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

Abstract

Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL) and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, while patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p-value=0.0284). Tracking individual patient

Developing 60-Day Readmission Risk Score among Home Healthcare Patients with Heart Failure

“…This study was a secondary data analysis of HHC patients with HF using the OASIS-C version that was used to develop the predictive model for allcause 60-day readmissions in the previous studies (Kang et al, 2016(Kang et al, , 2017(Kang et al, , 2020. The dataset was from a large HHC company with multiple agencies in one state, which provided the de-identified admission, transfer, and discharge OASIS-C data.…”

“…OASIS has been updated since its inception in 1999; the current version is E, initiated on January 1, 2023 (OASIS-E Guidance Manual). For this study, a convenience sample of OASIS-C data collected between 2011 and 2013 by HHC nurses was used (Kang et al, 2016(Kang et al, , 2017(Kang et al, , 2020. There were nearly 100 items in OASIS-C, and the number of OASIS-C items is different across time points.…”

“…Risk of HF readmission is multifactorial and due in large part to the multimorbidity common in older adults (Kang et al, 2020; van Walraven et al, 2015). According the Centers for Medicare and Medicaid Services, 55% of HF patients have more than five comorbidities (Moe, 2016), complicating HF management and leading to increased morbidity and mortality (van der Wal et al, 2017).…”

Demonstration of an Analytic Process using Home Health Care Electronic Health Records: A Case Example Exploring the Prevalence of Patients with a Substance Use History and a Venous Access Device

“…Although study findings from quantitative analyses of home health EHRs exist, 13,14 the details of the analytic process are rarely described. Given the merits and challenges of using data from EHRs, a case example of using EHRs for research or quality improvement purposes can help researchers and field clinicians in home health care understand potential usefulness and limitations while developing a better understanding of the analysis process.…”

Pain in Homebound Older Adults with Heart Failure after Hospital Discharge

“…Nearly 30% of Medicare beneficiaries with HF receive home healthcare services following hospital discharge (Middleton et al, 2019). These services typically include intermittent skilled care from a nurse, physical therapist, occupational therapist, home health aide, social worker, or speech therapist (Kang et al, 2020; Wang et al, 2017). However, pain experiences and management practices among homebound older adults with HF after hospital discharge remain poorly understood.…”