Strong Link Between Routine Physical Ability and Hospital Readmission Rates.

In one of the first large-scale studies of its kind, SPH researchers have shown that a patient’s ability to perform their daily activities before a hospital stay directly influences the risk of readmission within 30 days.

The study, published in the Journal of General Internal Medicine, looked at a representative sample of 3,722 incoming hospital patients who were asked to complete the SF-12 Health Survey before admission. The SF-12 is a brief 12-item, self-administered questionnaire that measures physical functioning, body pain, general health perceptions, energy and vitality levels, social functioning, and mental and emotional well-being.

Higher scores on the SF-12 indicate better functional status. A 10-unit difference in the results of the physical functional summary score of the questionnaire pointed to an 18 percent reduction in the odds of being readmitted to the hospital within a month.

“Our results suggest that physical functional status has a large and statistically significant influence on all hospital readmissions within 30 days,” said Marina Soley-Bori, a doctoral candidate in the Department of Health Policy and Management.

Soley-Bori is a research assistant in the Center for the Assessment of Pharmaceutical Practices (CAPP), directed by Lewis Kazis, a professor of health policy and management. In addition to Kazis, SPH researchers on the team included Rene Soria-Saucedo, a CAPP research fellow in the Department of Health Policy and Management, and Howard Cabral, a professor of biostatistics.

The research team adjusted for multiple factors that included demographic characteristics, co-morbid conditions, level of insurance coverage, mental functioning, reason for hospitalization, length of stay, region, and residential area.

The study could help hospitals gain additional insights on ways to reduce hospital readmission rates, which are a critical part of the health care improvement portions of the Affordable Care Act. Beginning in 2012, the ACA has penalized hospitals with high readmission rates within 30 days and forced them to forfeit a percentage of Medicare payments.

For decades before the implementation of the ACA, clinicians and policy makers struggled with hospital readmissions, which are both a medical and financial problem. More than half of all hospital readmissions are patients covered by Medicare, costing about $17.4 billion each year, according to figures cited in the study.

Reducing early hospital readmissions is “an opportunity to control health care expenditures and improve systematic errors in clinical care and transitions in levels of care,” researchers said.

Using functional status to assess risk of readmission may also help refine the hospital reimbursement models used by the Centers for Medicare & Medicaid Services and private payers. An accurate prediction of readmission risk is essential to avoid penalizing hospitals that may serve more complex patients, researchers wrote.

Perhaps most importantly, connecting functional status with readmission rates may help hospitals better coordinate discharge services and follow-up care. “Hospitals have a more targeted way to provide additional support to help patients as they transition out of the hospital,” Soley-Bori said.

“With this, and based on conversations with the patients, we can develop a deeper understanding of the total health needs of the patient and avoid having them readmitted.”