Biopsychosocial Predictors of Perception of Discharge Readiness and Its Association to 30-day Readmission in Chronic Heart Failure Patients

Abstract

Background: Of 1 million U.S. patients discharged from hospitals with a diagnosis of heart failure (HF) annually, 24% will be readmitted to the hospital within 30 days. Since some readmissions are preventable, the identification of risk factors is critical to improve discharge processes. Lower readiness for hospital discharge (RHD) is a new risk factor that has been associated with re-hospitalization. Purpose: The purpose of this study was to: 1) establish the psychometric properties of the readiness for hospital discharge scale short form (RHDS-SF); 2) identify predictors of RHDS-SF scores; and 3) examine the association between patient assessment of readiness for hospital discharge and 7-day post discharge self-care of heart failure (SCHF) scores, and 30-day hospital readmission risk for HF patients discharged from acute care hospitals. Methods: A cross-sectional secondary data analysis of data from the Improving Heart Failure Outcomes (IHO) study was conducted. IHO was a prospective study examining nursing care of HF patients admitted to acute care hospitals. Subjects and Setting: Subjects included 487 HF patients from a national sample of 36 hospitals. Results: In this sample, 21% were readmitted within 30 days. The intra-class correlation coefficient for 30 day readmission was 19%. Cronbach's alpha estimates for the 3-item RHDS-SF, was acceptable (α= 0.74) [vs the 4-item RHDS-SF (α= 0.37)]. Multi-level modeling (MLM) methods with data nested within hospitals were used to test associations. Patient characteristics associated with RHD were: Beck Depression Inventory scores (t= -2.60, p=0.01), baseline SCHF confidence (t=2.90, p≤0.005), pre discharge Dutch HF knowledge (t=2.50, p= 0.01), age (t=-2.26, p=0.02), and New York Heart Association class (t=2.31, p=0.02). Predictors of HF self-care practices 7-days post hospital discharge were: nurse 3 item RHDS scores (t= 3.59, p≤0.05), baseline SCHF maintenance (t= 3.18, p≤0.005), and baseline SCHF confidence (t= 2.13, p=0.04). No significant association was found between readiness for hospital discharge and 30-day readmission. Conclusions: The psychometric estimates for the RHDS-SF 3-item scale are acceptable. Patient and nurse RHDS scores were significantly associated with SCHF scores 7 days post discharge. Lack of statistical power precluded adequate modeling of associations with 30-day readmission.