Functional Status Impairment Is Associated With Unplanned Readmissions
Open accessAbstract
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.
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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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Cites
Austin, P. C. (2011) · Multivariate Behavioral Research · doi:10.1080/00273171.2011.568786 · Cited by 12,242 · see citing works
Comorbidity measures for use with administrative data.
Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998) · Medical Care · doi:10.1097/00005650-199801000-00004 · Cited by 9,921 · see citing works
Equivalence of the Mediation, Confounding and Suppression Effect
MacKinnon, D. P., Krull, J. L., & Lockwood, C. M. (2000) · Prevention Science · doi:10.1023/a:1026595011371 · Cited by 4,188 · see citing works
Reducing Bias in Observational Studies Using Subclassification on the Propensity Score
Rosenbaum, P. R., & Rubin, D. B. (1984) · Journal of the American Statistical Association · doi:10.1080/01621459.1984.10478078 · Cited by 3,082 · see citing works
Frailty as a predictor of surgical outcomes in older patients
Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., Takenaga, R., Devgan, L., Holzmueller, C. G., Tian, J., et al. (2010) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2010.01.028 · Cited by 2,184 · see citing works
Risk Prediction Models for Hospital Readmission
Kansagara, D. L., Englander, H. L., Salanitro, A. H., Kagen, D. I., Theobald, C. N., Freeman, M., & Kripalani, S. B. (2011) · JAMA · doi:10.1001/jama.2011.1515 · Cited by 1,712 · see citing works
Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51152.x · Cited by 1,670 · see citing works
The reliability of the functional independence measure: A quantitative review
Ottenbacher, K. J., Hsu, Y., Granger, C. V., & Fiedler, R. C. (1996) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(96)90184-7 · Cited by 1,415 · see citing works
Post-Hospital Syndrome — An Acquired, Transient Condition of Generalized Risk
Krumholz, H. M. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1212324 · Cited by 1,218 · see citing works
Needham, D. M., Korupolu, R., Zanni, J. M., Pradhan, P., Colantuoni, E., Palmer, J. B., Brower, R. G., & Fan, E. (2010) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2010.01.002 · Cited by 732 · see citing works
Self-citationHospital Readmissions as a Measure of Quality of Health Care
Benbassat, J., & Taragin, M. I. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.8.1074 · Cited by 610 · see citing works
Interrater reliability of the 7-level functional independence measure (FIM)
Dickson, H., & Köhler, F. (2020) · Journal of Rehabilitation Medicine · doi:10.2340/165019779527253256 · Cited by 577 · see citing works
Interrater reliability of the 7-level functional independence measure (FIM)
Hamilton, B., Laughlin, J., Fiedler, R., & Cv, G. (1994) · Journal of Rehabilitation Medicine · doi:10.2340/165019771994263115119 · Cited by 544 · see citing works
Mobilizing Patients in the Intensive Care Unit
Needham, D. M. (2008) · JAMA · doi:10.1001/jama.300.14.1685 · Cited by 469 · see citing works
Self-citationAmarasingham, R., Moore, B. J., Tabak, Y. P., Drazner, M. H., Clark, C. A., Zhang, S., Reed, W. G., Swanson, T. S., Ma, Y., & Halm, E. A. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181ef60d9 · Cited by 437 · see citing works
Posthospital Care Transitions: Patterns, Complications, and Risk Identification
Coleman, E. A., Min, S., Chomiak, A., & Kramer, A. M. (2004) · Health Services Research · doi:10.1111/j.1475-6773.2004.00298.x · Cited by 416 · see citing works
Hospital Readmission in General Medicine Patients: A Prediction Model
Hasan, O., Meltzer, D. O., Shaykevich, S., Bell, C. M., Kaboli, P. J., Auerbach, A. D., Wetterneck, T. B., Arora, V. M., Zhang, J., & Schnipper, J. L. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-1196-1 · Cited by 399 · see citing works
Hospital Readmission as an Accountability Measure
Axon, R. N., & Williams, M. V. (2011) · JAMA · doi:10.1001/jama.2011.72 · Cited by 370 · see citing works
Lyder, C. H., Wang, Y., Metersky, M. L., et al. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04106.x · Cited by 333 · see citing works
Prediction of rehabilitation outcomes with disability measures
Heinemann, A. W., Linacre, J. M., Wright, B. D., Hamilton, B. B., & Granger, C. V. (1994) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(94)90385-9 · Cited by 305 · see citing works
Primary Payer Status Affects Mortality for Major Surgical Operations
LaPar, D. J., Bhamidipati, C. M., Mery, C. M., Stukenborg, G. J., Jones, D. R., Schirmer, B. D., Kron, I. L., & Ailawadi, G. (2010) · Annals of Surgery · doi:10.1097/sla.0b013e3181e8fd75 · Cited by 299 · see citing works
Interrater reliability of the 7-level functional independence measure (FIM)
Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., & Granger, C. V. (1994) · PubMed · Cited by 291 · see citing works
Philbin, E. F., & DiSalvo, T. G. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00059-5 · Cited by 254 · see citing works
Hospital Readmissions Among the Elderly
Gooding, J., & Jette, A. M. (1985) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1985.tb06315.x · Cited by 224 · see citing works
Early Mobilization of Patients Hospitalized With Community-Acquired Pneumonia
Mundy, L. M., Leet, T. L., Darst, K., Schnitzler, M. A., & Dunagan, W. C. (2003) · CHEST Journal · doi:10.1378/chest.124.3.883 · Cited by 218 · see citing works
Are All Readmissions Bad Readmissions?
