Article

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. PARTICIPANTS: Consecutive patients (N=1515) admitted to a
CIIRP between January 2009 and June 2012. INTERVENTIONS: Patients' functional
status, the primary exposure variable, was assessed using tertiles of the total
FIM score at CIIRP admission, with secondary analyses using the FIM motor and
cognitive domains. A propensity score, consisting of 25 relevant clinical and
demographic variables, was used to adjust for confounding in the analysis. MAIN
OUTCOME MEASURES: Readmission to acute care was categorized as (1) readmission
before planned discharge from the CIIRP, (2) readmission within 30 days of
discharge from the CIIRP, and (3) total readmissions from both groups, with total
readmissions being the a priori primary outcome. RESULTS: Among the 1515
patients, there were 347 total readmissions. Total readmissions were
significantly associated with FIM scores, with adjusted odds ratios (AORs) and
95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the
highest tertile (AOR=2.6; 95% CI, 1.9-3.7; P<.001 and AOR=1.7; 95% CI, 1.2-2.4;
P=.002, respectively). There were similar findings for secondary analyses of
readmission before planned discharge from the CIIRP (AOR=3.5; 95% CI, 2.2-5.8;
P<.001 and AOR=2.1; 95% CI, 1.3-3.5l P=.002, respectively), and a weaker
association for readmissions after discharge from the CIIRP (AOR=1.6; 95% CI,
1.0-2.4; P=.047 and AOR=1.3; 95% CI, 0.8-1.9; P=.28, respectively). The FIM motor
domain score was more strongly associated with readmissions than the FIM
cognitive score. CONCLUSIONS: Functional status on admission to the CIIRP is
strongly associated with readmission to acute care, particularly for motor
aspects of functional status and readmission before planned discharge from the
CIIRP. Efforts to reduce hospital readmissions should consider patient functional
status as an important and potentially modifiable risk factor.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS