Characteristics Associated with Home Health Care Referrals at Hospital Discharge: Results from the 2012 National Inpatient Sample

Jones, Christine; M.D., M.P.H. Heidi L. Wald; Boxer, Rebecca S.; Masoudi, Mansoureh; Burke, Robert E.; Roberta, M.H.S.; Coleman, Michel P; Ginde, M.P.H. Adit A.

doi:10.1111/1475-6773.12504

Cited by 46 publications

(38 citation statements)

References 23 publications

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“…Our study of all Medicare fee‐for‐service beneficiaries hospitalized for HF discharged to SNF and subsequently discharged home found that patients who received HHC on discharge were less likely to be readmitted within 30 days than those discharged home without HHC. This is unexpected, as patients discharged with HHC are likely to have more functional impairments and had shorter SNF stays. The latter is a particularly salient finding as patients with shorter SNF stays theoretically may be at higher risk for readmission because they are fewer days out from hospital discharge and consequently may be less recovered from their acute illness than those with longer SNF stays.…”

Section: Discussionmentioning

confidence: 96%

Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

Weerahandi

Bao

Herrin

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. Here, we examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization. DESIGN Retrospective cohort study. SETTING Fee‐for‐service Medicare data, 2012 to 2015. PARTICIPANTS Beneficiaries, aged 65 years and older, hospitalized with HF who were subsequently discharged to SNF and then discharged home. MEASUREMENTS The primary outcome was unplanned readmission within 30 days of discharge to home from SNF. We compared time to readmission between those with and without HHC services using a Cox model. RESULTS Of 67 585 HF hospitalizations discharged to SNFs and subsequently discharged home, 13 257 (19.6%) were discharged with HHC, and 54 328 (80.4%) were discharged without HHC. Patients discharged home from SNFs with HHC had lower 30‐day readmission rates than patients discharged without HHC (22.8% vs 24.5%; P < .0001) and a longer time to readmission. In an adjusted model, the hazard for readmission was 0.91 (0.86‐0.95) with receipt of HHC. CONCLUSIONS Recipients of HHC were less likely to be readmitted within 30 days vs those discharged home without HHC. This is unexpected, as patients discharged with HHC likely have more functional impairments. Since patients requiring a SNF stay after hospital discharge may have additional needs, they may particularly benefit from restorative therapy through HHC; however, only approximately 20% received such services. J Am Geriatr Soc 68:96–102, 2019

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Section: Discussionmentioning

confidence: 96%

Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

Weerahandi

Bao

Herrin

et al. 2019

J American Geriatrics Society

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“…42 Another study that examined 1.1 million discharges of Medicare patients aged ≥65 years found that patients who were referred to home health care at discharge were more likely to be older, female, live in an urban location, have lower income, have a longer length of stay, have higher illness severity scores, have a diagnosis of heart failure or sepsis, and be hospitalized in New England (vs the Pacific). 15 Hartman et al 2007 analyzed the 2002 Medicare home health care data and found that although the proportion of Medicare beneficiaries nationwide who lived in areas with few home health care agencies was relatively low, less than 1% of urban beneficiaries lived in ZIP codes with no or low use of home health care compared to more than 17% of the most rural beneficiaries. 43 Unlike these previous studies that focused on the patient level, we focused on the county, an important and actionable perspective since improvement efforts require system changes beyond the reach of individual healthcare practitioners and patients.…”

Section: Discussionmentioning

confidence: 99%

National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015

Wang

Leifheit-Limson

Fine

et al. 2017

J American Geriatrics Society

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Objectives To evaluate national trends and geographic variation in the availability of home health care from 2002–2015 and identify county-specific characteristics associated with home health care. Design Observational study Setting All counties in the United States Participants All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. Measurements County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. Results The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002–2003 and 2014–2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North-East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. Conclusion The availability of home health care increased nationwide during the study period, but there was much geographic variation.

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“…4 A majority of older patients referred for HHC at hospital discharge have Medicare insurance, which requires that patients meet the following three conditions for skilled HHC services to be reimbursable: 1) are under the care of a physician, 2) have a need for a skilled HHC service (e.g., nursing, physical therapy) certified by a physician, and 3) are homebound (e.g., have great difficulty leaving home due to a medical condition). 5,6 Patients referred for HHC may be particularly vulnerable after hospital discharge, as they are nearly 3 years older, have one additional comorbidity, and have higher severity of illness than patients discharged home without HHC. 5 Readmission rates for HHC patients are higher than the national average for high-risk conditions such as heart failure (HF), in which 30-day readmission rates for Medicare beneficiaries discharged with HHC are as high as 23-26%, 7,8 compared to a 21.9% overall national average for Medicare patients discharged with HF.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Patients referred for HHC may be particularly vulnerable after hospital discharge, as they are nearly 3 years older, have one additional comorbidity, and have higher severity of illness than patients discharged home without HHC. 5 Readmission rates for HHC patients are higher than the national average for high-risk conditions such as heart failure (HF), in which 30-day readmission rates for Medicare beneficiaries discharged with HHC are as high as 23-26%, 7,8 compared to a 21.9% overall national average for Medicare patients discharged with HF. 9…”

Section: Introductionmentioning

confidence: 99%

“Connecting the Dots”: A Qualitative Study of Home Health Nurse Perspectives on Coordinating Care for Recently Discharged Patients

Jones

Richard

et al. 2017

J GEN INTERN MED

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In an era of shared accountability for patient outcomes across settings, solutions for improving care coordination with HHC are needed. Efforts to improve care coordination with HHC should focus on clearly defining accountability for orders, enhanced communication, improved alignment of expectations for HHC between clinicians and patients, a focus on reducing medication discrepancies, and prioritizing safety for both patients and HHC nurses.

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Characteristics Associated with Home Health Care Referrals at Hospital Discharge: Results from the 2012 National Inpatient Sample

Abstract: As health policy changes influence postacute HHC, defining specific diagnoses and regional patterns associated with HHC is a first step to optimize postacute HHC services.

Cited by 46 publications

References 23 publications

Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015

“Connecting the Dots”: A Qualitative Study of Home Health Nurse Perspectives on Coordinating Care for Recently Discharged Patients

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