Effectiveness of home health care in reducing return to hospital: Evidence from a multi-hospital study in the US

Siclovan, Danielle M.; Bang, James T.; Yakusheva, Olga; Hamilton, Morris; Bobay, Kathleen L.; Costa, Linda L.; Hughes, Ronda G.; Miles, Jane; Bahr, Sarah J.; Weiss, Marianne

doi:10.1016/j.ijnurstu.2021.103946

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…31 Readmissions could also be affected by the skill level of health care nurses and legal concerns, which may influence nurses to favor a cautious approach, recommending returns to the hospital in order to avoid negative outcomes at home. 32 Future studies should investigate the implementation of educational programs in hospitals to provide increased supportive care and education. In a pilot study, Graboyes et al started an informational program for patients who had HNC, to educate the patient and the caregiver.…”

Section: Discussionmentioning

confidence: 99%

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Discharge destination and readmissions among patients with head and neck cancer

Tucker

Hollenbeak

Goyal

2022

Laryngoscope Investig Oto

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Objective Lowering hospital readmission rates is a national goal, and presents an opportunity to lower health care costs, improve quality, and increase patient satisfaction. We aim to assess whether discharge disposition is associated with readmission. Methods A retrospective cohort study using logistic regression to quantify risk factors of hospital readmission in patients with confirmed head and neck cancer (HNC) who underwent surgery from 2010 to 2018 contained in the Pennsylvania Health Care Cost Containment Council database, which includes patients treated in Pennsylvania hospitals. Results The readmission rate in this study was 18.1%. Cancers of the hypopharynx had the highest rates of readmission (29.2%). Male sex (odds ratio [OR]: 0.87, 95% CI: 0.75–1.00), emergent admission (vs. elective admission: OR = 1.33, 95% CI: 1.02–1.74), discharge to home health (vs. home: OR = 1.85, 95% CI: 1.59–2.16), discharge to skilled nursing facility (SNF) (vs. home: OR = 2.21, 95% CI: 1.80–2.72), and having 4+ comorbidities (vs. 0–1: OR = 1.39, 95% CI: 1.09–1.76) were significant risk factors for hospital readmission. Conclusion It is necessary to consider the readmission risk associated with HNC patients. Reasons for readmission are multifactorial and can be related to demographics, hospital course, comorbidities, or discharge disposition–this requires further assessment. There is importance in increasing HNC awareness and staff education about the unique needs of this population. Level of Evidence 4.

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Section: Discussionmentioning

confidence: 99%

“…Patients are more likely to visit the emergency department on the day of a home health care visit 31 . Readmissions could also be affected by the skill level of health care nurses and legal concerns, which may influence nurses to favor a cautious approach, recommending returns to the hospital in order to avoid negative outcomes at home 32 …”

Section: Discussionmentioning

confidence: 99%

Discharge destination and readmissions among patients with head and neck cancer

Tucker

Hollenbeak

Goyal

2022

Laryngoscope Investig Oto

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“…While some studies have found HHC to be associated with improved symptoms and reduced hospitalization rates, 8,9 other studies have found the opposite-that HHC is associated with increased hospitalization and readmission rates among Medicare beneficiaries. 6,10 One reason may be because patients who receive HHC are often medically complex and require higher levels of care than what can be provided at home. However, another reason may be that HHC itself is sub-optimally delivered, with care poorly coordinated across various HHC agency staff and medical providers in the health system.…”

Section: Introductionmentioning

confidence: 99%

Self‐reported gaps in care coordination and preventable adverse outcomes among older adults receiving home health care

Sterling

Lau

Rajan

et al. 2022

J American Geriatrics Society

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Background Older adults see multiple outpatient providers and increasingly use home health care (HHC) services. Previous studies attempting to draw inferences about the association between HHC use and patient outcomes have been mixed. Whether HHC is associated with care coordination and how both influence outcomes are unknown. In addition, prior studies have not taken the patient perspective into account. We examined the association between receiving HHC and self‐reported gaps in care coordination and separately, preventable adverse outcomes. Methods The analysis for this cross‐sectional study was conducted between October 2021 and June 2022, using data on 4296 Medicare beneficiaries from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who completed a survey on care coordination from 2017 to 2018. The associations between the receipt of HHC and two outcomes (a gap in care coordination, and separately, a preventable adverse event) were examined with Poisson models with robust standard errors. Potential confounders were accounted for through propensity score‐based inverse probability weighting. Results Among 4296 participants, 430 (10%) received HHC and they were older and had more comorbidities and ambulatory visits than those without HHC. HHC was not associated with differences in self‐reported gaps in care coordination (33.3% HHC vs. 32.5% no‐HHC, p = 0.70). HHC recipients reported more preventable drug–drug interactions (9.1% vs. 4.0%, p < 0.001) but not more preventable ED visits or hospital admissions. In IPW‐adjusted models, HHC was not associated with gaps in care coordination (p = 0.60) but was associated with double the risk of a preventable adverse outcome (aRR 2.06; CI: 1.37, 3.10, p < 0.001). Conclusions HHC recipients were significantly more likely (than those without HHC) to report a potentially preventable adverse event (particularly a drug–drug interaction), suggesting an opportunity to improve patient safety by leveraging the observations of older adults receiving HHC.

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“…3,4 Evidence from randomized as well as observational studies of patients referred to or receiving HHC services suggests that readmission rates can be reduced with HHC. [5][6][7][8] Differences among race and ethnic groups in referral rates to HHC have been reported. For example, referral rates at hospital discharge were lower for Hispanic and American Indian patients than White patients in an analysis of a national sample of Medicare claims from 2014 to 2016 for discharges after diabetes-related index hospitalizations.…”

mentioning

confidence: 99%

“…Hospital discharge with referral to HHC is a strategy for reducing acute care length of stay and costs 3,4 . Evidence from randomized as well as observational studies of patients referred to or receiving HHC services suggests that readmission rates can be reduced with HHC 5–8 …”

mentioning

confidence: 99%

Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients

Yakusheva,

Lee,

Keller

et al. 2023

Medical Care

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Background: Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. Objective: To examine how the association of nurse assessments of patients’ readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. Research Design: Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014–03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. Subjects: All Medicare patients in the study’s intervention arm (n=14,684). Measures: Patient’s race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient’s Readiness for Hospital Discharge Scale (RHDS) score (0–10 scale) assessed by the discharging nurse on the day of discharge. Results: Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18–8.24), non-Hispanic Black (8.20; 95% CI: 8.12–8.28), Hispanic (7.92; 95% CI: 7.81–8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01–8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3–30.3; White: 32.6%, 95% CI: 31.1–34.1). Conclusions: Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.

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Effectiveness of home health care in reducing return to hospital: Evidence from a multi-hospital study in the US

Cited by 9 publications

References 27 publications

Discharge destination and readmissions among patients with head and neck cancer

Discharge destination and readmissions among patients with head and neck cancer

Self‐reported gaps in care coordination and preventable adverse outcomes among older adults receiving home health care

Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients

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