title: Hospital Readmission From Post-Acute Care Facilities: Risk Factors, Timing, and Outcomes.
abstract: OBJECTIVE
  Hospital discharges to post-acute care (PAC) facilities have increased rapidly. This increase may lead to more hospital readmissions from PAC facilities, which are common and poorly understood. We sought to determine the risk factors and timing for hospital readmission from PAC facilities and evaluate the impact of readmission on patient outcomes.
  
  
  METHODS
  Retrospective analysis of Medicare Current Beneficiary Survey (MCBS) from 2003-2009.
  
  
  METHODS
  The MCBS is a nationally representative survey of beneficiaries matched with claims data.
  
  
  METHODS
  Community-dwelling beneficiaries who were hospitalized and discharged to a PAC facility for rehabilitation.
  Potential readmission risk factors included patient demographics, health utilization, active medical conditions at time of PAC admission, and PAC characteristics.
  
  
  METHODS
  Hospital readmission during the PAC stay, return to community residence, and all-cause mortality.
  
  
  RESULTS
  Of 3246 acute hospitalizations followed by PAC facility stays, 739 (22.8%) included at least 1 hospital readmission. The strongest risk factors for readmission included impaired functional status (HR 4.78, 95% CI 3.21-7.10), markers of increased acuity such as need for intravenous medications in PAC (1.63, 1.39-1.92), and for-profit PAC ownership (1.43, 1.21-1.69). Readmitted patients had a higher mortality rate at both 30 days (18.9% vs 8.6%, P < .001) and 100 days (39.9% vs 14.5%, P < .001) even after adjusting for age, comorbidities, and prior health care utilization (30 days: OR 2.01, 95% CI 1.60-2.54; 100 days: OR 3.79, 95% CI 3.13-4.59).
  
  
  CONCLUSIONS
  Hospital readmission from PAC facilities is common and associated with a high mortality rate. Readmission risk factors may signify inadequate transitional care processes or a mismatch between patient needs and PAC resources.
authors.affiliation: Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: Robert.Burke5@va.gov.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Burke
authors.affiliation: Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Whitfield
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: David
authors.initials: D
authors.lastname: Hittle
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Sung-joon
authors.initials: SJ
authors.lastname: Min
authors.affiliation: Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO; Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Cari
authors.initials: C
authors.lastname: Levy
authors.affiliation: Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Allan V
authors.initials: AV
authors.lastname: Prochazka
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Coleman
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Robert
authors.initials: R
authors.lastname: Schwartz
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000639:trends*; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Post-acute care; care transition; readmission