Resumen de Predictors for Unplanned Hospitalization of New Home Care Clients
Jukka K. Rönneikkö, Matti Mäkelä, Esa R. Jämsen, Heini Huhtala, Harriet Finne-Soveri, Anja Noro, Jaakko N. Valvanne
Objectives To identify factors predicting unplanned hospitalization of new home care clients using the Resident Assessment Instrument for Home Care (RAI-HC).
Design A register-based study based on RAI-HC assessments and nationwide hospital discharge records.
Setting Municipal home care services in Finland.
Participants New Finnish home care clients aged 63 and older (N = 15,700).
Measurements Information from home care clients’ first RAI-HC assessment was connected to information regarding their first hospitalization over 1 year of follow-up. Multivariate regression analyses were used to evaluate the independent risk factors for hospitalization.
Results Forty-three percent (n = 6,812) of participants were hospitalized at least once. The strongest independent risk factors were hospitalization during the year preceding the RAI-HC assessment (odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.87–2.16), aged 90 and older (OR = 1.69, 95% CI = 1.48–1.92), renal insufficiency (OR = 1.44, 95% CI = 1.22–1.69) and using 10 or more drugs (OR = 1.41, 95% CI = 1.26–1.58). Other independent risk factors were male sex, previous emergency department visits or other acute outpatient care use, daily urinary incontinence, fecal incontinence, history of falls, cognitive impairment, chronic skin ulcer, pain, unstable health status, housing-related problems, and poor self-rated health. Parkinson's disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and cancer were independent prognostic indicators. A body mass index of 24 kg/m2 or greater and the client's own belief that functional capacity could improve had a protective role.
Conclusion Assessing new home care clients using the RAI-HC reveals modifiable risk factors for unplanned hospitalization. Systematic assessment by a multidisciplinary team at the beginning of the service and targeting modifiable risk factors could reduce the risk of unplanned hospitalization.
