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    1 Comment for this article
    Preventing falls
    Frederick Rivara, MD, MPH | University of Washington
    This article makes a lot of sense to me. We already know that fraility is an important risk factor for falls. We also know that being in a hospital leads to deconditioning. Combining the two, as shown in this study, results in additive effects for risk fo falls. What can we do during and after the hospitalization to prevent falls on discharge? Should we give accelerometers in hospitals to track how active they are?
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open.
    Original Investigation
    Geriatrics
    May 24, 2019

    Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older

    Author Affiliations
    • 1Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
    • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
    • 3Geriatric Research Education and Clinical Care Center (GRECC), VA Medical Center, Ann Arbor, Michigan
    • 4Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
    • 5Division of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
    • 6School of Public Health, Yale University, New Haven, Connecticut
    • 7Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
    • 8Veterans Affairs Center for Clinical Management and Research (CCMR), VA Medical Center, Ann Arbor, Michigan
    • 9Institute for Social Research, University of Michigan, Ann Arbor
    JAMA Netw Open. 2019;2(5):e194276. doi:10.1001/jamanetworkopen.2019.4276
    Key Points español 中文 (chinese)

    Question  To what extent do falls play a role in hospital readmissions for older patients, including those with acute geriatric risk factors?

    Findings  This cohort study using Hospital Cost and Utilization Project data from 8.3 million Medicare beneficiaries found that fall-related injuries ranked as high as the third-leading readmission diagnosis, depending on the type of initial hospitalization. Fall injuries ranked still higher for patients with a high preexisting risk of falling and for those discharged home or to home health care rather than to a skilled nursing facility.

    Meaning  Fall-related injuries are leading diagnoses for hospital readmissions, particularly for at-risk older adults discharged home, highlighting the need for greater attention to transitional prevention strategies to avoid postdischarge falls.

    Abstract

    Importance  Falls are common among older adults, particularly those with previous falls and cognitive impairment and in the postdischarge period. Hospitals have financial incentives to reduce both inpatient falls and hospital readmissions, yet little is known about whether fall-related injuries (FRIs) are common diagnoses for 30-day hospital readmissions.

    Objective  To compare fall-related readmissions with other leading rehospitalization diagnoses, including for patients at greatest risk of readmission.

    Design, Setting, and Participants  Retrospective cohort study of the Hospital Cost and Utilization Project’s Nationwide Readmissions Database of nationally representative US hospital discharges among Medicare beneficiaries aged 65 years and older from January 1, 2013, to November 30, 2014. The prevalence and ranking of FRIs compared with other diagnostic factors for 30-day unplanned hospital-wide readmissions were determined, overall and for 2 acute geriatric cohorts, classified by fall injury or cognitive impairment diagnoses observed at the index admission. Analyses were also stratified by patient discharge disposition (home, home health care, skilled nursing facility). Analyses were conducted from February 1, 2018, to February 26, 2018.

    Main Outcomes and Measures  Unplanned hospital-wide readmission within 30 days of discharge.

    Results  From the database, 8 382 074 eligible index admissions were identified, including 746 397 (8.9%) in the FRI cohort and 1 367 759 (16.3%) in the cognitive impairment cohort. Among the entire 8 382 074-discharge cohort, mean (SD) age was 77.7 (7.8) years and 4 736 281 (56.5%) were female. Overall, 1 205 962 (14.4%) of index admissions resulted in readmission, with readmission rates of 12.9% for those with a previous fall and 16.0% for patients with cognitive impairment. Overall, FRIs ranked as the third-leading readmission diagnosis, accounting for 60 954 (5.1%) of all readmission diagnoses. Within the novel acute geriatric cohorts, FRIs were the second-leading diagnosis for readmission both for patients with an FRI at index admission (10.3% of all readmission diagnoses) and those with cognitive impairment (7.0% of all readmission diagnoses). For those with an FRI at index admission and discharged home or to home health care, FRIs were the leading readmission diagnosis.

    Conclusions and Relevance  This study found that posthospital FRIs were a leading readmission diagnosis, particularly for patients originally admitted with a FRI or cognitive impairment. Targeting at-risk hospitalized older adults, particularly those discharged to home or home health care, is an underexplored, cost-effective mechanism with potential to reduce readmissions and improve patient care.

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