Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey

Abstract

Background: Hospital readmissions are expensive and they may signal poor quality of care. Whether functional status is related to hospital readmissions using a representative U.S sample remains unexplored .

Objective: We aimed to assess the relationship between functional status and all-cause 30-day hospital readmissions using a representative sample of the US population.

Design: This was a retrospective observational study (2003-2011).

Patients: The study included 3,772 patients who completed the SF-12 before being hospitalized. Three hundred and eighteen (8.4%) were readmitted within 30 days after being discharged.

Measurements: The Medical Expenditure Panel Survey (MEPS) was employed. Functional status was measured with the Short-Form 12-Item Health Survey Version 2® (SF-12). The probability of being readmitted was estimated using a logistic model controlling for demographic characteristics, comorbid conditions, insurance coverage, physical (PCS) and mental (MCS) summaries of the SF-12, reason for hospitalization, length of hospital stay, region, and residential area.

Results: A one-unit difference in PCS reduced the odds of readmission by 2% (odds ratio 0.98 [95% CI, 0.97 to 0.99]; p < 0.001), which implies an 18% reduction in the odds of readmissions for a ten-unit difference (one standard deviation) in PCS. The c-statistic of the model was 0.72.

Conclusion: Baseline physical function is associated with hospital readmissions. The SF-12 improves the ability to identify patients at high risk of hospital readmission.

Figure 1

Adjusted odds of 30-day readmission by physical functioning (PCS) deciles. Note: Higher physical scores indicate better physical functioning. The mean and the 95 % CI of each decile were: 0.14 (0.137, 0.152), 0.13 (0.124,0.139), 0.11 (0.106, 0.121), 0.09 (0.081, 0.099), 0.08 (0.075, 0.088), 0.065 (0.060, 0.071), 0.061 (0.056, 0.065), 0.05 (0.049, 0.057), 0.056 (0.052, 0.0612), 0.051 (0.047, 0.055).