Nursing homes looking to gauge whether a resident is at risk for readmission may have a new tea leaf to read.

Pouring over data from more than 700,000 patients, at a mean age of 78, Canadian researchers found that care setting, before and after the hospital episode, is a key predictor of rehospitalization within 30 days. Most notably, those returning to long-term care had a greater risk of readmission, while those newly admitted to long-term care had a lower risk.

“The information from this study will contribute to a better understanding of the extent to which complicated transitions to and from hospital influence readmission among older adults, which is essential for system planning,”, wrote Andrea Gruneir, Department of Family Medicine, University of Alberta and ICES in a summary of the study.

The large-scale study out of the University of Alberta was released Monday.  Investigators noted that providers typically do not consider how long-term care and home care settings can impact an individual’s chances of ending up back in a hospital bed.

Overall, about 12.6%, or 88,000, of the study population was readmitted to the hospital within 30 days, but this proportion varied greatly based on their combination of care settings.

Older adults discharged to home-based care were the most likely to be readmitted, and experienced the longest stays. Authors suggested this may be attributed to mismatches between patient needs and provisioning of home care services.

Meanwhile, individuals who started off in the community and were later discharged into long-term care had the lowest likelihood of hospital admission. Authors speculated this was because they were in the appropriate care setting.

Individuals admitted from and subsequently discharged to long-term care had an increased likelihood of readmission. Researches noted that evidence has suggested that long-term care residents are often prematurely discharged from hospital because providers there have little experience in long-term care and make erroneous assumptions about available resources.

“Health system planning and strategies to reduce readmissions among older adults should take into account the care setting both before admission and at discharge,” the authors write. “By contextualizing hospitalization within these care settings , our findings suggest an approach to understanding readmissions as a signal of the health system’s preparedness for the aging population.”