MedicalResearch.com: What is the background for this study?
Response: Hospital readmissions – when a patient is discharged from hospital but then returns to hospital in a short period of time – are known to be a problem, both for the patients and for the larger health system. Hospital readmissions have received considerable attention and there have been a number of initiatives to try to reduce them, but with mixed success. Older adults are among the most vulnerable group for hospital readmission. Older adults are also the largest users of continuing care services, such as home care and long-term care homes (also known as nursing homes). Yet, few large studies have really considered how older adults with different pathways through hospital compare on the risk of hospital readmission.
In our study, we take a population-level approach and use health administrative data to create a large cohort of older adults who were hospitalized in Ontario between 2008 and 2015. For each of the 701,527 patients in our study, we identified where they received care before the hospitalization (in the community or in long-term care) and where they received care after discharge (in the community, in the community with home care, or in long-term care).
MedicalResearch.com: What are the main findings?
Response: We found that approximately 40% of these patients were discharged from hospital to either home care or to a long-term care home. Where people were discharged to, combined with where they were before being hospitalized, was strongly associated with risk of hospital readmission.
Patients who were discharged with home care had the highest risk of hospital readmission (43% greater than those without home care). We do not know exactly why this is the case but there is reason to believe that these patients needed more care than home care alone was able to provide. Patients who were discharged to a long-term care home for the first time had the lowest risk of hospital readmission; however, they were also in hospital for very long periods of time (the majority for well over 2 weeks) and were frequently identified as “alternate level of care”, meaning that they no longer required hospital-level care but could not be discharged because there was nowhere else suitable.
The majority of these patients had a diagnosis of dementia.
MedicalResearch.com: What should readers take away from your report?
Response: A large proportion of older adults who have been in hospital also used some form of continuing care, whether that was home care services or admission to a long-term care home. It is important that we consider those sectors when we think about strategies to reduce hospital readmissions and health system planning.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: There are many issues related to this study that require more research but one of the most pressing is a focus on the home care sector and how to best strengthen it to meet the needs of our aging population. This includes research on why patients who received home care were at greater risk of hospital readmission and what changes to home care (including its connections to other sectors such as primary care and hospitals) are needed to prevent hospital readmission and other undesirable outcomes.
Disclosures: This study was funded by a grant from the Canadian Institutes of Health Research (CIHR) and Dr. Gruneir is funded by a New Investigator Award from CIHR. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).
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