Is health-related quality of life among older, chronically ill patients associated with unplanned readmission to hospital?

Background: Assessment of health-related quality of life (HRQL) is being used increasingly to assess the impact of treatment. Aims: To determine if HRQL, assessed shortly after acute hospitalisation, is associated with readmission to hospital. Methods: In a prospective, longitudinal study, 163 chronically ill, medical and surgical patients (mean age 67.0+/-16.3 years) discharged to home following acute hospitalisation were studied. HRQL was assessed at one month post-hospital discharge using the MOS 36-Item Short-Form Health Survey (SF-36). Patients were followed-up for six months thereafter to determine subsequent incidence of unplanned readmission. Results: HRQL as measured by the eight health dimensions of the SF-36, for the entire cohort, was lower relative to age and gender matched norms for the local population (p<0.01). During study follow-up, 47 (35%) patients had an unplanned readmission and one patient died. Patients who had an unplanned readmission demonstrated both significantly lower physical (32.2+/-9.8 vs 38.6+/-10.1: p<0.001) and mental (45.1+/-12.7 vs 49.9+/-12.3: p=0.03) health component scores in comparison to the remainder of the cohort. On multivariate analysis, independent correlates of unplanned readmission were: 1) presence of formal home assistance (OR 6.4: p<0.01), 2) greater than or equal to five prescribed medications (OR 2.4: p=0.04), 3) greater than or equal to two admissions in the six months before follow-up (OR 4.3: p<0.01) and 4) an SF-36 physical component score of less than or equal to 40 (OR 2.2: p=0.05). Conclusions: In this cohort of predominantly older and chronically ill patients recently discharged from acute hospital care, relatively lower SF-36 physical health component scores were independently associated with an increased risk of subsequent unplanned readmission.