Functional Status Across Post-Acute Settings is Associated With 30-Day and 90-Day Hospital Readmissions.
Chih-Ying Li, Allen Haas, Kevin T Pritchard and 4 others
PMID 34473961WHAT IT FOUND
Patients with lower self-care or mobility function at the initial post-acute stay had higher 30-day and 90-day readmission risk across stroke, lower extremity joint replacement and hip/femur fracture/procedure.
Function flags risk; it does not prove rehabilitation prevents readmission.
Key findings
01Patients who were more functionally dependent in self-care and mobility had higher 30-day and 90-day hospital readmission risk than patients who were more functionally independent.
02In stroke, the least independent mobility group had higher 30-day readmission risk (HR 1.36, 95% CI 1.30 to 1.42) and 90-day readmission risk (HR 1.39, 95% CI 1.33 to 1.46) than the most independent mobility group.
03For lower extremity joint replacement and hip/femur fracture/procedure, dependence in mobility carried greater readmission risk than dependence in self-care; for stroke, dependence in self-care carried greater readmission risk than dependence in mobility.
STILL TO COME
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What it does not show
The study used administrative claims and assessment data, which may not reflect clinical context and can contain coding or reporting errors. The analysis adjusted for comorbidities but did not account for frailty or prehospital mobility. The results cannot be generalized to patients younger than 66, those in managed care or private insurance, those admitted from a nursing facility, or those with missing functional scores. Cognitive domains such as attention and memory were not included, so function may have been underestimated. The data were collected before the IMPACT Act and may not match current post-acute policy or practice. Because this was an observational study, it cannot show that rehabilitation caused lower readmission risk.
Declared interests
No conflicts of interest were declared. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that improving self-care or mobility with rehabilitation will reduce readmissions. This study only shows that patients with lower function had higher readmission risk; it did not test a rehabilitation intervention or prove cause.