Associations of hospital discharge services with potentially avoidable readmissions within 30 days among older adults after rehabilitation in acute care hospitals in Tokyo, Japan.

Abstract Objective To examine the associations of three major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions within 30 days (30-day PAR) in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. Design Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. Setting Acute care hospitals Participants Patients who underwent rehabilitation and were discharged to home (n=31,247; mean age: 84.1 years, standard deviation: 5.7 years) between October 2013 and July 2014. Interventions None. Main Outcome Measure 30-day PAR. Results Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI]: 0.805-1.151) for discharge planning, 1.060 (95% CI: 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI: 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P Conclusions The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.