title: Functional status at discharge and 30-day readmission risk in COPD.
abstract: BACKGROUND
  Efforts to reduce 30-day readmissions are resource intensive. Healthcare systems need to target interventions at patients with the highest risk. Information on physical functioning has been found to increase the performance of previously published risk prediction models. We examined whether functional status documented during routine nursing care in the 24 h prior to discharge was an independent predictor of 30-day readmission risk in patients with COPD.
  
  
  METHODS
  Patients from a large integrated healthcare system were included in this retrospective cohort study if they were hospitalized for COPD and discharged between January 1, 2011, and December 31, 2012, age 40+, on a bronchodilator or steroid inhaler, alive at discharge, and continuously enrolled in the health plan 12 months prior to the index admission and at least 30-days post discharge. Our main outcome was 30-day all-cause readmission. Functional status was documented as part of routine nursing care within 24 h prior to discharge as follows: bed bound (Level I), able to sit (Level II), stand next to bed (Level III), walk <50 feet (Level IV), and walk >50 feet (Level V).
  
  
  RESULTS
  The sample included 2910 patients (n = 3631 index admissions) with a mean age of 72 ± 11. The 30-day readmission rate was 19%. Multivariate analyses showed that patients who were non-ambulatory at discharge (Levels I-III) were more than twice as likely to be re-admitted within 30-days compared to patients who were able to walk more than 50 feet (RR: 2.14, 95% CI 1.62-2.84, p < .001). There was no significant difference in readmission risk between patients classified as Level IV or V (p > .05).
  
  
  CONCLUSIONS
  Patients with COPD who were non-ambulatory within 24 h prior to discharge were at significantly greater risk of readmission compared to ambulatory patients. Functional status should be used to risk stratify patients for more intensive supportive interventions post discharge.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, United States. Electronic address: huong.q2.nguyen@kp.org.
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: Nguyen
authors.affiliation: Kaiser Permanente Southern California, Nursing Research Program, United States.
authors.forename: June
authors.initials: J
authors.lastname: Rondinelli
authors.affiliation: Kaiser Permanente Southern California, Anaheim, United States.
authors.forename: Annie
authors.initials: A
authors.lastname: Harrington
authors.affiliation: Kaiser Permanente Southern California, San Diego, United States.
authors.forename: Smita
authors.initials: S
authors.lastname: Desai
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, United States.
authors.forename: In-Liu
authors.initials: IL
authors.lastname: Amy Liu
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, United States.
authors.forename: Janet S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, United States.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gould
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: 30-day readmission; COPD; Functional status