Gorodeski, E. Z., Starling, R. C., & Blackstone, E. H. (2010) · New England Journal of Medicine · doi:10.1056/nejmc1001882 · Cited by 210 · see citing works
A Case-Mix Classification System for Medical Rehabilitation
Stineman, M. G., Escarce, J. J., Goin, J. E., Hamilton, B. B., Granger, C. V., & Williams, S. V. (1994) · Medical Care · doi:10.1097/00005650-199404000-00005 · Cited by 168 · see citing works
Deutsch, A. F., Granger, C. V., Heinemann, A. W., Fiedler, R. C., DeJong, G., Kane, R. L., Ottenbacher, K. J., Naughton, J., & Trevisan, M. (2006) · Stroke · doi:10.1161/01.str.0000221172.99375.5a · Cited by 130 · see citing works
Duration of Anesthesia and Venous Thromboembolism After Hip and Knee Arthroplasty
Jaffer, A. K., Barsoum, W. K., Krebs, V. E., et al. (2005) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)61526-7 · Cited by 126 · see citing works
Martens, E. P., Pestman, W. R., de Boer, A., Belitser, S. V., & Klungel, O. H. (2008) · International Journal of Epidemiology · doi:10.1093/ije/dyn079 · Cited by 126 · see citing works
VanSuch, M., Naessens, J. M., Stroebel, R. J., Huddleston, J. M., & Williams, A. R. (2006) · BMJ Quality & Safety · doi:10.1136/qshc.2005.017640 · Cited by 117 · see citing works
Ottenbacher, K. J., Smith, P. M., Illig, S. B., Linn, R. T., Fiedler, R. C., & Granger, C. V. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(01)00395-x · Cited by 86 · see citing works
Risk Factors for Frailty in the Older Adult
Espinoza, S. E., & Fried, L. P. (2007) · Cited by 73 · see citing works
Race/Ethnicity and Outcomes Following Inpatient Rehabilitation for Hip Fracture
Graham, J. E., Chang, P.-F. J., Berges, I. M., Granger, C. V., & Ottenbacher, K. J. (2008) · The Journals of Gerontology Series A · doi:10.1093/gerona/63.8.860 · Cited by 70 · see citing works
Stroke rehabilitation: Clinical predictors of resource utilization
Harvey, R. L., Roth, E. J., Heinemann, A. W., Lovell, L. L., McGuire, J. R., & Diaz, S. (1998) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(98)90226-x · Cited by 62 · see citing works
Four methods for characterizing disability in the formation of function related groups
Stineman, M. G., Hamilton, B. B., Granger, C. V., Goin, J. E., Escarce, J., & Williams, S. V. (1994) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(94)90273-9 · Cited by 56 · see citing works
Hospital Readmission in Persons With Stroke Following Postacute Inpatient Rehabilitation
Ottenbacher, K. J., Graham, J. E., Ottenbacher, A. J., Lee, J., Snih, S. A., Karmarkar, A. M., Reistetter, T., & Ostir, G. V. (2012) · The Journals of Gerontology Series A · doi:10.1093/gerona/glr247 · Cited by 56 · see citing works
Association of Self-reported Hospital Discharge Handoffs With 30-Day Readmissions
Oduyebo, I., Lehmann, C. U., Pollack, C. E., Durkin, N., Miller, J. D., Mandell, S. F., Ardolino, M., Deutschendorf, A., & Brotman, D. J. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.3746 · Cited by 55 · see citing works
Self-citationGuo, Y., Persyn, L., Palmer, J. L., et al. (2008) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e31817fb94e · Cited by 49 · see citing works
Characteristics of persons rehospitalized after stroke rehabilitation
Ottenbacher, K. J., Smith, P. M., Illig, S. B., Fiedler, R. C., Gonzales, V. A., & Granger, C. V. (2001) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2001.26088 · Cited by 49 · see citing works
Risks of acute hospital transfer and mortality during stroke rehabilitation
Stineman, M. G., Ross, R., Maislin, G., Fiedler, R. C., & Granger, C. V. (2003) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(02)04850-5 · Cited by 45 · see citing works
Risk factors for acute care transfer among traumatic brain injury patients
Deshpande, A. A., Millis, S. R., ZAFONTE, R. D., et al. (1997) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(97)90224-0 · Cited by 44 · see citing works
Length of stay and hospital readmission for persons with disabilities
Ottenbacher, K. J., Smith, P. M., Illig, S. B., et al. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.12.1920 · Cited by 39 · see citing works
