Association of impaired functional status at hospital discharge and subsequent rehospitalization
Open accessAbstract
OBJECTIVE: To determine whether functional status near the time of discharge from acute care hospitalization is associated with acute care readmission. PATIENTS AND METHODS: Retrospective cohort study of 9405 consecutive patients admitted from an acute care hospital to an inpatient rehabilitation facility between July 1, 2006 and December 31, 2012. Patients' functional status at admission to the rehabilitation facility was assessed by the Functional Independence Measure (FIM) score, and divided into low, middle, or high functional status. The main outcome was readmission to an acute care hospital within 30 days of acute care discharge (for all patients and by subgroup according to diagnostic group: medical, orthopedic, or neurologic). RESULTS: There were 1182 (13%) readmissions. FIM score was significantly associated with readmission, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for low and middle versus high FIM score category of 3.0 (2.5‐3.6; P < 0.001) and 1.5 (95% CI: 1.3‐1.8; P < 0.001), respectively. This relationship between FIM score and readmission held across diagnostic category. Medical patients with low functional status had the highest readmission rate (OR: 29%; 95% CI: 25%‐32%) and an adjusted OR for readmission of 3.2 (95% CI: 2.4‐4.3, P < 0.001) compared to medical patients with high FIM scores. CONCLUSIONS AND RELEVANCE: For patients admitted to an acute inpatient rehabilitation facility, functional status near the time of discharge from an acute care hospital is strongly associated with acute care readmission, particularly for medical patients with greater functional impairments. Reducing functional status decline during acute care hospitalization may be an important strategy to lower readmissions. Journal of Hospital Medicine 2014;9:277–282. © 2014 Society of Hospital Medicine
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For patients able to return home from an SNF, impaired physical function often persists as a poorly addressed component of failing health, rehospitalization, or death.
“Similarly, for those patients who are able to return home from an SNF, impaired physical function often persists as a poorly addressed component of failing health,232–234 rehospitalization,233,234 or death.235”
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- Authors
- Hoyer, E. H., Needham, D. M., Atanelov, L., Knox, B., Friedman, M., & Brotman, D. J.
- Affiliations
- Johns Hopkins University (US)
- MedStar Health (US)
- Corresponding author
- Hoyer, Erik H.
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2014-02-26
- Volume
- 9
- Issue
- 5
- Pages
- 277-282
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- PMC
- PMC4347875
- OpenAlex
- W2135046756
- Cited by
- 184
- References
- 57
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 20 · 2023: 15 · 2022: 14 · 2021: 19 · 2020: 18 · 2019: 12 · 2018: 17 · 2017: 9 · 2016: 17 · 2015: 15 · 2014: 6
- FWCI
- 40.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Hospital Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD001097)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- functional status, hospital readmission, 30-day readmission, Functional Independence Measure, inpatient rehabilitation, hospital discharge, functional disability, medical patients, orthopedic patients, neurological patients, functional decline
- MeSH terms
- Activities of Daily Living, Acute Disease, Aged, Diagnosis-Related Groups, Female, Humans, Male, Patient Discharge, Patient Readmission, Patient Transfer, Rehabilitation Centers, Retrospective Studies, Severity of Illness Index, Chi-Square Distribution, Logistic Models
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