Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals

Luke A Turcotte,Chris M Perlman,John P Hirdes,Brant E Fries

doi:10.1186/s12913-019-4024-2

Abstract

BackgroundPost-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals.MethodsUsing information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2.0 (MDS 2.0), a sample of 91,113 episodes of care for patients admitted to Complex Continuing Care hospitals between March 31, 2001 and March 31, 2013 was established. All patients in the sample were either discharged to a residential long-term care facility (e.g., nursing home) or to the community. Long-stay patients for each discharge destination were identified based on a length of stay in the 95th percentile. A series of multivariate logistic regression models predicting long-stay patient status for each discharge destination pathway were fit to characterize the association between demographic factors, residential history, health severity measures, and service utilization on prolonged length of stay in post-acute care.ResultsRisk factors for prolonged length of stay in the adjusted models included functional and cognitive impairment, greater pressure ulcer risk, paralysis, antibiotic resistant and HIV infection need for a feeding tube, dialysis, tracheostomy, ventilator or a respirator, and psychological therapy. Protective factors included advanced age, medical instability, a greater number of recent hospital and emergency department visits, cancer diagnosis, pneumonia, unsteady gait, a desire to return to the community, and a support person who is positive towards discharge. Aggressive behaviour was only a risk factor for patients discharged to residential long-term care facilities. Cancer diagnosis, antibiotic resistant and HIV infection, and pneumonia were only significant factors for patients discharged to the community.ConclusionsThis study identified several patient attributes and process of care variables that are predictors of prolonged length of stay in post-acute care hospitals. This is valuable information for care planners and health system administrators working to improve patient flow in Complex Continuing Care and other post-acute care settings such as skilled nursing and inpatient rehabilitation facilities.

Highlights

The Canadian health care system comprises a series of primary, secondary, and tertiary service settings organized along a “continuum of care.” Individuals with chronic and complex health conditions may access several of these services settings during an episode of care [1]
As an intermediary setting along the continuum of care, Complex Continuing Care (CCC) hospitals often discharge patients to community care or residential long-term care (LTC) settings such as nursing homes; more than a third of patients die in these facilities [4]
The Continuing Care Reporting System (CCRS) is maintained by the Canadian Institute for Health Information and includes MDS 2.0 assessments from LTC and CCC facilities in nine Canadian provinces and territories [17]

Summary

Introduction

The Canadian health care system comprises a series of primary, secondary, and tertiary service settings organized along a “continuum of care.” Individuals with chronic and complex health conditions may access several of these services settings during an episode of care [1]. With the aim of reducing costs and ensuring timely access to care for all system users, patients are transitioned to the most appropriate service setting relative to their needs in time. As an intermediary setting along the continuum of care, CCC hospitals often discharge patients to community care or residential long-term care (LTC) settings such as nursing homes; more than a third of patients die in these facilities [4]. The median length of stay for patients in CCC facilities ranges between 28 and 31 days by age group [5]. Episodes of care are short for most CCC patients, more than 40% stay longer than 90 days [6]. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals

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