Acuity level and other factors associated with hospital readmission of older adults
Lilly, Elizabeth S.
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As the population in the United States continues to age, the number of older adults needing health care is increasing. Through the implementation of the Diagnosis Related Group prospective payment system, the federal government is attempting to control rising health care costs by denying payment for inappropriate care, such as readmission to the hospital. As a result, the length of hospital stay has decreased while patients' level of acuity has increased. This study was conducted (a) to compare young/middle adults (under 65 years of age) and older adults (65 years of age and over) in terms of length of hospital stay, nursing acuity at discharge, social acuity at discharge, discharge destination, readmission rate, and length of time between discharge and readmission; and (b) to investigate age, gender, length of hospital stay, nursing acuity at discharge, social acuity at discharge, and discharge destination as predictors of readmission to the hospital among older adults. Records of 2310 patients 18 years of age and older discharged from a community hospital over a period of 3 months were used to obtain data for the study. Frequency distributions and measures of central tendency were used to describe the sample and its subsets of older adults and young/middle adults. Results indicated that 8.7% of the older adults were readmitted within 30 days following discharge as compared to 6.3% of the young/middle adults. Results of t_ tests showed that older adults had a significantly longer length of hospital stay, a higher nursing acuity at discharge, and a higher social acuity at discharge than young/middle adults. Chi-square analysis revealed that older adults had a greater than expected frequency of nursing home placements and home health services following discharge and a higher percentage of readmissions. Results of multiple regression analysis provided no support for age, gender, length of hospital stay, nursing acuity at discharge, and social acuity at discharge as predictors of readmission rate or length of time between discharge and readmission among older adults. Results of a one-way ANOVA showed that older adults discharged to home with home health services had a longer length of time between discharge and readmission than did older adults discharged to home without home health services.