Discharge disposition disagreements and re-admission risk among older adults: a retrospective cohort study

OBJECTIVES: Re-admissions after hospitalisation are a burden for patients and costly. Our objective was to examine whether re-admissions were increased among older patients when they or their surrogates disagreed with the discharge disposition recommended by the clinical team at hospital discharge. DESIGN: Retrospective cohort study. SETTING: Large academic medical centre in New York, NY. PARTICIPANTS: 514 hospital discharges of older patients admitted to a geriatric inpatient service between 1 July 2007 and 30 June 2008. PRIMARY OUTCOME MEASURE AND MAIN INDEPENDENT VARIABLE: Re-admissions for any reason to any hospital within 30 days after discharge were identified. Agreement or disagreement with the discharge disposition recommended by the clinical team at hospital discharge was assessed. RESULTS: Among 514 hospital discharges of older patients, the mean age was 83.1 years (SD=8.3), 75.7% were women, and approximately 90% were living at home prior to hospitalisation, despite 47.1% having some degree of cognitive impairment and 56.4% requiring assistance for activities of daily living or independent activities of daily living. There were 42 (8.2%) disposition disagreements; the majority (n=25; 59.5%) were discharged home despite the clinical team's recommendation for discharge to an acute or subacute facility. Overall, 158 (30.7%) were re-admitted within 30 days. There was no difference in re-admission rates between discharges with and without disposition disagreements (33.3% (144 of 472) vs 30.5% (14 of 42), respectively; OR=1.14, 95% CI 0.57 to 2.19; p=0.71). Adjusted analyses were consistent with these findings. CONCLUSIONS: Discharge disposition disagreements occurred relatively infrequently after hospitalisation among a group of older patients managed by a geriatrics inpatient service. In addition, we found no differences in re-admission when comparing patients who agreed or disagreed with the clinical team's recommended discharge disposition.