Predictors of formal home health care use in elderly patients after hospitalization.
OBJECTIVE
To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied.


METHODS
Prospective cohort study.


METHODS
Medical and surgical wards at a university teaching hospital, followed by 23 Medicare-certified HHC agencies in the study catchment area.


METHODS
226 medical and surgical patients aged 70 years and older immediately after discharge from acute care.


METHODS
HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records.


RESULTS
The incidence of HHC initiated within 2 weeks post-discharge was 75/226 (34%). The median duration of service was 30 days (range 3-483) with a median of 3 visits per week. Four independent predictors of HHC were identified through multivariate analysis: educational level < or = 12 years (relative risk (RR) 3.3; 95% confidence interval (CI) 1.6 to 6.6); less accessible social support (RR, 1.7; CI 0.9 to 3.1); impairment in at least one instrumental activity of daily living (RR, 1.9; CI, 1.0, 3.4); and prior HHC use (RR, 2.1; CI, 1.2 to 3.6). Risk strata were created by adding one point for each risk factor present: with 0-1 risk factors, 8% used HHC; with two risk factors, 28%; with three risk factors, 45%, with four risk factors, 76%. This trend was statistically significant (P < 0.001).


CONCLUSIONS
HHC use is common among elderly patients after discharge from acute care. A simple predictive model based on four risk factors can be used on admission to predict HHC use. This model may be useful for discharge planning and health care utilization planning for the elderly population.
Solomon
D H
DH
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Wagner
D R
DR
Marenberg
M E
ME
Acampora
D
D
Cooney
L M
LM
Inouye
S K
SK
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016001:Confidence Intervals; D004522:Educational Status; D005260:Female; D005544:Forecasting; D015577:Geriatric Assessment; D006285:Health Planning; D006302:Health Services Research; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support