title: Rehospitalization in a national population of home health care patients with heart failure.
abstract: OBJECTIVE
  Patients with heart failure (HF) have high rates of rehospitalization. Home health care (HHC) patients with HF are not well studied in this regard. The objectives of this study were to determine patient, HHC agency, and geographic (i.e., area variation) factors related to 30-day rehospitalization in a national population of HHC patients with HF, and to describe the extent to which rehospitalizations were potentially avoidable.
  
  
  METHODS
  Chronic Condition Warehouse data from the Centers for Medicare & Medicaid Services.
  
  
  METHODS
  Retrospective cohort design.
  
  
  METHODS
  The 2005 national population of HHC patients was matched with hospital and HHC claims, the Provider of Service file, and the Area Resource File.
  
  
  RESULTS
  The 30-day rehospitalization rate was 26 percent with 42 percent of patients having cardiac-related diagnoses for the rehospitalization. Factors with the strongest association with rehospitalization were consistent between the multilevel model and Cox proportional hazard models: number of prior hospital stays, higher HHC visit intensity category, and dyspnea severity at HHC admission. Substantial numbers of rehospitalizations were judged to be potentially avoidable.
  
  
  CONCLUSIONS
  The persistently high rates of rehospitalization have been difficult to address. There are health care-specific actions and policy implications that are worth examining to improve rehospitalization rates.
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue,Cleveland, OH 44106-4904, USA. elizabeth.madigan@case.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Madigan
authors.forename: Nahida H
authors.initials: NH
authors.lastname: Gordon
authors.forename: Richard H
authors.initials: RH
authors.lastname: Fortinsky
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.forename: Ileana
authors.initials: I
authors.lastname: Piña
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Riggs
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000628:therapy*; D018574:Home Care Agencies / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D044469:Racial Groups; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors