Community-Level Association Between Home Health and Nursing Home Performance on Quality and Hospital 30-Day Readmissions for Medicare Patients

Wang, Yun; Pandolfi, Michelle M.; Fine, Jonathan; Metersky, Mark L.; Wang, Changqin; Ng, Beng Koon; Galusha, Deron; Nuti, Sudhakar V.; Murugiah, Karthik; Spenard, Ann; Elwell, Timothy; Krumholz, Harlan M.

doi:10.1177/1084822316639032

Cited by 9 publications

(13 citation statements)

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“…Better performance may lead to better care. The association between nursing home and home health performance in quality of care and outcomes has been studied . For example, one study found that individuals receiving care in higher‐quality skilled nursing facilities had lower readmission rates (18%) than those in lower‐quality skilled nursing facilities (22%) .…”

Section: Discussionmentioning

confidence: 99%

“…For example, one study found that individuals receiving care in higher‐quality skilled nursing facilities had lower readmission rates (18%) than those in lower‐quality skilled nursing facilities (22%) . Another study found that improving nursing home and home health performance was associated with lower community‐level risk‐standardized readmission rates . The existing standard is that all agencies should achieve the highest score for quality care.…”

Section: Discussionmentioning

confidence: 99%

“…Medicare‐certified home health agencies, which provide a comprehensive array of in‐home services, including home health aide assistance, social work, nursing, occupational therapy, physical therapy, and speech therapy, serve a critical role in caring for individuals receiving ongoing outpatient care or who have been discharged from a nursing home or hospital . High‐quality home health care can benefit individuals and health systems by improving individuals' health status and quality of life, shortening hospital stays, lowering hospital costs, and preventing unplanned readmissions . As the population in the United States ages and the number of elderly individuals grows (from 45 million in 2015 to a projected 84 million in 2050), the provision of high‐quality home health care is an increasingly important component of the U.S. healthcare system.…”

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confidence: 99%

“…Despite increased attention to the quality of home health care, data about the quality of performance of agencies and variation in performance are limited . Prior studies have largely focused on home health care use and services .…”

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confidence: 99%

“…1,2 High-quality home health care can benefit individuals and health systems by improving individuals' health status and quality of life, shortening hospital stays, lowering hospital costs, and preventing unplanned readmissions. [3][4][5][6][7][8][9][10][11][12][13][14] As the population in the United States ages and the number of elderly individuals grows (from 45 million in 2015 to a projected 84 million in 2050), 15 the provision of high-quality home health care is an increasingly important component of the U.S. healthcare system. Given that home health agencies provide the majority of home health care in this country, there are increasing national efforts to monitor and improve the quality of agency performance.…”

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confidence: 99%

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Home Health Agency Performance in the United States: 2011–15

Wang

Spatz

Tariq

et al. 2017

J American Geriatrics Society

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OBJECTIVES To evaluate home health agency quality performance. DESIGN Observational study. SETTING Home health agencies PARTICIPANTS All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. MEASUREMENTS Twenty-two quality indicators, five patient survey indicators, and their composite scores. RESULTS The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011–12 to 2014–15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. CONCLUSION Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Home Health Agency Performance in the United States: 2011–15

Wang

Spatz

Tariq

et al. 2017

J American Geriatrics Society

Self Cite

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Does Home Health Care Increase the Probability of 30-Day Hospital Readmissions? Interpreting Coefficient Sign Reversals, or Their Absence, in Binary Logistic Regression Analysis

Papadopoulos

Stark²

2020

The American Statistician

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Home Health Agency Factors Associated With Acute Care Hospitalization and Emergency Department Use

Osakwe

Sosina

Agu

et al. 2020

Home Healthcare Now

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We linked the Medicare Provider Utilization and Payment Data for Home Health and the Home Health Compare data for the year 2016 to identify home healthcare agency (HHA) characteristics associated with acute care hospitalization (ACH) or emergency department (ED) use. The study cohort consisted of 9,800 HHAs. Beta regression was used to examine the association between average age, race/ethnic composition, number of skilled nursing visits, number of therapy visits, percentage of dual eligible patients, HHA ownership, HHA location, Medicare tenure, proportion of patients with a diagnosis of schizophrenia, stroke, diabetes, depression, chronic obstructive pulmonary disease (COPD), heart failure, cancer and Alzheimer disease, and ACH or ED use. After controlling for HHA-level characteristics, variations in HHAs' ACH and unplanned ED visits were found. For-profit HHAs were significantly less likely to have patients with ACH. (Odds ratio = -0.05, p = 0.020), HHAs in the Midwest, South, and West had lower odds of ACH. HHAs that serve more than 50% Black patients had significantly decreased odds (β = -0.16, p < 0.001) of ACH. A 1-unit increase in the proportion of patients with a diagnosis of schizophrenia, COPD, stroke, heart failure, and Alzheimer disease was associated with increased odds of hospitalization. For each unit increase in the number of skilled nursing visits, the odds of ACH increased by 0.02 (p = 0.001). For-profit and nonprofit HHAs had a significant decrease in the odds of unplanned ED visits (p < 0.05). An increase in the proportion of patients with COPD was associated with increased odds of unplanned ED visits (p < 0.001). HHA characteristics are associated with hospitalization and ED use without hospitalization. These characteristics point to variation in quality of care measured by ACH and ED use.

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Community-Level Association Between Home Health and Nursing Home Performance on Quality and Hospital 30-Day Readmissions for Medicare Patients

Cited by 9 publications

References 28 publications

Home Health Agency Performance in the United States: 2011–15

Home Health Agency Performance in the United States: 2011–15

Does Home Health Care Increase the Probability of 30-Day Hospital Readmissions? Interpreting Coefficient Sign Reversals, or Their Absence, in Binary Logistic Regression Analysis

Home Health Agency Factors Associated With Acute Care Hospitalization and Emergency Department Use

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