Objectives

To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge following an acute hospitalization.

Design

Retrospective cohort study

Setting

One inpatient unit of a rural, academic medical center

Participants

Hospitalized patients 70 years or older from October 1, 2013 to June 1, 2014

Measurements

Patient age at the time of admission, modified Folstein Mini-Mental Status Exam score, and self-reported instrumental activities of daily living two weeks prior to admission were used to calculate a HARP score. The primary predictor was HARP score and the primary outcome was discharge disposition (home, facility, or deceased). Multivariate analysis evaluated the association between HARP score and discharge disposition adjusting for age, sex, comorbidities, and length of stay.

Results

Four hundred twenty eight patients, admitted from home, were screened and categorized by HARP score as low (162 [37.8%]), intermediate (157 [36.7%]), or high (109 [25.5%]). Patients with high HARP scores were significantly more likely to be discharged to a facility compared to those with low HARP scores (55% vs. 20%; p<0.001). After adjustment, patients with high compared to low HARP scores were over 4 times more likely to be discharged to a facility (OR 4.58, 95% CI 2.42–8.66).

Conclusion

Among a population of older hospitalized adults, the HARP score (using readily available admission information) identifies patients at increased risk for skilled nursing or acute rehabilitation facility discharge. Early patient identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning.