title: Predictors for Unplanned Hospitalization of New Home Care Clients.
abstract: OBJECTIVE
  To identify factors predicting unplanned hospitalization of new home care clients using the Resident Assessment Instrument for Home Care (RAI-HC).
  
  
  METHODS
  A register-based study based on RAI-HC assessments and nationwide hospital discharge records.
  
  
  METHODS
  Municipal home care services in Finland.
  
  
  METHODS
  New Finnish home care clients aged 63 and older (N = 15,700).
  
  
  METHODS
  Information from home care clients' first RAI-HC assessment was connected to information regarding their first hospitalization over 1 year of follow-up. Multivariate regression analyses were used to evaluate the independent risk factors for hospitalization.
  
  
  RESULTS
  Forty-three percent (n = 6,812) of participants were hospitalized at least once. The strongest independent risk factors were hospitalization during the year preceding the RAI-HC assessment (odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.87-2.16), aged 90 and older (OR = 1.69, 95% CI = 1.48-1.92), renal insufficiency (OR = 1.44, 95% CI = 1.22-1.69) and using 10 or more drugs (OR = 1.41, 95% CI = 1.26-1.58). Other independent risk factors were male sex, previous emergency department visits or other acute outpatient care use, daily urinary incontinence, fecal incontinence, history of falls, cognitive impairment, chronic skin ulcer, pain, unstable health status, housing-related problems, and poor self-rated health. Parkinson's disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and cancer were independent prognostic indicators. A body mass index of 24 kg/m2or greater and the client's own belief that functional capacity could improve had a protective role.
  
  
  CONCLUSIONS
  Assessing new home care clients using the RAI-HC reveals modifiable risk factors for unplanned hospitalization. Systematic assessment by a multidisciplinary team at the beginning of the service and targeting modifiable risk factors could reduce the risk of unplanned hospitalization.
authors.affiliation: Ylöjärvi Health Care Centre, Ylöjärvi, Finland.
authors.forename: Jukka K
authors.initials: JK
authors.lastname: Rönneikkö
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Mäkelä
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Gerontology Research Center, Universities of Jyväskylä and Tampere, Tampere, Finland.|Service Line of General Practice and Geriatrics, Hatanpää Hospital, Tampere, Finland.
authors.forename: Esa R
authors.identifier: http://orcid.org/0000-0002-8218-7432
authors.initials: ER
authors.lastname: Jämsen
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Social Services and Health Care, Helsinki, City of Helsinki, Finland.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: Department of Social and Health Services, Ministry of Social Affairs and Health, Helsinki, Finland.
authors.forename: Anja
authors.initials: A
authors.lastname: Noro
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Gerontology Research Center, Universities of Jyväskylä and Tampere, Tampere, Finland.|Promotion of Senior Citizens' Welfare, City of Tampere, Finland.|Tampere University Hospital, Tampere, Finland.
authors.forename: Jaakko N
authors.initials: JN
authors.lastname: Valvanne
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005387:Finland / Q000453:epidemiology; D015577:Geriatric Assessment; D006699:Home Care Services; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019338:Polypharmacy; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors
keywords: RAI assessment; home care; hospitalization