TY - JOUR
T1 - Predicting clinical instability of older patients in post-acute care units
T2 - A nationwide cohort study
AU - Lee, Wei Ju
AU - Chou, Ming Yueh
AU - Peng, Li Ning
AU - Liang, Chih Kuang
AU - Liu, Li Kuo
AU - Liu, Chien Liang
AU - Chen, Liang Kung
AU - Wu, Yung Hung
AU - iu, Ching Yi
AU - Yu, Weng Pin
AU - Tseng, Yao Hsien
AU - Luo, Ta Wei
AU - Lin, Chu Sheng
PY - 2014
Y1 - 2014
N2 - Aim: Although patients admitted to post-acute care (PAC) units are usually clinically stable, unexpected medical conditions requiring acute ward readmissions still occur and can jeopardize the clinical effectiveness of PAC services. The main purpose of the present study was to evaluate predictive factors for clinical instability of patients in PAC units to improve the quality of PAC services. Methods: This was a nationwide multicenter cohort study that recruited patients from five PAC units in Taiwan between July 2007 and June 2009. All patients received the comprehensive geriatric assessment (CGA) within 72h of PAC unit admissions. Conditions requiring acute ward re-admissions from PAC units were defined as clinical instability. Causes of clinical instability for all patients and data of CGA were collected for analysis. Results: Of 918 enrolled participants, 119 (12.9%) experienced acute ward readmissions, including 106 (89.1%) admissions related to medical conditions and 13 (10.9%) for surgical causes. Common conditions included diseases of the respiratory system (n=32, 26.9%), genitourinary system (n=24, 20.2%) and digestive system (n=14, 11.8%). Surgical conditions, mainly fractures and dislocation of upper limbs, were significantly more likely to occur later (P=0.05) in the PAC unit admissions than medical conditions. Compared with the non-readmission group, the readmission group was leaner (mean body mass index 21.1±2.8 vs 22.0±3.8kg/m2, P=0.007), having poorer functional status (mean Barthel Index 41.0±19.4 vs 45.4±20.3, P=0.02; mean IADL: 1.3±1.6 vs 1.7±1.8, P=0.016), poorer cognitive function (mean Mini-Mental State Examination: 16.8±6.4 vs 18.3±6.4, P=0.022), poorer ambulation (mean Timed Up & Go test 32.7±18.7 vs 26.6±11.7s, P=0.039) and poorer nutritional status (mean Mini-Nutrition Assessment 13.3±5.7 vs 15.4±5.8, P<0.001), but similar in depression status (mean Geriatric Depression Score 3.7±3.3 vs 3.4±2.8, P=0.247). In multivariate logistical regression model, lower Mini-Mental State Examination score was the only independent predictor for clinical instability (odds ratio 3.8, 95% confidence interval 1.348-10.870, P=0.012). Conclusion: Approximately 13% of PAC patients might experience acute ward readmissions, and nearly 90% of them are caused by medical conditions. Poor cognitive function is a significant predictive factor for clinical instability in PAC, which deserves more clinical attention for all PAC patients.
AB - Aim: Although patients admitted to post-acute care (PAC) units are usually clinically stable, unexpected medical conditions requiring acute ward readmissions still occur and can jeopardize the clinical effectiveness of PAC services. The main purpose of the present study was to evaluate predictive factors for clinical instability of patients in PAC units to improve the quality of PAC services. Methods: This was a nationwide multicenter cohort study that recruited patients from five PAC units in Taiwan between July 2007 and June 2009. All patients received the comprehensive geriatric assessment (CGA) within 72h of PAC unit admissions. Conditions requiring acute ward re-admissions from PAC units were defined as clinical instability. Causes of clinical instability for all patients and data of CGA were collected for analysis. Results: Of 918 enrolled participants, 119 (12.9%) experienced acute ward readmissions, including 106 (89.1%) admissions related to medical conditions and 13 (10.9%) for surgical causes. Common conditions included diseases of the respiratory system (n=32, 26.9%), genitourinary system (n=24, 20.2%) and digestive system (n=14, 11.8%). Surgical conditions, mainly fractures and dislocation of upper limbs, were significantly more likely to occur later (P=0.05) in the PAC unit admissions than medical conditions. Compared with the non-readmission group, the readmission group was leaner (mean body mass index 21.1±2.8 vs 22.0±3.8kg/m2, P=0.007), having poorer functional status (mean Barthel Index 41.0±19.4 vs 45.4±20.3, P=0.02; mean IADL: 1.3±1.6 vs 1.7±1.8, P=0.016), poorer cognitive function (mean Mini-Mental State Examination: 16.8±6.4 vs 18.3±6.4, P=0.022), poorer ambulation (mean Timed Up & Go test 32.7±18.7 vs 26.6±11.7s, P=0.039) and poorer nutritional status (mean Mini-Nutrition Assessment 13.3±5.7 vs 15.4±5.8, P<0.001), but similar in depression status (mean Geriatric Depression Score 3.7±3.3 vs 3.4±2.8, P=0.247). In multivariate logistical regression model, lower Mini-Mental State Examination score was the only independent predictor for clinical instability (odds ratio 3.8, 95% confidence interval 1.348-10.870, P=0.012). Conclusion: Approximately 13% of PAC patients might experience acute ward readmissions, and nearly 90% of them are caused by medical conditions. Poor cognitive function is a significant predictive factor for clinical instability in PAC, which deserves more clinical attention for all PAC patients.
KW - Comprehensive geriatric assessment
KW - Elderly
KW - Post-acute care
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=84897503315&partnerID=8YFLogxK
U2 - 10.1111/ggi.12083
DO - 10.1111/ggi.12083
M3 - Article
C2 - 23647665
AN - SCOPUS:84897503315
SN - 1444-1586
VL - 14
SP - 267
EP - 272
JO - Geriatrics and Gerontology International
JF - Geriatrics and Gerontology International
IS - 2
ER -