TY - JOUR
T1 - A Longitudinal Analysis of Functional Disability, Recovery, and Nursing Home Utilization After Hospitalization for Ambulatory Care Sensitive Conditions Among Community-Living Older Persons
AU - Gettel, Cameron J.
AU - Venkatesh, Arjun K.
AU - Leo-Summers, Linda S.
AU - Murphy, Terrence E.
AU - Gahbauer, Evelyne A.
AU - Hwang, Ula
AU - Gill, Thomas M.
N1 - Funding Information:
Disclosures: Dr Gettel is supported by the Yale National Clinician Scholars Program and by Clinical and Translational Science Award (CTSA) Grant Number TL1TR00864 from the National Center for Advancing Translational Science (NCATS). Dr Venkatesh reports career development support of grant KL2TR001862 from the NCATS and Yale Center for Clinical Investigation and the American Board of Emergency Medicine–National Academy of Medicine Anniversary Fellowship. Dr Murphy and Dr Gill are supported by the Yale Claude D Pepper Older Americans Independence Center (P30AG021342), and Dr Gill is additionally supported by a grant from the National Institute on Aging (NIA) (R01AG017560). Dr Hwang is also supported by the NIA (R33AG058926, R61AG069822), the John A Hartford Foundation, and the Gary and Mary West Health Institute. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript.
Funding Information:
We thank Denise Shepard, BSN, MBA, Andrea Benjamin, BSN, Barbara Foster, and Amy Shelton, MPH, for assistance with data collection; Geraldine Hawthorne, BS, for assistance with data entry and management; Peter Charpentier, MPH, for design and development of the study database and participant tracking system; and Joanne McGloin, MDiv, MBA, for leadership and advice as the Project Director. Each of these persons were paid employees of Yale School of Medicine during the conduct of this study. Disclosures: Dr Gettel is supported by the Yale National Clinician Scholars Program and by Clinical and Translational Science Award (CTSA) Grant Number TL1TR00864 from the National Center for Advancing Translational Science (NCATS). Dr Venkatesh reports career development support of grant KL2TR001862 from the NCATS and Yale Center for Clinical Investigation and the American Board of Emergency Medicine–National Academy of Medicine Anniversary Fellowship. Dr Murphy and Dr Gill are supported by the Yale Claude D Pepper Older Americans Independence Center (P30AG021342), and Dr Gill is additionally supported by a grant from the National Institute on Aging (NIA) (R01AG017560). Dr Hwang is also supported by the NIA (R33AG058926, R61AG069822), the John A Hartford Foundation, and the Gary and Mary West Health Institute. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript.
Publisher Copyright:
© 2021 Society of Hospital Medicine.
PY - 2021/8
Y1 - 2021/8
N2 - BACKGROUND/OBJECTIVE: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are considered potentially preventable. With little known about the functional outcomes of older persons after ACSC-related hospitalizations, our objectives were to describe: (1) the 6-month course of postdischarge functional disability, (2) the cumulative monthly probability of functional recovery, and (3) the cumulative monthly probability of incident nursing home (NH) admission. METHODS: The analytic sample included 251 ACSC-related hospitalizations from a cohort of 754 nondisabled, community-living persons aged 70 years and older who were interviewed monthly for up to 19 years. Patient-reported disability scores in basic, instrumental, and mobility activities ranged from 0 to 13. Functional recovery was defined as returning within 6 months of discharge to a total disability score less than or equal to that immediately preceding hospitalization. RESULTS: The mean age was 85.1 years, and the mean disability score was 5.4 in the month prior to the ACSC-related hospitalization. After the ACSC-related hospitalization, total disability scores peaked at month 1 and improved modestly over the next 5 months, but remained greater than the pre-hospitalization score. Functional recovery was achieved by 70% of patients, and incident NH admission was experienced by 50% within 6 months after the 251 ACSC-related hospitalizations. CONCLUSIONS: During the 6 months after an ACSC-related hospitalization, older persons exhibited total disability scores that were higher than those immediately preceding hospitalization, with 3 of 10 not achieving functional recovery and half experiencing incident NH admission. These findings provide evidence that older persons experience clinically meaningful adverse patient-reported outcomes after ACSC-related hospitalizations.
AB - BACKGROUND/OBJECTIVE: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are considered potentially preventable. With little known about the functional outcomes of older persons after ACSC-related hospitalizations, our objectives were to describe: (1) the 6-month course of postdischarge functional disability, (2) the cumulative monthly probability of functional recovery, and (3) the cumulative monthly probability of incident nursing home (NH) admission. METHODS: The analytic sample included 251 ACSC-related hospitalizations from a cohort of 754 nondisabled, community-living persons aged 70 years and older who were interviewed monthly for up to 19 years. Patient-reported disability scores in basic, instrumental, and mobility activities ranged from 0 to 13. Functional recovery was defined as returning within 6 months of discharge to a total disability score less than or equal to that immediately preceding hospitalization. RESULTS: The mean age was 85.1 years, and the mean disability score was 5.4 in the month prior to the ACSC-related hospitalization. After the ACSC-related hospitalization, total disability scores peaked at month 1 and improved modestly over the next 5 months, but remained greater than the pre-hospitalization score. Functional recovery was achieved by 70% of patients, and incident NH admission was experienced by 50% within 6 months after the 251 ACSC-related hospitalizations. CONCLUSIONS: During the 6 months after an ACSC-related hospitalization, older persons exhibited total disability scores that were higher than those immediately preceding hospitalization, with 3 of 10 not achieving functional recovery and half experiencing incident NH admission. These findings provide evidence that older persons experience clinically meaningful adverse patient-reported outcomes after ACSC-related hospitalizations.
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U2 - 10.12788/jhm.3669
DO - 10.12788/jhm.3669
M3 - Article
C2 - 34328835
AN - SCOPUS:85114055233
SN - 1553-5592
VL - 16
SP - 469
EP - 475
JO - Journal of Hospital Medicine
JF - Journal of Hospital Medicine
IS - 8
ER -