Risk factors for hospitalization in a national sample of medicare home health care patients.
Acute care hospitalization during or immediately following a Medicare home health care (HHC) episode is a major adverse outcome, but little has been published about HHC patient-level risk factors for hospitalization. The authors determined risk factors at HHC admission associated with subsequent acute care hospitalization in a nationally representative Medicare patient sample (N = 374,123). Hospitalization was measured using Medicare claims data; risk factors were measured using Outcome Assessment and Information Set data. Seventeen percent of sample members were hospitalized. Multivariate logistic regression analysis found that the most influential risk factors (all p < .001) were skin wound as primary HHC diagnosis, clinician-judged guarded rehabilitation prognosis, congestive heart failure as primary HHC diagnosis, presence of depressive symptoms, dyspnea severity, and Black, compared to White. HHC initiatives that minimize chronic condition exacerbations and actively treat depressive symptoms might help reduce Medicare patient hospitalizations. Unmeasured reasons for higher hospitalization rates among Black HHC patients deserve further investigation.
UConn Center on Aging, University of Connecticut Health Center (UCHC), Farmington, CT, USA.
Richard H
RH
Fortinsky
Elizabeth A
EA
Madigan
T Joseph
TJ
Sheehan
Susan
S
Tullai-McGuinness
Alison
A
Kleppinger
D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D003863:Depression / Q000175:diagnosis; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy; D001741:Black or African American
Medicare population; home health care; racial disparities