# Impact of Elderly Acute Care Discharge Services on Prevention of Rehospitalisation: A Retrospective Cohort Study Using National Health Data from Kita Ward, Tokyo

## TL;DR

This study examines how discharge services for elderly patients in Tokyo affect rehospitalization rates, finding mixed results based on age and hospital stay length.

## Contribution

The study provides new insights into how discharge services influence rehospitalization, particularly for elderly patients and those with specific hospital stay durations.

## Key findings

- Discharge services were associated with increased readmission events overall (HR = 2.92).
- Preventive effects were observed for 85-year-olds (HR = 0.68) and those with 15–21-day stays (HR = 0.73).
- Healthcare system influences may lower barriers to readmission for some groups.

## Abstract

Integrated care poses a significant challenge for healthcare policies in Japan as evaluation of hospital discharge services is limited. This study aimed to elucidate the effects of discharge services for elderly acute-care patients on preventing rehospitalisation.

A retrospective cohort study was conducted using national health data from Kita Ward, Tokyo. Survival analysis was performed with a Cox proportional hazards model, with readmission hazard ratios (HRs) as the primary endpoint. Subgroup analysis examined interactions between each discharge service category (dummy variable) and readmission.

The study encompassed 6,681 subjects. The Cox model adjusted for age, gender, and complications revealed increased readmission events in the discharge service group (HR = 2.92, 95% CI 2.60–3.27). Subgroup analysis by age and length of hospital stay identified a preventive effect in the 85-year-old group (HR = 0.68, 95% CI 0.49–0.93) and 15–21-day length of stay group (HR = 0.73, 95% CI 0.53–1.01), suggesting that discharge services may inadvertently lower barriers to readmission due to healthcare system influences.

While discharge services may elevate readmission demand, they appear to have a preventive effect for individuals aged 85 and over or with an average length of stay of 15–21 days.