Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Home Health Care

Abstract

Background: Beginning in 2019, home health agencies’ rates of potentially preventable hospital readmissions over the 30 days following discharge will be publicly reported. Objectives: Our primary objective was to determine the association between patients’ functional status at discharge from home health care and 30-day potentially preventable readmissions. A secondary objective was to identify the most common conditions resulting in potentially preventable readmissions. Design: Retrospective cohort study Setting: Community Participants: 1,510,297 Medicare fee-for-service beneficiaries discharged from home health care in 2013–2015. Average age was 75.9 (SD, 10.9) years, 60.0% were female, and 84.2% non-Hispanic white. Measurements: 30-day potentially preventable readmissions following home health discharge. Functional status measures included mobility, self-care, and impaired cognition. Results: The overall rate of 30-day potentially preventable readmissions was 2.6% (N=39,452), which accounted for 40% of all 30-day readmissions. After adjusting for sociodemographic and clinical characteristics, the odds ratios (OR) for the most dependent score quartile versus the most independent was 1.58 (95% CI: 1.53–1.63) for mobility and 1.65 (95% CI: 1.59–1.69) for self-care. The OR for impaired versus intact cognition was 1.21 (95% CI: 1.18–1.24). The five most common conditions resulting in a potentially preventable readmission were congestive heart failure (23.6%), septicemia (16.7%), bacterial pneumonia (9.8%), chronic obstructive pulmonary disease (9.4%), and renal failure (7.5%). Conclusions: Functional limitations at discharge from home health are associated with increased risk for potentially preventable readmissions. Future research is needed to determine whether improving functional independence decreases the risk for potentially preventable readmissions following home health care.

Association of cognitive impairment severity with potentially avoidable readmissions: A retrospective cohort study of 8897 older patients

“…Respiratory infection was also found to be a major cause of readmission in our study population, which was consistent with previous findings 6,7,11 . Severe cognitive impairment is a risk factor of dysphagia that can lead to aspiration pneumonia 42,43 .…”

“…To inform and improve the development of preventive strategies, it is important to consider the possible mechanisms through which later‐stage cognitive impairment increases the risk of PAR. Our finding that congestive heart failure is one of the most common reasons for PAR was consistent with previous studies conducted in the United States and Japan 6,8,11 . Moreover, heart failure is a target condition for the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program 35 .…”

Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia

“… 4 , 5 , 6 , 7 , 8 Studies have identified an inverse association between functional status and risk of hospital readmission. 9 , 10 , 11 , 12 In addition, there is a growing body of literature on the detrimental effects of acute care hospitalization on functional independence. 13 , 14 , 15 , 16 Loyd et al 14 reported that 30% of adults aged 65 years and older who were hospitalized in medical-surgical acute care experienced hospital-associated disability, defined as loss of independence in activities of daily living (ADLs) following acute hospitalization.…”

Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services

“…Several studies have demonstrated that the presence of pain was one of the risk factors for rehospitalization among patients with HF (Kang et al, 2016;Madigan et al, 2012a). A number of studies have examined functional status among patients with HF during home healthcare as it is known to be associated with HF however none have explored the link between symptoms and functional status (Fergenbaum et al, 2015;Madigan et al, 2012b;McClintock et al, 2014;Middleton et al, 2019;Sezgin et al, 2017). Moreover, there is an absence of studies using OASIS data that have examined the relationship between pain and functional status among HF patients.…”