Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30‐ and 60‐Day Hospitalization: The Depression Care for Patients at Home Cluster‐Randomized Trial

Abstract

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services.

Effective mental health interventions to reduce hospital readmission rates: a systematic review

“…The evidence supporting mental health strategies as a mechanism to reduce readmissions is mixed; however, we did find evidence from two randomized controlled, and a multi-site randomized cluster trial, Villani (30), Roncella (31), and Bruce (32), that mental health strategies in the post-discharge period, can effectively reduce physical health readmissions. In all three studies, the post-discharge mental health intervention was delivered in-person.…”

“…Bruce and colleagues (32) used a cluster randomized trial to study the impact of a depression management protocol for older adult patients with positive Patient Health Questionnaire two-item (PHQ-2) depression screens. In the Bruce study, home health nursing supervisors across six different home care agencies were randomized to intervention and control groups.…”

Prevalence of and Factors Related to Prescription Opioids, Benzodiazepines, and Hypnotics Among Medicare Home Health Recipients

“…They frequently provide care over time and have unique opportunities to improve care management. For example, recent efforts to improve outcomes related to depression have produced positive patient outcomes and illustrate the effectiveness of training home care nurses to assist in managing specific conditions among the home care population (Bruce et al, 2011 and Bruce et al, 2016). From this vantage point, home health clinicians can assist in assessment, education, and monitoring in order to help reduce the risk of adverse outcomes associated with opioid prescription usage.…”

Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study

“…Mental health assessment is also beneficial to identify those with depressive symptoms who are not ready or able to be engaged in the plan of care. There is evidence of lower risk of hospitalizations when integrating depression care management into routine HH nursing care for patients screening positive for depression (Bruce, Lohman, Greenberg, Bao, & Raue, 2016). …”