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

Wang, Jinjiao; Dietrich, Mary S.; Bell, Susan P.; Maxwell, Cathy A.; Simmons, Sandra F.; Kripalani, Sunil

doi:10.1136/bmjopen-2018-024766

Cited by 8 publications

(13 citation statements)

References 45 publications

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“…The possibility of ceiling effect is minimal, because baseline ADL limitation of AL residents was not close to the maximum (4.7 out of 9). This finding may be related to the frailty—an indicator of multi‐system vulnerability 33 and less subsequent functional improvement 23 (not measured in this study). Because AL residents are likely more frail than other Medicare HH recipients, they are less likely to regain ADL function during the HH admission, as previous Another possible explanation of this finding is difference in the type and amount of ADL‐ promoting services patients received during the HH admission.…”

Section: Discussionmentioning

confidence: 75%

“…According to the Andersen behavioral model of health services use 19 (Supplementary Figure S1), health outcomes depend on a range of factors, that is, system and environment (e.g., HH agency 20 and geographic variables 21 ), patient characteristics including predisposing factors (e.g., demographics 11 ), enabling factors (e.g., caregiver support, 22 education, 19 and insurance 21 ), and need factors (e.g., health and functional status, 12,14,23 perceived need 19 ), as well as healthcare service use (e.g., HH care 9,24 ). In this study, we did not control for education, perceived need, and the type and amount of HH services due to limitation of HH data.…”

Section: Methodsmentioning

confidence: 99%

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Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Wang

Ying

Temkin‐Greener

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Home health (HH) is a major type of home‐based skilled care available to Medicare beneficiaries. We examined the association between living situation (home alone, home with others, and assisted living (AL) residence) and utilization and functional outcomes among Medicare HH recipients. DESIGN Analysis of national data from the Outcome and Assessment Information Set, HH Compare, Medicare claims, and Area Health Resource Files. SETTING Medicare‐certified HH agencies in the United States. PARTICIPANTS National population of Medicare beneficiaries ≥65 years old who received HH care in CY 2017 (N = 6,637,496). MEASUREMENTS Outcomes included time‐to‐event measures of hospitalization and emergency department (ED) visits, and improvement in activities of daily living (ADL) from the start to the end of the HH admission. RESULTS AL residents (12%) and patients living alone at home (24%) had longer survival time without hospitalization and ED visits than patients living with others at home (64%). Adjusting for covariates and HH agency‐level random effects, and compared with patients living with others, AL residents had lower risk of hospitalization (hazard ratio (HR) = 0.85, P < .001) and ED visit (HR = 0.92, P < .001); however, less ADL improvement (β = 0.29 (29% less of total independence in one ADL)); and patients living alone had lower risk of hospitalization (HR = 0.94, P < .001) and ED visit (HR = 0.93, P < .001), yet more ADL improvement (β = −0.15 (15% more of total independence in one ADL)). CONCLUSION In the national population of Medicare HH recipients, patients living with others at home had the highest risk of hospitalization and ED visits, whereas AL residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits, meaning that combined support from HH and AL reduces acute care admissions. Evidence‐based interventions are needed for HH patients living with others at home to avoid unnecessary acute care use.

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Section: Discussionmentioning

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Wang

Ying

Temkin‐Greener

et al. 2020

J American Geriatrics Society

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“…A major challenge within Canada is in shifting health care resources towards prevention given our healthcare system is primarily designed to reactively address acute and episodic health issues for older adults with complex health conditions [60,61]. Older adults with multiple and complex health conditions often experience worse health outcomes after an acute care hospitalization; however, they are less likely to receive the rehabilitative care they require once returning home in the community [62]. Additional research is required to understand the availability and usage of home care services that support patients with complex needs and to identify the best place and point in time to connect older adults with home care services they require for health promotion, rehabilitation, and prevention of worsening health conditions leading to hospitalization [62].…”

Section: Discussionmentioning

confidence: 99%

“…Canada's relatively low investment in home care services does not re ect the growing need for home care services and the importance these community-based services have in preventative and rehabilitative care to reduce high costs across other healthcare services. Home care services are a critical piece of the public health system and care continuum that can help to reduce costs, such as avoiding unnecessary hospitalization and improving the health and care of older adults by reducing the number of transitions between health services, hospital re-admission, and premature admission to LTC [62]. Now more than ever there is a need for investing in the availability and types of home care services across communities, speci cally to improve supports available for unpaid caregivers such as increasing the number of service hours, access to a greater range of rehabilitative services, and to improve uptake of home care services earlier before a health decline occurs to ensure older adults have appropriate care and the choice to remain at home as long as possible.…”

