Care setting and 30-day hospital readmissions among older adults: a population-based cohort study
Gruneir A, Fung K, Fischer HD, Bronskill SE, Panjwani D, Bell CM, Dhalla I, Rochon PA, Anderson G. CMAJ. 2018; 190(38):E1124-33. Epub 2018 Sep 24.
Background — Despite the fact that many older adults receive home or long-term care (LTC) services, the effect of these care settings on hospital readmission is often overlooked. Efforts to reduce hospital readmissions, including capacity planning and intervention targeting, require clear data on the frequency of and risk factors for readmission among different populations of older adults.
Methods — We identified all adults >65 years discharged from an unplanned medical hospitalization in Ontario between April 2008 and December 2015. We defined two pre-admission (community, LTC) and three discharge (community, home care, LTC) care settings 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), of whom 414,302 (59.1%) started in and returned to the community. Overall, 12.6% were readmitted within 30 days but this varied by care setting combination. Following adjustment, individuals discharged with home care (adjusted odds ratio 1.43, 95% confidence interval 1.39-1.46) and returning to LTC (AOR 1.35, 95% CI 1.27-1.43) had increased risk of readmission while those newly admitted to LTC (AOR 0.68, 95% CI 0.63-0.72) had reduced risks relative to individuals returning to the community.
Interpretation — In Ontario, 40% of older people are discharged from hospital to either home care or LTC. These discharge settings, as well as whether the individual was admitted to hospital from LTC, have important implications for understanding 30-day readmissions. System planning and efforts to reduce readmission in older adults should take into account care settings at admission and discharge.
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