Factors Associated With Rehabilitation Outcomes, Nursing Home Placement and Survival of Patients in Singapore Community Hospitals

Abstract

This thesis focus on post-acute rehabilitation in Singapore. Rehabilitation outcomes of patients admitted to Singapore?s community hospitals have improved between 1996 and 2005 despite decreasing length of stay. There is an increasing trend in functional status at admission and discharge and an increase in effectiveness and efficiency of rehabilitation during this period. Discharge destinations have remained largely unchanged. The odds of nursing home placement are found to be increased in Chinese, males, single or widowed or separated/divorced, low socioeconomic status, dementia, no caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge. Comorbidity, disability, widowhood and institutionalization are independent predictors of mortality risks in patients after discharge from acute hospitalizations. We also found a novel synergistic interaction effect of comorbidity-disability on mortality risk. Using a total score accounted for 64% of initial variation in the 10 activities of daily living.