Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Mach
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Frances Payne Bolton School of Nursing , Case Western Reserve University, Cleveland, OH, USA; 2Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 4Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA; 5 Department of Family & Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 6Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA; 7Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA; 8Alpert School of Medicine, Brown University, Providence, RI, USA; 9Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA; 10Providence Veterans Administration Medical Center, Providence, RI, USA.
BACKGROUND: Limitations in instrumental activities of daily living (IADL) hinder a person’s ability to live independently in the community and self-manage their conditions, but its impact on hospital readmission has not been firmly established. OBJECTIVE: To test the importance of IADL dependency as a predictor of 30-day readmissions and quantify its impact relative to other morbidities. DESIGN: A retrospective cohort study of the populationbased Health and Retirement Study linked to Medicare claims data. Random forest was used to rank each predictor variable in terms of its ability to predict readmission. Classification and regression tree (CART) was used to identify complex multimorbidity combinations associated with high or low risk of readmission. Generalized linear regression was used to estimate the adjusted relative risk of readmission for IADL limitations. SUBJECTS: Hospitalizations of adults age 65 and older (n = 20,007), from 6617 unique subjects. MAIN MEASURES: The main outcome was 30-day allcause unplanned readmission. The main predictor of interest was self-reported IADL limitation. Other key predictors were self-reported complex multimorbidity including chronic diseases, geriatric syndromes, and activities of daily living (ADL) limitations, along with demographic, socioeconomic, and behavioral factors. KEY RESULTS: The overall 30-day readmission rate in the study was 16.4%. Random forest analysis ranked ADLs and IADL limitations as the two most important predictors of 30-day readmission. CART identified
Prior Presentations An early version of this work was presented at AcademyHealth Annual Research Meeting 2018 under the title “Association of Specific Functional Limitations and 30-Day Hospital Readmission Among Medicare Enrollees.” Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-05982-0) contains supplementary material, which is available to authorized users. Received November 15, 2019 Accepted June 11, 2020
hospitalizations of patients with IADL limitations and diabetes as a subgroup at the highest risk of readmi
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