Risk Factors for Hospitalization in a National Sample of Medicare Home Health Care Patients

Abstract

Acute care hospitalization during or immediately following a Medicare home health care (HHC) episode is a major adverse outcome, but little has been published about HHC patient-level risk factors for hospitalization. We determined risk factors at HHC admission associated with subsequent acute care hospitalization in a nationally representative Medicare patient sample (n=374,123). Hospitalization was measured using Medicare claims data; risk factors were measured using Outcome Assessment and Information Set data. Seventeen percent of sample members were hospitalized. Multivariate logistic regression analysis found that the most influential risk factors (all p<.001) were: skin wound as primary HHC diagnosis; clinician-judged guarded rehabilitation prognosis; congestive heart failure as primary HHC diagnosis; presence of depressive symptoms; dyspnea severity; and Black, compared to White. HHC initiatives that minimize chronic condition exacerbations, and that actively treat depressive symptoms, might help reduce Medicare patient hospitalizations. Unmeasured reasons for higher hospitalization rates among Black HHC patients deserve further investigation.

Factors associated with unexpected admissions and mortality among low‐functioning older patients receiving home medical care

“…Several studies have reported that low BADL was associated with hospitalization or death . In the current study, we did not find an association between BADL and poor prognosis.…”

“…Several studies have reported that low BADL was associated with hospitalization or death. [16][17][18][19][20][21] In the current study, we did not find an association between BADL and poor prognosis. Because ONEHOME participants were skewed to very low BADL, this might have obscured the significance of BADL as a factor.…”

Utilizing Home Healthcare Electronic Health Records for Telehomecare Patients With Heart Failure

“…1–6 Studies of the causes of rehospitalization reveal inconsistent patterns of risk factors for rehospitalizations in the home health care setting. 7–9 Due to the complex nature of HF, evaluating individual risk factors for rehospitalization in isolation may limit the ability of clinicians to optimally target health services such as telehomecare, which is a remote monitoring intervention used in the home health care setting. Instead, understanding associations among risk factors for rehospitalization using the standardized home health care electronic health records for Medicare recipients (i.e., the Outcome and Assessment Information Set (OASIS), which may be elucidated using data mining techniques, may provide guidance for admission assessments by home health care clinicians to help target those patients most likely to benefit from telehomecare, or who may need additional interventions.…”

“…Multiple studies have utilized the OASIS as administrative data to discover risk factors for hospitalization, 7,9,14,15 and two studies have used data mining techniques to evaluate the OASIS data set. 16,17 However, to our knowledge, no studies have applied these approaches to the OASIS-C version that was initiated in 2010, which we obtained from a large home health care company to identify risk factors for rehospitalization among telehomecare patients with HF.…”

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

“…13 Using claims data in a national sample of Medicare HH beneficiaries (N = 374,123), depressive symptoms were similarly identified as a risk factor for hospitalization. 12 Evidence that depression contributes to the risk of hospitalization in HH beneficiaries is important because depression is prevalent in this population and is potentially modifiable in the context of routine HH practice. Onequarter of HH beneficiaries experience depressive symptoms, and 14% meet criteria for major depressive disorder.…”