care) and 3 discharge care settings (community, home care, long-term care) and used multinomial regression to estimate associations with 30-day readmission (and death as a competing risk).

Results: We identified 701 527 individuals (mean age 78.4 yr), of whom 414 302 (59.1%) started in and returned to the community. Overall, 88 305 in dividuals (12.6%) were re admitted within 30 days, but this proportion varied by care setting combination. Relative to individuals returning to the community, those discharged to the community with home care (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.39-1.46) and those returning to long-term care (adjusted OR 1.35, 95% CI 1.27-1.43) had a greater risk of readmission, whereas those newly admitted to long-term care had a lower risk of readmission (adjusted OR 0.68, 95% CI 0.63-0.72).

Interpretation: In Ontario, about 40% of older people were discharged from hospital to either home care or long-term care. These discharge settings, as well as whether an individual was admitted to hospital from long-term care, have important implications for understanding 30-day readmission rates. System planning and efforts to reduce readmission among older adults should take into account care settings at both admission and discharge.

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Conflict of interest statement

Competing interests: Chaim Bell is a medical consultant with the Policy and Innovations Branch of the Ontario Ministry of Health and Long-Term Care. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Care setting combinations for patients admitted to hospital from the community or long-term care and discharged to various settings after the hospital stay.
See this image and copyright information in PMC

References

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