Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis

PLoS One. 2013 Dec 23;8(12):e82697. doi: 10.1371/journal.pone.0082697. eCollection 2013.

Abstract

Objectives: To (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore.

Design: National data were retrospectively extracted from medical records of community hospital.

Data sources: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37), other community hospital (n = 31), death in community hospital (n = 12), acute hospital (n = 1,182) and discharge against doctor's advice (n = 24) were excluded.

Outcome measure: Nursing home placement.

Results: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001) and 65% (p = 0.043) respectively compared to stroke patients.

Conclusions: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Hospitalization / statistics & numerical data*
  • Hospitals, Community / statistics & numerical data*
  • Humans
  • Inpatients / statistics & numerical data*
  • Length of Stay
  • Male
  • Multivariate Analysis
  • Nursing Homes / statistics & numerical data*
  • Odds Ratio
  • Rehabilitation Centers / statistics & numerical data*
  • Singapore / epidemiology

Grants and funding

This study was supported by a National University of Singapore (NUS) Start-Up Grant, the NUS Provost Matching Grant, the NUS Academic Research Fund, and Ministry of Health (Singapore) Health Services Research Competitive Research Grant Number HSRG/0006/2013. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.