Patient selection: patient >= 65 years of age receiving rehabilitation after an acute hospital admission
Outcome: unplanned readmission within 30-days
Parameters:
(1) number of medications
(2) change in functional status (delta Barthel Index) compared to baseline
(3) length of stay in hospital in days
delta Barthel index =
= (delta Barthel index 1 month prior to admission) - (Barthel index on admission for rehabilitation)
|
Parameter
|
Finding
|
Points
|
|
number of medications
|
< 7
|
0
|
|
|
>= 7
|
1
|
|
delta Barthel Index
|
< 56
|
0
|
|
|
>= 56
|
1
|
|
length of stay
|
< 13 days
|
0
|
|
|
>= 13 days
|
1
|
where:
• A Barthel index of 100 indicates no disability while 0 indicates total disability.
• The hazard ratios for medications was 3.9, for decline in functional status 2.7, and hospital stay 2.7.
• Polypharmacy indicates multiple comorbidities and greater risk for adverse drug effects.
number of risk factors for unplanned readmission =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
• The risk for unplanned readmissions increases with the number of risk factors.
