A study shows that patients who refuse post acute care services tend to be young, well educated and healthy. They are also twice as likely to have 30 and 60 day readmissions as compared to those who agree to post-acute services.
Approximately 20 million patients are discharged from hospitals in the U.S. every year. A third of these patients are referred to post acute care including long-term hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies. 30 percent of patients refuse post acute care services offered upon hospital discharge.
The study was conducted with 495 patients 55 years and older and discharged from two large academic medical centers. Patients who accepted (acceptors) post acute services with those who refused (refusers) were compared on the basis of their sociodemographic and clinical characteristics, quality of life, health related problems and unmet needs. The association between refusal of these services and the risk of hospital readmission was assessed.
The results of the study show that refusers were generally younger with an average age of 68 years versus 73 years in the acceptors group. They were also more likely to be married (62 percent versus 46 percent), privately insured (35 percent versus 18 percent) and with a lower risk of mortality and severity of illness. They also had shorter hospital stays (4.8 days versus 7.5 days in the acceptor group), higher quality of life after discharge and fewer unmet needs after discharge. Despite these positive statistics, the study also found that refusers had higher 30 day (21 percent versus 16 percent) and 60 day (31 percent versus 25 percent) readmission rates. Logistic regression showed twice-higher odds at 30 day and 60-day readmission.
The findings suggest that there is a need to investigate the reasons for refusal of post-acute services and to foster enhanced patient communication to improve rates of such acceptance and in effect, reduced hospital readmissions.
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