Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study.
Functional decline
Institutionalization
Mortality
Patient discharge
Readmission
Self-care
Journal
Applied nursing research : ANR
ISSN: 1532-8201
Titre abrégé: Appl Nurs Res
Pays: United States
ID NLM: 8901557
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
11
02
2020
revised:
20
04
2020
accepted:
29
04
2020
entrez:
12
7
2020
pubmed:
12
7
2020
medline:
31
7
2021
Statut:
ppublish
Résumé
There is growing evidence that patients with functional decline are at increased risk of readmission, mortality and institutionalization. Instruments to measure the status of self-care could provide important information for efficient care planning. The widely used Self Care Index serves as an indicator for the severity of nursing dependency. To date, no evidence is available on the association of the instrument with rehospitalization, mortality and institutionalization. To examine the association of functional status measures (Self Care Index on admission, at discharge and functional decline) with 30-day mortality, readmission and institutionalization in hospitalized non-surgical patients. Prospective cohort study. We included 4540 emergency medical patients at a single hospital in Switzerland. Primary outcome was 30-day mortality rate; secondary outcomes were 30-day readmission and institutionalization. We analyzed the association of the functional status with the binary endpoints using logistic regression models and C-statistics for discrimination. All of the examined measures were significant predictors of overall 30-day mortality; Self Care Index on admission: adj. OR: 0.90 (95% CI: 0.87-0.92); Self Care Index at discharge: adj. OR: 0.86 (95% CI: 0.83-0.88); functional decline: adj. OR: 1.22 (95% CI: 1.14-1.31) and all Self Care Index single items. A combined model (functional status on admission and functional decline during hospitalization) showed a good accuracy with regard to the AUC: adj. AUC: 0.80 (95% CI: 0.74-0.86). Several functional measures were associated with 30-day mortality. Self Care Index total score, five single items and a combined model showed the best performance.
Sections du résumé
BACKGROUND
There is growing evidence that patients with functional decline are at increased risk of readmission, mortality and institutionalization. Instruments to measure the status of self-care could provide important information for efficient care planning. The widely used Self Care Index serves as an indicator for the severity of nursing dependency. To date, no evidence is available on the association of the instrument with rehospitalization, mortality and institutionalization.
OBJECTIVES
To examine the association of functional status measures (Self Care Index on admission, at discharge and functional decline) with 30-day mortality, readmission and institutionalization in hospitalized non-surgical patients.
DESIGN
Prospective cohort study.
PARTICIPANTS
We included 4540 emergency medical patients at a single hospital in Switzerland.
METHODS
Primary outcome was 30-day mortality rate; secondary outcomes were 30-day readmission and institutionalization. We analyzed the association of the functional status with the binary endpoints using logistic regression models and C-statistics for discrimination.
RESULTS
All of the examined measures were significant predictors of overall 30-day mortality; Self Care Index on admission: adj. OR: 0.90 (95% CI: 0.87-0.92); Self Care Index at discharge: adj. OR: 0.86 (95% CI: 0.83-0.88); functional decline: adj. OR: 1.22 (95% CI: 1.14-1.31) and all Self Care Index single items. A combined model (functional status on admission and functional decline during hospitalization) showed a good accuracy with regard to the AUC: adj. AUC: 0.80 (95% CI: 0.74-0.86).
CONCLUSIONS
Several functional measures were associated with 30-day mortality. Self Care Index total score, five single items and a combined model showed the best performance.
Identifiants
pubmed: 32650896
pii: S0897-1897(20)30069-0
doi: 10.1016/j.apnr.2020.151274
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
151274Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors of this manuscript declare no competing financial interests related to this work.