Home-Time After Discharge Among Patients Hospitalized With Heart Failure

Greene, Stephen J.; O’Brien, Emily C.; Mentz, Robert J.; Luo, Nancy; Hardy, N. Chantelle; Laskey, Warren K.; Heidenreich, Paul A.; Chang, Che Shoa; Turner, Stuart; Yancy, Clyde W.; Hernandez, Adrian F.; Curtis, Lesley H.; Peterson, Pamela N.; Fonarow, Gregg C.; Hammill, Bradley G.

doi:10.1016/j.jacc.2018.03.517

Cited by 81 publications

(78 citation statements)

References 37 publications

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“…For most lay persons, interpretation of treatment effect, summarized as a gain or loss in home time, is more intuitive than relative risks or hazard ratios. For these reasons, home time has been examined in relation to mortality in heart failure [3][4][5] as well as global disability and modified Rankin score in stroke [6][7][8][9][10][11] in administrative claims data sets. For example, warfarin therapy in Medicare beneficiaries with atrial fibrillation who were hospitalized for ischemic stroke was associated with a 48-day gain in home time over 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the number of days alive and spent out of hospitals and skilled nursing facilities (SNFs) in a given time period, also known as "home time," has been proposed as a measure of quality of life. 2 Home time can be conveniently obtained from administrative claims data and has been endorsed by patients as a meaningful health outcome, [3][4][5][6][7][8][9][10][11] and it can be more intuitively understood. However, not all hospitalizations and SNF stays represent poor health or low quality of life in older adults.…”

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confidence: 99%

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Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Lee

Shi

Kim

2018

J American Geriatrics Society

131

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BACKGROUND Home time, the number of days alive and spent out of hospital and skilled nursing facility, has been proposed as a patient‐centered outcome that can be readily calculated in administrative claims data. OBJECTIVES To compare home time against existing patient‐centered outcome measures. DESIGN Retrospective cohort study. SETTING Community. PARTICIPANTS A total of 4594 Medicare beneficiaries 65 years or older with complete survey and claims data in the Medicare Current Beneficiary Survey 2010 to 2011. MEASUREMENTS Home time was calculated from the 2011 claims data (range, 0‐365 days). The 1‐year incidence of patient‐centered outcomes (poor self‐rated health, mobility impairment, depression, limited social activity, and difficulty in self‐care) was measured. The minimum clinically important difference (MCID) was derived by contrasting the mean home time between those who experienced functional decline or death and those who did not. RESULTS The mean home time was 355.8 days (SD, 42.1 days); 84.1% had a home time of 365 days, and 5.7% had a home time of 336 days or fewer. The incidence of poor self‐rated health ranged from 2% (home time, 365 days) to 21% (home time, less than 337 days). Similarly, the corresponding incidence risks were 11% to 59% for mobility impairment, 5% to 19% for depression, 17% to 67% for limited social activity, and 13% to 68% for difficulty in self‐care. The risk of mobility impairment, depression, and difficulty in self‐care increased steeply after home time loss of 15 days or greater. The MCID of home time was 18.6 days. CONCLUSION A loss in home time is associated with decline in several patient‐centered outcome measures in community‐dwelling Medicare beneficiaries. These results provide empirical evidence to promote adoption of home time and its clinical interpretation for database studies of medical interventions. J Am Geriatr Soc 67:347–351, 2019.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Lee

Shi

Kim

2018

J American Geriatrics Society

131

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“…The utilisation of state wide administrative data sets and national death index ensured accurate capture of the complex interplay between length of stay, readmission and death, which increases its validity to different healthcare systems . Other outcomes may be more relevant to patients in this elderly cohort such as home time over 1 year …”

Section: Discussionmentioning

confidence: 99%

Cardio‐geriatric model of care in acute heart failure: initial experience of a multidisciplinary approach in complex elderly patients

Mulligan

Seman

Abramowski

et al. 2020

Internal Medicine Journal

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“…Total hospital encounters, a composite outcome defined as an ED visit with or without hospitalization, was included as a patient‐centered outcome given that patients are unaware if they need to be hospitalized when seeking ED care. We also examined days at home over 1 year as the total days alive from the admission date minus days spent in a hospital, facility, or skilled nursing home . Home time is an outcome correlated with patient‐reported outcomes and reflects the burden of hospital use among seriously ill patients, and it is a patient‐centered metric that can be feasibly obtained from administrative data …”

Section: Methodsmentioning

confidence: 99%

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Lee

Streid

Sturgeon

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Few studies examine the impact of frailty on long-term patient-oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1-year outcomes. DESIGN: Retrospective cohort study using 2008 to 2014 Medicare claims. SETTING: Acute care hospitals. PARTICIPANTS: Patients 65 years or older who received one of the five EGS procedures with the highest mortality burden (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy). MEASUREMENTS: A validated claims-based frailty index (CFI) identified patients who were not frail (CFI < .15), prefrail (.15 ≤ CFI < .25), mildly frail (.25 ≤ CFI < .35), and moderately to severely frail (CFI ≥ .35). Multivariable Cox regression compared 1-year mortality. Multivariable Poisson regression compared rates of post-discharge hospital encounters (hospitalizations, intensive care unit stay, emergency department visit) and home time over 1 year after discharge. All regression models adjusted for age, sex, race, admission from facility, procedure, sepsis, inpatient palliative care delivery, trauma center designation, hospital bed size, and teaching status, and they were clustered by patient and hospital referral region. RESULTS: Among 468 459 older EGS adults, 37.4% were pre-frail, 12.4% were mildly frail, and 3.6% were moderately to severely frail. Patients with mild frailty experienced a higher risk of 1-year mortality compared with non-frail patients (hazard ratio = 1.97; confidence interval [CI] = 1.94-2.01). In the year after discharge, patients with mild and moderate to severe frailty had more hospital encounters compared with non-frail patients (7.8 and 11.5 vs 2.0 per person-year; incidence rate ratio [IRR] = 4.01; CI = 3.93-4.08 vs IRR = 5.89; CI = 5.70-6.09, respectively). Patients with mild and moderate to severe frailty also had fewer days at home in the year after discharge compared with non-frail patients (256 and 203 vs 302 mean days; IRR = .97; CI = .96-.97 vs IRR = .95; CI = .94-.95, respectively). CONCLUSION: Older EGS patients with frailty are at increased risk for poor 1-year outcomes and decreased home time. Targeted interventions for older EGS patients with frailty during the index EGS hospitalization are urgently needed to improve long-term outcomes.

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Home-Time After Discharge Among Patients Hospitalized With Heart Failure

Cited by 81 publications

References 37 publications

Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Cardio‐geriatric model of care in acute heart failure: initial experience of a multidisciplinary approach in complex elderly patients

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

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