The Predictive Utility of Functional Status at Discharge: A Population-level Cohort Analysis

Background: Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes.Methods: In this population-based retrospective cohort study, Adults 65+ who experienced an acute hospitalization between 4 November 2008 and 16 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care (HOBIC) tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge.Results: A total of 80,020 patients were included. 38,928 (48.6%) re-presented to the ED, 24,222 (30.3%) were re-admitted, 5,037 (6.3%) were LTCF ready, and 9,047 (11.3%) died at 180 days. Beyond age, functional status at discharge was the factor most associated with LTCF readiness (Odds Ratio [OR] 4.11; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (pConclusion: Routinely collected functional status at discharge meaningfully improves models to predict long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and service planning for older adults.