scholarly journals FUNCTIONAL STATUS ASSOCIATED WITH RISK OF READMISSION DURING HOME HEALTH CARE FOR PATIENTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Sara Knox ◽  
Brian Downer ◽  
Allen Haas ◽  
Addie Middleton ◽  
Kenneth Ottenbacher
Keyword(s):  
Social Support ◽  
Health Care ◽  
Functional Status ◽  
Home Health Care ◽  
Self Care ◽  
Cognitive Status ◽  
Home Health ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Increased Risk

Abstract Approximately 14.0% of Medicare beneficiaries are readmitted to a hospital within 30-days of home health admission. Individuals with dementia account for 30% of all home health care admissions and are at high-risk for rehospitalizations. Our primary objective was to determine the association between functional status and social support at admission to home health and 30-day potentially preventable readmissions (PPR) during home health care. We conducted a retrospective cohort study of 124,119 Medicare beneficiaries receiving home health (7/2013 – 6/2015) and diagnosed with dementia (ICD-9 codes). Approximately 65% of participants were over the age of 81, 61% were female, and 80% were Caucasian. The primary outcome was 30-day PPR during home health. OASIS items were used to create mobility, self-care, social support, and cognition categories. The overall rate of 30-day PPR was 7.6% (95% CI: 7.4-7.7) but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratios (OR) for the most dependent score quartile versus the most independent was 1.68(1.56,1.80 95% CI) for mobility, 1.78 (95% CI: 1.66- 1.91) for self-care, and 1.10(95%CI: 1.03-1.17) for social support. The OR for impaired versus intact cognition was 1.12 (95% CI: 1.05-1.20). Impaired functional and cognitive status as well as limited social support at admission to home health care are associated with increased risk of PPR for individuals with dementia. Future research is needed to determine if strategies targeted at mobility and self-care can decrease PPR during home health for individuals with severe dementia.

scholarly journals GREATER DEMENTIA SEVERITY IS ASSOCIATED WITH INCREASED RISK OF POTENTIALLY PREVENTABLE READMISSIONS DURING HOME HEALTH CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S119-S120
Author(s):  
Sara Knox ◽  
Brian Downer ◽  
Allen Haas ◽  
Addie Middleton ◽  
Kenneth Ottenbacher
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Predictor Variable ◽  
Primary Objective ◽  
Home Health ◽  
Care Utilization ◽  
Future Research ◽  
Medicare Beneficiaries ◽  
Dementia Severity ◽  
Increased Risk

Abstract Approximately 14.0% of Medicare beneficiaries are readmitted to a hospital within 30-days of home health admission. Individuals with dementia account for 30% of all home health care admissions and are at high-risk for rehospitalizations. Our primary objective was to determine the association between dementia severity at admission to home health and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity category from OASIS items based on the Functional Assessment Staging Tool (FAST). Retrospective cohort study of 124,119 Medicare beneficiaries receiving home health (7/2013 – 6/2015) and diagnosed with dementia (ICD-9 codes). The primary outcome was 30-day PPR during home health. The predictor variable of dementia severity was categorized into six levels (non-affected to severe). The overall rate of 30-day PPR was 7.6% (95% CI 7.4, 7.7) but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, patients classified as stage 6 and stage 7 had 1.36 (95% CI 1.28, 1.45) and 1.90 (95% CI 1.59, 2.26) times higher odds to experience a 30-day PPR compared to patients classified as stage 1-2. Dementia severity in the later stages is associated with increased risk for PPR. Development of a dementia severity category based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing PPR during home health for individuals with severe dementia. Future research is needed to validate the proposed dementia severity categories used in this study.

scholarly journals Description, Health Care Utilization, and Outcomes for Home Health Care (HHC) COVID-19 Patients Early in the Pandemic: A Comparison to the General HHC Population

