Policy makers and health care professionals are united in a desire to reduce the number of avoidable rehospitalizations, which not only come at an enormous cost to the health care delivery system, but have also been shown to increase functional decline in older adults. New research suggests that discharge destinations are an important factor in readmission rates for older adults, depending on their cognitive status.
Researchers from Indiana University and Regenstrief Institute found that there is a substantial link between beneficiaries’ cognitive functioning, where they go after being discharged from the hospital, and rehospitalization rates.
Older adults with cognitive impairments who are discharged to a skilled nursing facility following a hospitalization are less likely to be readmitted within 30 days, compared to those who return to their own homes or a caregiver’s home, found the study, which included 976 participants aged 65 and better. The researchers believe that this may be tied to the ability to provide proper post-acute care.
An estimated 75 percent of rehospitalizations are believed to be avoidable, but various efforts that have been launched to prevent them have produced largely inconsistent results.
A solution may lie in customizing discharge planning based on individual and system-level characteristics, encompassing not just the patient’s age, gender, cognitive status, and medical history, among other factors, but also physician practices, site of care, and discharge destination.
It’s not clear why cognitively impaired individuals discharged to a facility tend to have longer times to rehospitalizations, the researchers said, but a possible reason is that they get more support in reducing some of the risk factors associated with being readmitted, including not adhering to medication routines and poor management of complex chronic illnesses.
While this points to better post-discharge care in a facility setting for those with cognitive impairments, that doesn’t rule out home settings.
More than 60 percent of Medicare spending related to medical costs of individuals with cognitive impairment is related to hospitalization and rehospitalization, according to the researchers, but when transitional care coaches or advanced practice nurses are assigned to individuals who have been discharged into the home, the cost of care decreases.
The researchers cite other studies that show interventions targeting cognitively impaired individuals and their caregivers produce better outcomes and care costs than interventions that only focus on the beneficiary.
In order to achieve cost-efficient care, the researchers conclude, it will be important to tailor discharge planning not just to the cognitively impaired individual, but also to where that individual will be receiving post-acute care.
Nazir A, LaMantia M, Chodosh J, et al. Interaction between cognitive impairment and discharge destination and its effect on rehospitalization. Journal of the American Geriatrics Society (2013); 61.11: 1958–1963.