Despite the high prevalence of functional limitations in community‐dwelling Medicare patients and Medicare penalties for “excessive” readmission rates, there is limited information on effects of these functional limitations on readmission for hospitalized Medicare patients.
Our cohort included 6,695 Health and Retirement Study (HRS) subjects enrolled who were hospitalized at least once from 2000‐2008 (20,357 hospitalizations). Our outcome was a repeat hospital admission within 30 days, assessed by Medicare claims. Main predictor was functional limitations as determined from the HRS interview preceding the hospitalization and stratified into 3 levels: no functional limitations (independent in IADL and ADL), difficulty with IADL but not ADL, or difficulty with ADL. Adjustment variables included age, race, gender, income, and net worth (obtained from HRS) and comorbid conditions (Charlson score calculated from Medicare claims data), and prior history of admission. We performed descriptive statistics and multivariable regression analysis adjusted for clustering at patient level to characterize the association of functional limitations on readmission rates.
Mean age was 78 (65‐105), 44% male, 77% White, 90% reported ≥3 comorbidities, 61% with ≥1 hospitalization in previous year; 47% had either IADL difficulty ADL dependency prior to admission.
Overall, 22% had ≥1 IADL difficulty and 25% had ≥1 ADL dependency prior to admission (Table). In adjusted MV regression we found that any IADL difficulty was associated with higher readmission (OR 1.14; 95% CI 1.02‐1.28) as was any ADL dependency (OR 1.37; 1.22‐1.53
Given the focus of Medicare penalties on hospital readmission rates, we also calculated predicted probabilities for readmission stratified by functional limitations using the same adjustors above. Readmission rates predicted for patients with no functional limitations were 14% (CI 13.5‐15.2) compared to 16% (14.8‐17.4) for IADL difficultly (no ADL) and 18.6% for ADL dependency (17.3‐19.9).
Nearly half of hospitalized Medicare patients have pre‐admission functional limitations. These limitations are associated with higher readmission rates, with effect sizes increasing as the severity of limitations increase from IADLs to ADLs. Identifying pre‐existing functional limitations during hospitalization may help focus limited resources for hospitals to reduce their risk of “excessive” readmission rates and associated Medicare penalties.
To cite this abstract:Greysen S, Cenzer I, Auerbach A, Covinsky K. Association of Functional Limitations with Readmission in Medicare Patients. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 155. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/association-of-functional-limitations-with-readmission-in-medicare-patients/. Accessed November 17, 2019.