Predictors of functional capacity changes in a US population of Medicare home health care (HHC) patients with heart failure (HF)

Abstract

Purpose Functional capacity is widely recognized as a key factor in maintaining the ability of older people to live independently and safely at home. Promoting functional capacity is an important priority particularly in home health care (HHC). The purpose of the study was to examine predictors of functional capacity change among HHC patients with heart failure (HF). Materials and methods Clinical and administrative data from 2005 from the Medicare Chronic Conditions Warehouse were linked at the population level for HHC patients with a primary diagnosis of HF. The primary outcome was change in functional capacity score from HHC admission to HHC discharge. Results Over the course of the episode (M = 44 days), most (70%) patients improved, 15.6% stayed the same, and 14.4% declined in ADL scores. The mean change score was modest (mean = −0.74, SD = 1.11) with a median change of −0.58. Multivariate analyses (R2 = .23) showed that the largest influence was the admission ADL score followed by receiving any physical therapy, admission ability to manage oral medications, cognitive functioning, rehabilitation prognosis, and urinary incontinence. Discussion There is a modest rate of improvement from admission to discharge that likely represents the progressive nature of HF and/or the short time frames over which home health care is provided. Providers may want to use the predictive factors to identify patients most at risk for functional decline.

Clinical Outcomes and Quality of Life of Home Health Care Patients

“…Functional status is important because it is necessary for independent living and QOL (Scharpf & Madigan, 2010; Shaughnessy et al, 2002. Most recently, Madigan et al (2012) reiterated the importance of functional capacity as a key factor in maintaining the ability of older people to live independently and safely at home and as a key focus area for home health care. In this study, both clinical outcomes (in terms of ADL and IADL) and QOL were significantly improved at discharge or 60 days compared with the levels at the start of care.…”

Assessment of Activity of Daily Living Among Older Adult Patients in Home Healthcare and Skilled Nursing Facilities

“…Among the eight reviewed articles, five were cross sectional studies (Lee, 2006; Leland et al 2015; Madigan et al, 2012; Scharpf & Madigan, 2010; Wysocki, Thomas & Mor, 2015), one quasi experimental study (Tinetti, Charpentier, Gottschalk & Baker., 2012), one prospective cohort study (Thygesen, Saevereid, Linstrom, Nygaard & Engedal, 2009) and one retrospective cohort study (Jung, Trivedi, Grabowski et al, 2016). Four of the studies were conducted in HHC settings (Thygesen et al, 2009; Scharpf et al, 2010; Madigan et al, 2012 & Tinetti et al, 2012) and four in SNF (Lee, 2006; Wysocki et al, 2015; Leland et al, 2015 & Jung et al, 2016).…”

“…Four of the studies were conducted in HHC settings (Thygesen et al, 2009; Scharpf et al, 2010; Madigan et al, 2012 & Tinetti et al, 2012) and four in SNF (Lee, 2006; Wysocki et al, 2015; Leland et al, 2015 & Jung et al, 2016). Of the 4 HHC studies, one was conducted in a single site (Tinetti et al 2012), one in a multi city HHC in Norway (Thygesen et al, 2009), and 2 used large representative samples from the United States (Madigan et al 2012; Scharpf, et al 2010). Of the 4 studies conducted in SNF, 3 used large national data sets (Jung et al 2016; Leland et al, 2015 & Wysocki et al, 2015), and one was a single site study (Lee, 2006).…”

“…Of the 4 studies conducted in SNF, 3 used large national data sets (Jung et al 2016; Leland et al, 2015 & Wysocki et al, 2015), and one was a single site study (Lee, 2006). Two studies used the Andersen Model of Health Services Utilization (Madigan et al, 2012; Thygesen et al, 2009) to guide the analyses. Study sample sizes ranged from 131 to 1,023,036.…”

“…2006; Madigan et al, 2012; Tinetti et al, 2012; Tao et al, 2012 & Wysocki et al, 2015) and one HHC study (Tinetti et al, 2012) focused on Medicare patients only. Two HHC studies (Scharpf et al, 2010; Madigan et al, 2012) included Medicaid and Medicare patients.…”