Risk Factors for Hospitalization Among Medicare Home Care Patients

Abstract

This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.

In Hospital We Trust: Experiences of older peoples' decision to seek hospital care

“…31 This is particularly important as it has been suggested that home health care nurses in U.S. have the competence to identify patients with higher risk of readmission. 14 According to the participants in the present study, good health care involves quality as well as availability of health care. These results indicate that the participants had perceptions about what health care quality they wanted for one self.…”

“…Quantitative studies have focused on factors related to the hospital setting 10e12 as well as on risk factors related to measurable patient characteristics and health outcomes to reduce avoidable hospitalization and rehospitalization. 1,13,14 It has been shown that the risk for hospitalization among home health care patients increases with decreased functional ability, 14 lacking informal care, and incidence of chronic conditions as congestive heart failures (CHF), respiratory problems, wound problems and diabetes. 14,15 However, reasons for seeking hospital care seem to be more complex than can be captured by quantitative data.…”

Regardless of Age: Incorporating Principles from Geriatric Medicine to Improve Care Transitions for Patients with Complex Needs

“…31 SHHC agencies perform a comprehensive assessment of all admissions to SHHC, but they currently lack the means by which to effectively track care transitions, 28 in part because SHHC providers are not immediately aware of when patients are re-hospitalized. 32 SHHC agencies are required to submit patient-level and agency-level data on process and outcome measures to CMS, but these measures do not provide information on satisfaction with care during transitions and subsequent hospital utilization. Recommendations: SHHC agencies must be actively engaged as "receivers" in care transitions improvement efforts.…”

Preliminary Assessment of Appropriateness of Emergency Care Service Use: Actions Taken and Consultations Obtained Before Emergency Care Presentation

“…Previous studies have addressed issues related to care transitions (e.g., Coleman et al, 2006;Fortinsky, Madigan, Sheehan, Tullai-McGuinness, & Fenster, 2006;Parry, Kramer, & Coleman, 2006;Parry, Mahoney, Chalmers, & Coleman, 2008;Parry, Min, Chugh, Chalmers, & Coleman, 2009;Rosati & Huang, 2007;Rosati, Huang, Navaie-Waliser, & Feldman, 2003). Some of them focused on Medicare populations but mostly they looked at rehospitalization.…”