title: Effect of a restorative model of posthospital home care on hospital readmissions.
abstract: OBJECTIVE
  To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care.
  
  
  METHODS
  Quasiexperimental; matched and unmatched.
  
  
  METHODS
  Community, home care.
  
  
  METHODS
  Seven hundred seventy individuals receiving care from a large home care agency after hospitalization.
  
  
  METHODS
  A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory.
  
  
  METHODS
  Hospital readmission, length of home care episode.
  
  
  RESULTS
  Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43-1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses.
  
  
  CONCLUSIONS
  Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign.
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut 06520, USA. mary.tinetti@yale.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.forename: Peter
authors.initials: P
authors.lastname: Charpentier
authors.forename: Margaret
authors.initials: M
authors.lastname: Gottschalk
authors.forename: Dorothy I
authors.initials: DI
authors.lastname: Baker
mesh_terms: D000368:Aged; D005260:Female; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010359:Patient Readmission / Q000706:statistics & numerical data*