Section: Discussionmentioning

confidence: 99%

Hospital to Home: Supporting the Transition from Hospital to Home for Older Adults

Barber

Weeks

Steeves-Dorey

et al. 2021

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Background: An increasing proportion of older adults experience avoidable hospitalizations, and some are potentially entering long-term care homes earlier and often unnecessarily. Within Canada, approximately 10 percent of newly admitted long-term care residents could have potentially been cared for at home. Without adequate support from health care services to transition older adults from hospital to home, they often lack access to appropriate services when they are needed in the community thus making them more vulnerable to avoidable hospital visits, rapid deterioration of health, and earlier and unnecessary placement into residential long-term care. The purpose of this study was to collaborate with an existing enhanced home care program called Home Again in Halifax, Nova Scotia, to identify factors that contribute to older adult patients being assessed as requiring long-term care when they could potentially return home with enhanced supports. Methods: Through a retrospective case study design, we analyzed nine interviews for three focal patient cases including older adult patients, their family or friend caregivers, and healthcare professionals. Results: Findings indicate home care services for older adults are being sought too late, after hospital re-admission, or a rapid decline in health status when family caregivers are already experiencing caregiver burnout. Limitations in home care services ultimately led to barriers preventing family caregivers from continuing to care for older adults at home, such as absence of overnight services, a lack of information about home care services, and a lack of knowledge to navigate resources available. Conclusion: This study contributes knowledge about gaps within home care and transitional care services, highlighting the significance of investing in additional home care services for rehabilitation and the prevention of rapidly deteriorating health when older adults are discharged home after their first hospital visit. By understanding experiences and challenges of patients, family or friend caregivers, and healthcare professionals, we identified ways to reduce healthcare costs and improve the delivery and quality of home care services to better support older adult patients and their family or friend caregivers and to ensure hospitalized older adults are not unnecessarily admitted to nursing homes.

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“…Indeed, much debate exists regarding whether and how transitions to postacute care providers such as SNF and HHC may render better outcomes for patients. 18,[23][24][25] In spite of the vulnerability and increased risk of hospitalization among AL residents, our knowledge is limited about these referrals among AL residents and their relationship to subsequent patient outcomes. No published study has used national data to examine the post-acute care transitions of Medicare beneficiaries residing in ALs and their subsequent outcomes.…”

Section: Introductionmentioning

confidence: 99%

Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities

Wang

Mao

McGarry

et al. 2022

J American Geriatrics Society

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Background Despite the rapid growth of assisted living (AL) and frequent hospitalizations among AL residents, little is known about their patterns of post‐acute care transitions and outcomes. This study examined the post‐acute care transitions among AL residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Methods This study used data from 2018 national Medicare enrollment and claims datasets, the Minimum Data Set (MDS), and Medicare Provider Analysis and Review (MedPAR) of 104,497 unique Medicare beneficiaries residing in ALs in the U.S. Post‐acute care referrals, based on hospital discharge status, to skilled nursing facilities (SNF), home with home health care (HHC), home without HHC, and other settings. Outcomes included 30‐day and 60‐day hospital readmissions, emergency department (ED) visits, long‐stay care nursing home placement, and mortality. Multinomial logistic regression analysis and logistic regression analysis were conducted. Results The most common post‐acute care referral was to SNF (40%), followed by home without HHC (28%), home with HHC (17%), and others (15%). Compared to discharge home without HHC, discharge to SNF was associated with a lower likelihood of ED visits (Odds Ratio = 0.597, p < 0.01) and hospital readmissions (OR = 0.856, p < 0.001), and higher likelihood of long‐stay nursing home placement (OR = 11.224, p < 0.01) and mortality (OR = 2.025, p < 0.01). Discharge home with HHC was associated with a higher likelihood of hospital readmissions (OR = 1.148, p < 0.01) and a lower likelihood of long‐stay nursing home placement (OR = 0.737, p < 0.05) than discharge home without HHC. The results were similar within the first 30 days as well as 60 days after hospital discharge. Conclusions AL residents who are discharged to different post‐acute care settings tend to differ in 30‐day and 60‐day outcomes. At hospital discharge, clinicians and discharge planners should be provided information about the exact type and availability of services at AL to make the most appropriate discharge referrals for AL residents.

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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

Cited by 8 publications

References 45 publications

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Hospital to Home: Supporting the Transition from Hospital to Home for Older Adults

Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities

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