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Health-related quality of life at hospital discharge as a predictor for 6-month unplanned readmission and all-cause mortality of acutely admitted older medical patients

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Abstract

Purpose

To assess whether health-related quality of life (HRQOL) status, using the European Quality of life-5 dimensions (EQ5D), in acutely admitted older medical patients was associated with a combined end-point including first unplanned readmission or death without prior readmission within 6 months. Secondly, to assess if HRQOL was associated with death regardless of previous readmissions.

Methods

Patients from seven medical and two acute medical units were included and the EQ5D was obtained at discharge. Associations were assessed using Cox regression. Harrell’s C-statistics indicated the predictive performance.

Results

1328 patients were included, 50% (n = 664) were readmitted (n = 635) or had died without prior readmission (n = 29) within 6 months. In total, 15.2% (n = 202) died within 6 months. In the gender- and age-adjusted analysis, a lower EQ5D index score was associated with a higher hazard ratio (HR) of unplanned readmission or death without prior readmission for all categories of scores below 1 (< 1 to 0.741, < 0.741 to 0.438 and < 0.438 to − 0.40), HR 1.60, 1.93 and 2.02. Likewise, a lower EQ5D score was associated with a higher HR of death, HR 1.72, 2.54 and 3.79. Harrell’s C values were 0.56 and 0.63.

Conclusion

HRQOL measured at discharge may identify acutely admitted older medical patients at especially high risk of readmission or death up to 6 months after discharge. Incorporating assessment of HRQOL should be considered when risk stratifying a heterogeneous population of acutely admitted older medical patients.

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Acknowledgements

The authors would like to thank the study participants and the staff at the participating medical and acute medical units for their contributions to this study.

Funding

The study was funded by the Danish Development and Research Fund (13-12-2013).

Author information

Authors and Affiliations

  1. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Jane Andreasen

  2. Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg, Denmark

    Jane Andreasen

  3. Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands

    Robbert J. J. Gobbens

  4. Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, The Netherlands

    Robbert J. J. Gobbens

  5. Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Robbert J. J. Gobbens

  6. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark

    Helle Højmark Eriksen

  7. Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Kim Overvad

  8. Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark

    Kim Overvad

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  1. Jane Andreasen
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  2. Robbert J. J. Gobbens
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Corresponding author

Correspondence to Jane Andreasen.

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The authors declare that they have no conflict of interest.

Ethical approval

The Danish Regional Ethics Committee assessed the study and stated that no approval was required (ID-Number N-20140016). The Danish Data Protection Agency approved the study (2008-58-0028). The study complied with the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Andreasen, J., Gobbens, R.J.J., Eriksen, H.H. et al. Health-related quality of life at hospital discharge as a predictor for 6-month unplanned readmission and all-cause mortality of acutely admitted older medical patients. Qual Life Res 28, 3015–3024 (2019). https://doi.org/10.1007/s11136-019-02259-w

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