Factors associated with transfers from healthcare facilities among readmitted older adults with chronic illness
Authors: Islam Tasneem , O'Connell Beverly , Hawkins Mary 
Published: March 2014

Objective Because chronic illness accounts for a considerable proportion of Australian healthcare expenditure, there is a need to identify factors that may reduce hospital readmissions for patients with chronic illness. The aim of the present study was to examine a range of factors potentially associated with transfer from healthcare facilities among older adults readmitted to hospital within a large public health service in Melbourne, Australia. Methods Data on readmitted patients between June 2006 and June 2011 were extracted from hospital databases and medical records. Adopting a retrospective case-control study design, a sample of 51 patients transferred from private residences was matched by age and gender with 55 patients transferred from healthcare facilities (including nursing homes and acute care facilities). Univariate and multivariate logistic regression analyses were used to compare the two groups, and to determine associations between 46 variables and transfer from a healthcare facility. Results Univariate analysis indicated that patients readmitted from healthcare facilities were significantly more likely to experience relative socioeconomic advantage, disorientation on admission, dementia diagnosis, incontinence and poor skin integrity than those readmitted from a private residence. Three of these variables remained significantly associated with admission from healthcare facilities after multivariate analysis: relative socioeconomic advantage (odds ratio (OR) 11.30; 95% confidence interval (CI) 2.62–48.77), incontinence (OR 7.18; 95% CI 1.19–43.30) and poor skin integrity (OR 18.05; 95% CI 1.85–176.16). Conclusions Older adults with chronic illness readmitted to hospital from healthcare facilities are significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. The findings direct efforts towards addressing the apparent disparity in management of patients admitted from a facility as opposed to a private residence. What is known about the topic? Older adults with chronic disease require ongoing medical care in both community and healthcare settings. They may frequently require emergency admission to hospital for management of exacerbations of their chronic disease. Previous Australian research has found that transfer from a healthcare facility may be associated with likelihood of readmission among older adults. What does this paper add? This research addresses the shortage of research on the link between transfer from a healthcare facility and likelihood of readmission within Australia. Older adults with chronic illness readmitted to hospital from healthcare facilities were found to be significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. What are the implications for practitioners? The findings may be used to identify older readmitted patients with chronic diagnoses at greater risk of presenting with poor skin integrity or incontinence, and direct efforts towards addressing the apparent disparity in management of patients admitted from facilities as opposed to private residences. Sound discharge planning and clear channels of communication between healthcare facilities are particularly important for patients transferred between facilities.