Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals
Abstract Background Post-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attri...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4024-2 |
| _version_ | 1819063550099849216 |
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| author | Luke A. Turcotte Chris M. Perlman Brant E. Fries John P. Hirdes |
| author_facet | Luke A. Turcotte Chris M. Perlman Brant E. Fries John P. Hirdes |
| author_sort | Luke A. Turcotte |
| collection | DOAJ |
| description | Abstract Background Post-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals. Methods Using information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2.0 (MDS 2.0), a sample of 91,113 episodes of care for patients admitted to Complex Continuing Care hospitals between March 31, 2001 and March 31, 2013 was established. All patients in the sample were either discharged to a residential long-term care facility (e.g., nursing home) or to the community. Long-stay patients for each discharge destination were identified based on a length of stay in the 95th percentile. A series of multivariate logistic regression models predicting long-stay patient status for each discharge destination pathway were fit to characterize the association between demographic factors, residential history, health severity measures, and service utilization on prolonged length of stay in post-acute care. Results Risk factors for prolonged length of stay in the adjusted models included functional and cognitive impairment, greater pressure ulcer risk, paralysis, antibiotic resistant and HIV infection need for a feeding tube, dialysis, tracheostomy, ventilator or a respirator, and psychological therapy. Protective factors included advanced age, medical instability, a greater number of recent hospital and emergency department visits, cancer diagnosis, pneumonia, unsteady gait, a desire to return to the community, and a support person who is positive towards discharge. Aggressive behaviour was only a risk factor for patients discharged to residential long-term care facilities. Cancer diagnosis, antibiotic resistant and HIV infection, and pneumonia were only significant factors for patients discharged to the community. Conclusions This study identified several patient attributes and process of care variables that are predictors of prolonged length of stay in post-acute care hospitals. This is valuable information for care planners and health system administrators working to improve patient flow in Complex Continuing Care and other post-acute care settings such as skilled nursing and inpatient rehabilitation facilities. |
| first_indexed | 2024-12-21T15:16:27Z |
| format | Article |
| id | doaj.art-6e9526aae5bf413b9fbc10ebe535c3ab |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T15:16:27Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-6e9526aae5bf413b9fbc10ebe535c3ab2022-12-21T18:59:09ZengBMCBMC Health Services Research1472-69632019-04-0119111010.1186/s12913-019-4024-2Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitalsLuke A. Turcotte0Chris M. Perlman1Brant E. Fries2John P. Hirdes3School of Public Health and Health Systems, University of WaterlooSchool of Public Health and Health Systems, University of WaterlooGeriatrics Center, Department of Internal Medicine and School of Public Health, University of MichiganSchool of Public Health and Health Systems, University of WaterlooAbstract Background Post-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals. Methods Using information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2.0 (MDS 2.0), a sample of 91,113 episodes of care for patients admitted to Complex Continuing Care hospitals between March 31, 2001 and March 31, 2013 was established. All patients in the sample were either discharged to a residential long-term care facility (e.g., nursing home) or to the community. Long-stay patients for each discharge destination were identified based on a length of stay in the 95th percentile. A series of multivariate logistic regression models predicting long-stay patient status for each discharge destination pathway were fit to characterize the association between demographic factors, residential history, health severity measures, and service utilization on prolonged length of stay in post-acute care. Results Risk factors for prolonged length of stay in the adjusted models included functional and cognitive impairment, greater pressure ulcer risk, paralysis, antibiotic resistant and HIV infection need for a feeding tube, dialysis, tracheostomy, ventilator or a respirator, and psychological therapy. Protective factors included advanced age, medical instability, a greater number of recent hospital and emergency department visits, cancer diagnosis, pneumonia, unsteady gait, a desire to return to the community, and a support person who is positive towards discharge. Aggressive behaviour was only a risk factor for patients discharged to residential long-term care facilities. Cancer diagnosis, antibiotic resistant and HIV infection, and pneumonia were only significant factors for patients discharged to the community. Conclusions This study identified several patient attributes and process of care variables that are predictors of prolonged length of stay in post-acute care hospitals. This is valuable information for care planners and health system administrators working to improve patient flow in Complex Continuing Care and other post-acute care settings such as skilled nursing and inpatient rehabilitation facilities.http://link.springer.com/article/10.1186/s12913-019-4024-2Patient flowLength of stayPost-acute careDischarge planning |
| spellingShingle | Luke A. Turcotte Chris M. Perlman Brant E. Fries John P. Hirdes Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals BMC Health Services Research Patient flow Length of stay Post-acute care Discharge planning |
| title | Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals |
| title_full | Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals |
| title_fullStr | Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals |
| title_full_unstemmed | Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals |
| title_short | Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals |
| title_sort | clinical predictors of protracted length of stay in ontario complex continuing care hospitals |
| topic | Patient flow Length of stay Post-acute care Discharge planning |
| url | http://link.springer.com/article/10.1186/s12913-019-4024-2 |
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