Effects of discharge planning services and unplanned readmissions on post-hospital mortality in older patients: A time-varying survival analysis

Background: Older patients often encounter negative health outcomes after discharge from the hospital. The purpose of this study was to explore the effects of discharge planning services and unplanned readmissions on the risk of death within 1 year after discharge in older patients. Method: A prospective observational study was conducted from November 2018 to May 2020. Participants were inpatients aged over 65 years in 13 general wards of a medical center in Taiwan. Data were collected by interviews and patients’ medical records, including the offer of discharge planning services, the occurrence of unplanned readmissions, and death which occurred within 1 year after discharge. A proportional hazard regression model with a time-varying covariate was performed for data analysis. Results: In total, 300 patients completed the interview and medical records, and 297 were assessed for eligibility; 42.1% of participants received discharge planning services, 43.4% of participants had an unplanned readmission, and 34 (11.4%) participants died from all causes within 1 year after discharge. After controlling for age, operation, tube use, physical and mental disabilities or major illnesses, body-mass index, incontinence, muscle weakness, malnutrition problems, and length of stay in the hospital, older patients who had received discharge planning services had a significantly lower risk of death within 1 year after discharge (adjusted hazard ratio (aHR)=0.08, p<0.001). Older patients who experienced an unplanned readmission had a significantly higher risk of death within 1 year after discharge (aHR=12.78, p = 0.001). Conclusions: After being discharged from the hospital, patients experiencing an unplanned readmission may have an increased chance of death. Therefore, the development of continuous hospital discharge planning services and the achievement of a collaborative partnership are recommended to improve patients' compliance and positive health outcomes after discharge from the hospital.