Chung, D. M., Niewczyk, P. M., DiVita, M. A., Markello, S., & Granger, C. V. (2012) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3182aac27 · Cited by 38 · see citing works
Association of Physical Functioning with Same-Hospital Readmission After Stroke
Bohannon, R. W., & Lee, N. (2004) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/00002060-200406000-00005 · Cited by 37 · see citing works
Early Unplanned Transfers from Inpatient Rehabilitation
Carney, M. L., Ullrich, P. M., & Esselman, P. C. (2006) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/01.phm.0000214279.04759.45 · Cited by 35 · see citing works
Ploumis, A., Kolli, S., Patrick, M., et al. (2010) · Spinal Cord · doi:10.1038/sc.2010.132 · Cited by 34 · see citing works
Hospital readmission of persons with hip fracture following medical rehabilitation
Ottenbacher, K. J., Smith, P. M., Illig, S. B., Peek, M. K., Fiedler, R. C., & Granger, C. V. (2002) · Archives of Gerontology and Geriatrics · doi:10.1016/s0167-4943(02)00052-3 · Cited by 31 · see citing works
Risk factors for nonelective hospital readmissions
Smith, D. M., Katz, B. P., Huster, G. A., Fitzgerald, J. F., Martin, D., & Freedman, J. A. (1996) · Journal of General Internal Medicine · doi:10.1007/bf02598996 · Cited by 24 · see citing works
Risks of acute hospital transfer and mortality during stroke rehabilitation
Stineman, M. G., Ross, R. J. M., Maislin, G., et al. (2003) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(03)04850-5 · Cited by 21 · see citing works
Functional and Economic Outcomes of Cardiopulmonary Patients
Vincent, H. K., & Vincent, K. R. (2008) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e31816dd251 · Cited by 16 · see citing works
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Research works printed but not linked: 1
- [23]Carter G, Relles D, Buchanan J, A classification system for inpatient rehabilitation patients: a review and proposed revisions to the functional independence measure-function related groups. Washington (DC): U.S. Department of Commerce, National Technical Information Services Report No. PB98-105992; 1997
Cited by
Sorted by citations
Forman, D. E., Arena, R., Boxer, R., Dolansky, M. A., Eng, J. J., Fleg, J. L., Haykowsky, M., Jahangir, A., Kaminsky, L. A., Kitzman, D. W., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000483 · Cited by 319 · see citing works
Association of impaired functional status at hospital discharge and subsequent rehospitalization
Hoyer, E. H., Needham, D. M., Atanelov, L., Knox, B., Friedman, M., & Brotman, D. J. (2014) · Journal of Hospital Medicine · doi:10.1002/jhm.2152 · Cited by 184 · see citing works
Self-citationStøve, M. P., & Larsen, B. T. (2020) · European Journal of Physiotherapy · doi:10.1080/21679169.2019.1628300 · Cited by 5 · see citing works
- Authors
- Hoyer, E. H., Needham, D. M., Miller, J., Deutschendorf, A., Friedman, M., & Brotman, D. J.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Hoyer, Erik H.
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 94
- Issue
- 10
- Pages
- 1951-1958
- ISSN
- 0003-9993 (ISSN-L)
- PMC
- PMC6140789
- OpenAlex
- W1970926870
- Cited by
- 98
- References
- 51
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 12 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 7 · 2016: 10 · 2015: 10 · 2014: 10
- FWCI
- 25.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Medicare and Medicaid Services (IC1-12-0001)
- 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 › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Keywords
- unplanned hospital readmission, functional status, Functional Independence Measure, motor function, cognitive function, hospital readmission, rehabilitation admission, propensity score adjustment, stroke rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, multiple sclerosis rehabilitation, cerebral palsy rehabilitation, brain injury rehabilitation, chronic pain rehabilitation, psychiatric rehabilitation, drug rehabilitation
- MeSH terms
- Adult, Aged, Disability Evaluation, Female, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Patient Readmission, Retrospective Studies
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