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Researchers find high rehospitalization rate, substantial proportion of potentially avoidable rehospitalizations among home health care patients with HF

Wednesday, May 09 2012 | Comments
Evidence Grade 0 What's This?
Among patients who are hospitalized for heart failure and subsequently receive home health care services, a substantial proportion are rehospitalized within 30 days of discharge, and many of those rehospitalizations appear to be potentially avoidable, study data indicate.

According to the authors of the study, more than 10,000 home health care agencies provide care to more than 3 million patients in this country. Such services are available to Medicare beneficiaries who meet established guidelines, the authors added, noting that "home health care patients may represent some of the 'sicker' patients with heart failure because of the Medicare homebound requirements."

The researchers used data from the Centers for Medicare & Medicaid Services' Chronic Condition Data Warehouse to identify all home health care patients with a primary home health care diagnosis of heart failure who received home health care services in 2005 and whose care was paid for by the Medicare fee-for-service program. Additional data were obtained from other government databases, including the MedPAR file, the Standard Analytic File for Home Health Care and the Area Resource File.

To be included in the analysis, patients had to have had an index hospital stay, defined as a hospital discharge within 14 days before home health care services were initiated. Rehospitalizations were those that involved a hospital stay within 30 days of the index hospital discharge; these were categorized as all-cause or cardiac-related, and Prevention Quality Indicator criteria established by the Agency for Healthcare Research and Quality (AHRQ) were used to determine whether the rehospitalizations were potentially avoidable.

The final data set for the analysis included 74,580 patients, with an average age of 80.4 years. The 30-day rehospitalization rate among these patients was 26.4 percent (n=19,714). While most had only a single rehospitalization, 16.4 percent had two and 2.3 percent had three or more. The average time to rehospitalization was 13.6 days, and the average length of stay during the rehospitalization was 6.5 days.

More than four in 10 of the rehospitalizations (42 percent) were associated with a cardiac-related diagnosis. For 34 percent of the patients who were rehospitalized with a primary diagnosis of heart failure, the rehospitalization was considered potentially avoidable. Additional potentially avoidable rehospitalizations included those for 55 percent of the patients who had heart failure as a secondary diagnosis, 34 percent of the patients who had hypertension as a secondary diagnosis and 32 percent of the patients who had chronic obstructive pulmonary disease as a secondary diagnosis.

In multivariate analyses, the strongest predictor of rehospitalization was the number of hospitalizations the patient had in the six-month period before the index hospitalization. Having dyspnea, or difficulty breathing, that interfered with activity was the second strongest predictor of rehospitalization. Geographic and home health care agency-related factors had "relatively little influence" with regard to the likelihood of rehospitalization, the study authors remarked.

"Although most of the factors identified with rehospitalization are not 'actionable' per se, the findings do indicate that home health care agencies and referring providers might use the findings to identify the patients at highest risk for rehospitalization and target services [such as telehealth, frontloading visits, prompt physician follow-up and patient education on self-management] to potentially reduce the rehospitalization rates among the highest risk patients," the authors suggested.

They said the extent to which the rehospitalizations were potentially avoidable needs further study within the home health care setting, noting that although many of the rehospitalizations in this analysis met the AHRQ criteria for being potentially avoidable, it is unclear what interventions could be implemented within home health care to reduce such rehospitalizations.

This research was published online April 23 ahead of print by the journal Health Services Research.

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