title: Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.
abstract: OBJECTIVE
  To (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore.
  
  
  METHODS
  National data were retrospectively extracted from medical records of community hospital.
  
  
  METHODS
  There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37), other community hospital (n = 31), death in community hospital (n = 12), acute hospital (n = 1,182) and discharge against doctor's advice (n = 24) were excluded.
  
  
  METHODS
  Nursing home placement.
  
  
  RESULTS
  Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001) and 65% (p = 0.043) respectively compared to stroke patients.
  
  
  CONCLUSIONS
  In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Nasheen
authors.initials: N
authors.lastname: Naidoo
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Er
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Angela
authors.initials: A
authors.lastname: Cheong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Ngan Phoon
authors.initials: NP
authors.lastname: Fong
authors.affiliation: Planning Division, Agency for Integrated Care, Singapore, Singapore.
authors.forename: Choo Yian
authors.initials: CY
authors.lastname: Tay
authors.affiliation: Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore, Singapore.
authors.forename: Kin Ming
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Medical Services, St Luke's Hospital, Singapore, Singapore.
authors.forename: Boon Yeow
authors.initials: BY
authors.lastname: Tan
authors.affiliation: Medical Services, St Andrew's Community Hospital, Singapore, Singapore.
authors.forename: Edward
authors.initials: E
authors.lastname: Menon
authors.affiliation: Bright Vision Hospital, Singapore, Singapore.
authors.forename: Chye Hua
authors.initials: CH
authors.lastname: Ee
authors.affiliation: Bright Vision Hospital, Singapore, Singapore.
authors.forename: Kok Keng
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yee Sien
authors.initials: YS
authors.lastname: Ng
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore ; Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore, Singapore ; Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore, Singapore ; Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore.
authors.forename: Yik Ying
authors.initials: YY
authors.lastname: Teo
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Gerald C H
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012846:Singapore / Q000453:epidemiology