Effects of Early Postdischarge Rehabilitation Services on Care Needs-Level Deterioration in Older Adults With Functional Impairment: A Propensity Score-Matched Study.

Abstract

To examine the effects of early postdischarge rehabilitation on care needs-level deterioration in older Japanese patients. Propensity score-matched retrospective cohort study. A secondary data analysis was conducted using medical and long-term care insurance claims data from a suburban city in Japan. We analyzed patients (N=2746) aged 65 years or older who were discharged from hospital to home between April 2012 and March 2014 and had care needs certification indicating functional impairment. The provision of early rehabilitation services by rehabilitation therapists within 1 month of discharge. Propensity score matching was used to control for differences in characteristics between patients with and without early rehabilitation services. Any deterioration in care needs level during the 12-month period after discharge. Cox proportional hazards analyses were conducted to identify the association between the exposure and outcome variables after matching. Among 2746 patients, 573 (20.9%) used early rehabilitation services. Care needs-level deterioration occurred in 508 patients (incidence: 18.3 per 1000 person-months), of which 76 used early rehabilitation services (12.3 per 1000 person-months) and 432 did not use early rehabilitation services (20.0 per 1000 person-months). One-to-one propensity score matching produced 566 matched pairs that adjusted for the differences in all covariables. In these matched pairs, the hazard of care needs-level deterioration was significantly lower among patients who used early rehabilitation services (hazard ratio=0.712, 95% CI, 0.529-0.958). A Kaplan-Meier survival analysis showed similar results (log-rank: P=.023). Early rehabilitation services provided by rehabilitation therapists after hospital discharge appeared effective in preventing care needs-level deterioration, and involving rehabilitation therapists in transitional care may aid the optimization of health care for older Japanese adults with functional impairment.