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Am J Manag Care. 2015 Jun;21(6):424-33.

Higher 30-day and 60-day readmissions among patients who refuse post acute care services.

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University of Pennsylvania School of Nursing, Philadelphia, PA 19104. E-mail:



To compare patients who accepted ("acceptors") post acute care services (PAC) with those who were offered services and refused ("refusers") in terms of their sociodemographic and clinical characteristics, quality of life, health-related problems, and unmet needs; and to examine the association between refusing PAC services and the risk for 30- and 60-day readmission.


Secondary data analysis from a cross-sectional study.


Bivariate analysis and logistic regressions were used to examine the association between refusing PAC services and 30- and 60-day readmission.


A convenience sample of 495 PAC-referred patients 55 years and older discharged from 2 large academic medical centers in the northeastern United States completed the study questionnaires, with a resulting 28% (n = 139) that refused PAC services. Refusers were significantly younger (average age 68 years vs 73 years; P < .001), as well as more likely to be married (62% vs 46%; P < .001), privately insured (35% vs 18%; P < .001), and with lower risk of mortality/severity of illness. Refusers also had shorter hospital stays (4.8 days vs 7.5 days; P < .001); higher quality of life after discharge (0.83 vs 0.73; P < .001); and fewer unmet needs after discharge. However, refusers had higher 30-day (21% vs 16%; P = .17) and 60-day (31% vs 25%; P = .18) readmission rates; with logistic regression showing about twice-higher odds of 30-day (OR [odds ratio], 2.13; 95% CI, 1.11-3.02; P = .01) and 60-day (OR, 1.8; 95% CI, 1.11-3.02; P = .02) readmission.


PAC refusers are younger, better educated, and healthier, but they have twice-higher odds of 30- and 60-day readmissions, compared with PAC acceptors. Further investigation into reasons for PAC refusal is critical to foster enhanced patient communication regarding PAC services, improve rates of service acceptance, and ultimately decrease readmissions.

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