Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study

Xiao, Roy; Miller, Jacob A.; Zafirau, William; Gorodeski, Eiran Z.; Young, James B.

doi:10.1016/j.amjmed.2017.11.010

Cited by 40 publications

(27 citation statements)

References 30 publications

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“…In addition, patients who received at least 2 months of HHC spent 8 months longer at home before nursing home placement, compared with those who received no or shorter duration of HHC 44. On the contrary, patients who did not receive enough HHC (as deemed by family members) were 1.8 times more likely to die 21. Since the current study did not include measures of the timing (eg, when HHC services were provided) or visit intensity of HHC (eg, how many home visits of each involved discipline in HHC were provided in real time after discharge), it is unknown if the delayed improvement in vulnerability was due to (1) late or inadequate HHC provided in the first week (or 30 days) after hospital discharge or (2) null effect of HHC on vulnerability changes in this period even with early and intensive HHC.…”

Section: Discussionmentioning

confidence: 98%

“…Studies have shown that HHC promotes functional improvement,18 reduces the risk of rehospitalisation19 and delays nursing home placements 20. Medical expenditures for HHC users were also lower with an adjusted cost saving of US$6433 in the 365 days after hospital discharge 21. As such, it seems that HHC provides efficient and cost-effective services to prevent postdischarge adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

et al. 2019

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Objectives(1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period.DesignSecondary analysis of longitudinal data from a cohort study.Participants and setting834 older (≥65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121).OutcomeVulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching.ResultsOverall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=−1.34(–2.07, –0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%–16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year.ConclusionAfter adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

et al. 2019

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“…Similarly in the US studies, HHC could improve access to medical care and reduce hospital admissions and the healthcare expenditure. [10,11] Furthermore, a Barcelona HHC program for individuals with multimorbidities revealed a decrease of number of hospital admissions and length of stay with lower cost. [2] However, the reduction of the healthcare expenditure in our study was smaller compared with those in the US study (approximately US$42 per person per day) [11] and in the Barcelona study (approximately US$49 per person per day).…”

Section: Discussionmentioning

confidence: 99%

“…[10,11] Furthermore, a Barcelona HHC program for individuals with multimorbidities revealed a decrease of number of hospital admissions and length of stay with lower cost. [2] However, the reduction of the healthcare expenditure in our study was smaller compared with those in the US study (approximately US$42 per person per day) [11] and in the Barcelona study (approximately US$49 per person per day). [2] The reason for this difference might be because the average medical care payment in Taiwan was much lower than the payment in high-income countries.…”

Section: Discussionmentioning

confidence: 99%

Impact of a home health care program for disabled patients in Taiwan

Lee

Huang

et al. 2019

Medicine

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The aim of this study was to evaluate the impact of home health care (HHC) for disabled patients. We conducted a nationwide population-based retrospective cohort study. A total of 5838 disabled patients with HHC were identified to match by propensity score with 15,829 disabled patients without HHC receiving tube or catheter care (tracheostomy tube, nasogastric tube, urinary catheter, cystostomy tube, nephrostomy tube) or stage 3 or 4 pressure sore care from the Taiwanese National Health Insurance Research Database between 2005 and 2009. After 1:1 matching, 2901 subjects in the HHC group and 2901 subjects in the non-HHC group were selected and analyzed. Generalized estimating equations (GEEs) were used to compare the risk of health outcomes (rate of hospitalization and emergency services use) and the healthcare expenditure between the 2 groups. Compared to those in the non-HHC group, the patients in the HHC group had significantly higher risk for hospitalization (odds ratio [OR] = 18.43, 95% confidence interval [CI]: 15.62–21.75, P < .001) and emergency services use (OR = 3.72, 95% CI: 3.32–4.17, P < .001) 1 year before the index date. However, 1 year after the index date, the risk for hospitalization (OR = 1.6, 95% CI: 1.41–1.83, P < .001) and emergency services use (OR = 1.16, 95% CI: 1.04–1.30, P < .05) attenuated significantly. Regarding the comparison of total healthcare expenditure 1 year before and after the index date, our study showed an insignificant decrease of US$1.5 per person per day and a significant increase of US$5.2 per person per day ( P < .001) in the HHC and non-HHC groups, respectively. The HHC for disabled patients has a potential role to reduce hospitalization and emergency services use. Besides, the improvement of healthcare quality through HHC was not accompanied by increased healthcare expenditure. The clinical impact of HHC emphasizes the importance for public health officials to promote HHC model to meet the needs of disabled patients.

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“…These services include a wide range of primary and advanced services offered at three levels of prevention by different individuals from health care professionals to volunteers, such as friends, family members, and neighbors [ 2 ]. This type of care leads to shorter hospital stays, fewer readmissions, fewer and less serious hospital-acquired complications, a reduced need for repeated referrals to the emergency departments, the shortening of the waiting time in treatment centers, vacancy of specialty hospital beds, decreased emergency department crowding, improving the quality of life and savings in health care expenses [ 3 – 5 ]. The management of the delivery of home care services is a challenging and difficult task, because of the variety of services needed, the variety of resources needed to offer the services, and shortage of human resources [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study

et al. 2018

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BackgroundBecause of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task.ObjectivesThe purpose of this study was to explore the administrative aspects of the delivery of home health care services.MethodsThis qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method.Results23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories.ConclusionHealth policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

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Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study

Cited by 40 publications

References 30 publications

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

Impact of a home health care program for disabled patients in Taiwan

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study

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