The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65032

David J. Reynen, MPH, MPPA, Chronic Disease Epidemiology and Control Section, California Department of Health Services, 1616 Capitol Avenue, Suite 74.317, MS 7212, PO Box 942732, Sacramento, CA 94234-7320, (916) 552-9882, DReynen@dhs.ca.gov and Edward E. Graham, PhD, MPH, Cancer Detection Section, California Department of Health Services, 1616 Capitol Avenue, Suite 74.421, MS 7203, PO Box 942732, Sacramento, CA 94234-7320.

Background: This study is an examination of factors associated with non-routine dispositions of chronic-disease-related hospital discharges of San Francisco’s oldest old (i.e., 85+), whose San Francisco acute care hospital discharge abstracts indicated the patients were admitted from but not discharged back to their homes. For both long-term planning and health policy reasons, understanding these factors is critical.

Methods: (1) Selection was by age/residence; source of admission; type/location of facility. (2) Any discharge with 1+ mention of the following, within the twenty-five listed diagnoses on the discharge abstract, was retained: Heart Disease; Stroke; COPD; Diabetes; Liver Disease/Cirrhosis; Alzheimer’s; Cancer; (3) Logistic regression was performed to examine factors associated with non-routine disposition at discharge (i.e., anywhere but home).

Results: In San Francisco, during 1999, of 3,854 chronic-disease-related hospital discharges among the oldest old (admitted from home), only 1,453 (37.7%) were discharged back home; the others were discharged to a health or residential care facility. Factors associated with non-routine discharge (controlling for age) include having a diagnosis of Stroke (OR=2.20, 95% CI=1.80-2.70), Alzheimer’s (OR=1.79, 95% CI=1.21-2.65), or Heart Disease (OR=0.74, 95% CI=0.61-0.88); having a “long” (OR=2.09, 95%CI=1.73-2.52), “costly” (OR=1.84, 95% CI=1.54-2.21), or unscheduled (OR=1.92, 95% CI=1.46-2.53) stay; being female (OR=1.27, 95% CI=1.10-1.47); being non-white (OR=0.85, 95% CI=0.73-0.99); and having a governmental payer (OR=0.69, 95% CI=0.59-0.82).

Conclusions: Having a better understanding of non-routine discharges will allow for health and medical care communities to provide support and guidance to patients and their families when the likelihood is that the patient will not be returning home.

Learning Objectives:

• At the conclusion of this presentation, a member of the audience will be able to do the following:
• 3. Appreciate why it is important to better understand non-routine hospital discharges among the oldest old, as presented in this paper.
  6. List factors associated with non-routine hospital discharges among the oldest old, as presented in this paper.
  9. Discuss how the information concerning non-routine hospital discharges among the oldest old, as presented in this paper, might be applied within health and medical care communities.

Keywords: Elderly, Chronic Diseases

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.