Association between frailty and 30-day outcomes after discharge from hospital.

BACKGROUND: Readmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. We evaluated the impact of frailty on readmission or death within 30 days after discharge from general internal medicine wards. METHODS: We prospectively enrolled patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton. Frailty was defined by means of the previously validated Clinical Frailty Scale. The primary outcome was the composite of readmission or death within 30 days after discharge. RESULTS: Of the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate, and 11 (2%) had severe frailty. Frail patients were older, had more comorbidities, lower quality of life, and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among nonfrail patients (39 [24.1%] v. 46 [13.8%]). Although frailty added additional prognostic information to predictive models that included age, sex and LACE score, only moderate to severe frailty (31.0% event rate) was an independent risk factor for readmission or death (adjusted odds ratio 2.19, 95% confidence interval 1.12-4.24). INTERPRETATION: Frailty was common and associated with a substantially increased risk of early readmission or death after discharge from medical wards. The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from general internal medicine wards.

Patient-Reported Discharge Readiness and 30-Day Risk of Readmission or Death: A Prospective Cohort Study.

BACKGROUND: Early readmissions to hospital after discharge are common, and clinicians cannot accurately predict their occurrence. We examined whether patients who feel unready at the time of discharge have increased readmissions or death within 30 days. METHODS: This was a prospective cohort study of adult patients discharged home from 2 tertiary care hospitals in Edmonton, Alberta, Canada, between October 2013 and November 2014. Patient-reported discharge readiness was measured with an 11-point Likert response scale, with scores <7 indicating subjective unreadiness. The primary outcome was readmission or death within 30 days. Logistic regression models were adjusted for age, sex, and a validated risk prediction score for postdischarge events (LACE index). RESULTS: Of 495 patients (mean age 62 years, 51% female, mean Charlson comorbidity index 2.8), 112 (23%) reported being unready for discharge. Risk factors for being unready at discharge were cognitive impairment (mild vs none), low satisfaction with health care services, depression, lower education, previous hospital admissions (12 months), and persistent symptoms or disability. At 30 days, 85 patients (17%) had been readmitted or died, with no significant difference between patients who felt unready or ready (15% vs 18%, adjusted odds ratio 0.84, 95% confidence interval 0.46-1.54, P = .59). CONCLUSIONS: Although nearly one-quarter of hospitalized medical patients reported being unready at the time of discharge, they did not experience any higher risk of readmission or death in the first 30 days after discharge, compared with patients who felt ready for discharge.

Comparing three different measures of frailty in medical inpatients: Multicenter prospective cohort study examining 30-day risk of readmission or death.

BACKGROUND: Multiple tools are used to identify frailty. OBJECTIVE: To compare the global Clinical Frailty Scale (CFS) with more objective phenotypic tools (modified Fried score and the Timed Up and Go Test [TUGT]). DESIGN: Prospective cohort study. SETTING: General medical wards in Edmonton, Canada. PARTICIPANTS: Adults being discharged back to the community. MEASUREMENTS: All frailty assessments were done within 24 hours of discharge. Patients were classified as frail if they scored ≥5 on the CFS and/or ≥3 on the modified Fried score, and/or had reduced mobility (>20 seconds on the TUGT). The main outcome was readmission or death within 30 days. RESULTS: Of 495 patients, 211 (43%) were frail according to at least 1 assessment, 46 (9%) met all 3 frailty definitions, and 17% died or were readmitted to the hospital within 30 days. Although patients classified as frail on the CFS exhibited significantly higher 30-day readmission/death rates (23% vs 14% for not frail, P = 0.005; 28% vs. 12% in the elderly, P < 0.001), even after adjusting for age and sex (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.19-3.41 for all adults; aOR: 3.20, 95% CI: 1.55-6.60 for the elderly), patients meeting either of the phenotypic definitions for frailty but not the CFS definition were not at higher risk of 30-day readmission/death (aOR: 0.87, 95% CI: 0.34-2.19 for all adults and aOR: 1.41, 95% CI: 0.72-2.78 for the elderly). CONCLUSIONS: Frailty has a significant impact on postdischarge outcomes, and the CFS is the most useful of the frequently used frailty tools for predicting poor outcomes after discharge. Journal of Hospital Medicine 2016;11:556-562. © 2016 Society of Hospital Medicine.