Non-routine hospital discharge of the chronically-ill oldest-old in rural California, 2004

Background: This study is an examination of factors associated with the non-routine dispositions of chronic-disease-related hospital discharges of California's oldest-old (i.e., 85+), living in rural counties, whose rural 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, developing an understanding of these factors is important.

Methods: Using the 2004 California Patient Discharge Data Files, the following was performed. First, study subject selection was by age (85+); rural residence (i.e., residents of 37 California counties with populations of 250,000+); source of hospital admission (from home); and type and location of facility (i.e., acute care hospitals within the 37 California counties of interest). Next, any discharge with at least one mention of any of the following diagnoses, within the up to twenty-five listed diagnoses on the patient's discharge abstract, was retained: Heart Disease; Stroke; Chronic Obstructive Pulmonary Disease (COPD); Diabetes; Liver Disease/Cirrhosis; Alzheimer's Disease; and Cancer. Finally, logistic regression was performed to examine factors associated with non-routine disposition at discharge (i.e., anywhere but home) for these oldest-old study subjects from rural California. The final logistic regression model was tested for adequacy using the Hosmer and Lemeshow Goodness-of-Fit Test.

Results: In the 37 rural California counties in which the study subjects resided during 2004, of the 16,910 chronic-disease-related hospital discharges among the oldest-old (admitted from home; mean hospital stay of 4.9 days), only 7,830 (43.6%) were discharged back home; the others (i.e., those not discharged back to their homes) were discharged to another health or residential care facility. The factors shown to be associated with non-routine discharge (controlling for age) include the following: having a diagnosis of Alzheimer's Disease (OR=2.15, 95% CI=1.86-2.48), Stroke (OR=1.65, 95% CI=1.49-1.82), Diabetes (OR=1.19, 95% CI=1.09-1.30), COPD (OR=1.15, 95% CI=1.06-1.24), or Heart Disease (OR=0.87, 95% CI=0.79-0.95); having a “long” (OR=2.99, 95% CI=2.76-3.24), “costly” (OR=1.56, 95% CI=1.44-1.68), or unscheduled (OR=1.55, 95% CI=1.37-1.75) stay; being female (OR=1.17, 95% CI=1.09-1.25); and being non-white (OR=0.44, 95% CI=0.40-0.49). The final logistic regression model was determined to be adequate (p=0.40).

Conclusions: Having a better understanding of the factors associated with the non-routine disposition of the discharges examined in this study will allow for the health and medical care communities in rural California to provide support and guidance to patients and their families when the likelihood is that the oldest-old patient will not be returning home.