Is health-related quality of life among older, chronically ill patients associated with unplanned readmission to hospital?
BACKGROUND
Assessment of health-related quality of life (HRQL) is being used increasingly to assess the impact of treatment.


OBJECTIVE
To determine if HRQL, assessed shortly after acute hospitalisation, is associated with readmission to hospital.


METHODS
In a prospective, longitudinal study, 163 chronically ill, medical and surgical patients (mean age 67.0+/-16.3 years) discharged to home following acute hospitalisation were studied. HRQL was assessed at one month post-hospital discharge using the MOS 36-Item Short-Form Health Survey (SF-36). Patients were followed-up for six months thereafter to determine subsequent incidence of unplanned readmission.


RESULTS
HRQL as measured by the eight health dimensions of the SF-36, for the entire cohort, was lower relative to age and gender matched norms for the local population (p<0.01). During study follow-up, 47 (35%) patients had an unplanned readmission and one patient died. Patients who had an unplanned readmission demonstrated both significantly lower physical (32.2+/-9.8 vs 38.6+/-10.1: p<0.001) and mental (45.1+/-12.7 vs 49.9+/-12.3: p=0.03) health component scores in comparison to the remainder of the cohort. On multivariate analysis, independent correlates of unplanned readmission were: 1) presence of formal home assistance (OR 6.4: p<0.01), 2) > or =five prescribed medications (OR 2.4: p=0.04), 3) > or =two admissions in the six months before follow-up (OR 4.3: p<0.01) and 4) an SF-36 physical component score of < or =40 (OR 2.2: p=0.05).


CONCLUSIONS
In this cohort of predominantly older and chronically ill patients recently discharged from acute hospital care, relatively lower SF-36 physical health component scores were independently associated with an increased risk of subsequent unplanned readmission.
Pearson
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Department of Surgery, The Queen Elizabeth Hospital/University of Adelaide, SA. imoraw@tqehsmtp.tqeh.sa.gov.au
Stewart
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Rubenach
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D000368:Aged; D002908:Chronic Disease; D006801:Humans; D015999:Multivariate Analysis; D010359:Patient Readmission; D011446:Prospective Studies; D011788:Quality of Life