Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
BMC Geriatr. 2022 Jan 3;22(1):8. doi: 10.1186/s12877-021-02652-6.
Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes.
In this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing ('LTCF readiness'), and death at 180 days from discharge.
A total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission.
Routinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults.
功能状态是一个患者重要的、以患者为中心的测量指标。功能状态测量在告知出院后患者需求方面的效用尚不清楚。我们试图研究从老年住院患者中常规收集的功能状态测量值，以预测一系列出院后结果的效用。
在这项基于人群的回顾性队列研究中，纳入了 2008 年 11 月 4 日至 2016 年 3 月 18 日期间在加拿大安大略省因急性住院治疗出院且在出院时使用健康结果更好信息和护理工具评估功能状态的 65 岁以上成年人。多变量回归分析用于确定功能状态与急诊科（ED）再次就诊、医院再入院、长期护理机构（LTCF）入院或等待名单（“LTCF 准备就绪”）以及出院后 180 天死亡之间的关系。
共纳入 80020 例出院患者。38928 例（48.6%）再次到急诊科就诊，24222 例（30.3%）再次入院，5037 例（6.3%）准备好入住长期护理机构，9047 例（11.3%）在出院后 180 天死亡。除年龄外，出院时功能状态下降是与 LTCF 准备就绪最相关的因素（与能够独立完成日常生活活动的患者相比，完全依赖日常生活活动的患者调整后的优势比[OR]为 4.11；95%置信区间[CI]：3.70-4.57）和死亡（OR 3.99；95%CI：3.67-4.35）。功能状态与每种结局也存在分级关系，并提高了预测死亡和 LTCF 准备就绪的模型的区分度（p<0.01），但对急诊科再次就诊或医院再入院的预测没有改善。
出院时常规收集的功能状态显著提高了长期护理机构准备就绪和死亡的预测能力。常规评估功能状态可以为老年人提供出院后护理和计划方面的信息。
