• Cynthia Chen, Nasheen Naidoo, Benjamin Er, Angela Cheong, Ngan Phoon Fong, Choo Yian Tay, Kin Ming Chan, Boon Yeow Tan, Edward Menon, Chye Hua Ee, Kok Keng Lee, Yee Sien Ng, Yik Ying Teo, and Gerald C H Koh.
• Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
• Plos One. 2013 Jan 1; 8 (12): e82697.

ObjectivesTo (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore.DesignNational data were retrospectively extracted from medical records of community hospital.Data SourcesThere were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37), other community hospital (n = 31), death in community hospital (n = 12), acute hospital (n = 1,182) and discharge against doctor's advice (n = 24) were excluded.Outcome MeasureNursing home placement.ResultsThose who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001) and 65% (p = 0.043) respectively compared to stroke patients.ConclusionsIn our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes.

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