2021 ◽  
pp. 108482232110013
Author(s):  
Tami M. Videon ◽  
Robert J. Rosati ◽  
Steven H. Landers
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Home Health Care ◽  
Private Insurance ◽  
Health Agency ◽  
Home Health ◽  
Care Utilization ◽  
Observational Cohort ◽  
Racial Ethnic ◽  
Retrospective Observational Cohort Study

COVID-19 patients represent a new and distinct population in home health care. Little is known about health care utilization and incremental improvements in health for recovering COVID-19 patients after admission to home health care. Using a retrospective observational cohort study of 5452 episodes of home health care admitted to a New Jersey Home Health Agency between March 15 and May 31, 2020, this study describes COVID-19 Home Health Care (HHC) patients ( n = 842) and compare them to the general HHC population ( n = 4610). COVID HHC patients differ in significant ways from the typical HHC population. COVID patients were more likely to be 65 years of age and younger (41% vs 26%), be from a racial/ethnic minority (60% vs 31%), live with another person (85% vs 76%), have private insurance (28% vs 16%), and began HHC with greater independence in activities-of-daily-living (ADL/IADLs). COVID patients received fewer overall visits than their non-COVID counterparts (11.7 vs 16.3), although they had significantly more remote visits (1.7 vs 0.3). Multivariate analyses show that COVID patients early in the pandemic were 34% (CI, 28%-40%) less likely to be hospitalized and demonstrated significantly greater improvement in all the outcome measures examined compared to the general home health population.

scholarly journals Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

2021 ◽  
Vol 18 (11) ◽  
pp. 5623
Author(s):  
Jamie M. Smith ◽  
Haiqun Lin ◽  
Charlotte Thomas-Hawkins ◽  
Jennifer Tsui ◽  
Olga F. Jarrín
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Race And Ethnicity ◽  
Health Care Services ◽  
Propensity Scores ◽  
The United States ◽  
Home Health ◽  
Medicare Beneficiaries ◽  
Timely Initiation ◽  
Care Services

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

scholarly journals Impact of Family Caregiver Training on Hospitalization During Medicare Home Health Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 252-253
Author(s):  
Julia Burgdorf ◽  
Jennifer Wolff
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Acute Care ◽  
Home Health Care ◽  
Family Caregiver ◽  
Unmet Need ◽  
Home Health ◽  
Care Utilization ◽  
Caregiver Training ◽  
Acute Care Utilization

Abstract Medicare home health providers are required to offer family caregiver training; however, there is little information regarding the impact of family caregiver training on patient outcomes in home health or other care delivery settings. A better understanding of this relationship is necessary to guide development of caregiver training interventions and inform policy discussions surrounding family caregiver training access. This research assesses whether and how unmet need for family caregiver training is associated with acute care utilization during Medicare home health. We examine 1,217 (weighted n=5,870,905) fee-for-service Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011-2016. We link NHATS data with home health patient assessments and Medicare claims, drawing measures of family caregivers’ need for training from home health clinician reports and determining provision of training from Medicare claims. Using weighted, multivariable logistic regressions, we model the marginal change in probability of acute care utilization during home health as a function of family caregivers’ unmet need for training. We found that older adults whose family caregivers had an unmet need for training had a probability of acute care utilization during home health that was 18 percentage points (p=0.001) greater than those whose family caregivers both needed and received training, holding all covariates at their means. Findings support the importance of connecting family caregivers to training resources and suggest one avenue by which investing in caregiver training may be cost-effective for integrated payers and providers.

Posthospitalization Home Health Care Use and Changes in Functional Status in a Medicare Population

Medical Care ◽  
2000 ◽  
Vol 38 (5) ◽  
pp. 494-507 ◽  
Author(s):  
Jack Hadley ◽  
David Rabin ◽  
Andrew Epstein ◽  
Susan Stein ◽  
Carolyn Rimes
Keyword(s):  
Health Care ◽  
Functional Status ◽  
Home Health Care ◽  
Home Health ◽  
Health Care Use ◽  
Medicare Population
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