Long-term care facilities to rehabilitation hospital transitions in the United States: principal diagnoses at admission and hospitalization outcomes with comorbid conditions.

BACKGROUND AND

OBJECTIVES

Hospitalization outcomes of long-term care facility (LTCF) residents aged 60 years or older who are admitted to rehabilitation hospitals may differ by diagnosis at admission. This study aimed to determine the relationship between principal admitting diagnoses and discharge destination and the role of length of stay (LoS) and comorbid conditions.

RESEARCH DESIGN AND

METHODS

This retrospective cohort study utilized the Texas Inpatient Public Use Data File from October 2022 to June 2024. The cohort included 3,446 patients admitted to rehabilitation hospitals from LTCFs. Discharge destination (five-level) was modeled with multinomial logistic regression, adjusting for age, gender, race/ethnicity, and health insurance status.

RESULTS

Neurological disorders (20.0%) and myopathies (20.2%) were the most common principal admitting diagnoses. Compared with neurological disorders, myopathies had a higher likelihood of transferring to subacute or short-term hospital care (RRR = 2.18, 95% CI: 1.41-3.37) and home under care (RRR = 1.69, 95% CI: 1.21-2.36). General symptoms or functional impairments were similarly associated with a higher relative risk of discharge from acute to short-term care hospitals (RRR = 2.05, 95% CI: 1.13-3.72) and home under care (RRR = 1.73, 95% CI: 1.08-2.77). Post-surgical or orthopedic aftercare had a lower relative risk of discharge to skilled nursing rather than rehabilitation hospital facilities (RRR = 0.50, 95% CI: 0.28-0.88).

DISCUSSION AND IMPLICATIONS: Among patients admitted to rehabilitation hospitals from LTCFs, a neurological principal admitting diagnosis and extended LoS with comorbid conditions carry a higher likelihood of discharge to an intensive care facility. These findings suggest a need for proactive admission diagnosis-tailored discharge planning and attention for patients with extended LoS.