title: Exploratory analysis of the relationship between home health agency engagement in a national campaign and reduction in acute care hospitalization in US home care patients.
abstract: OBJECTIVE
  To determine whether US home health agencies that intensively engaged with the 2010 Home Health Quality Improvement National Campaign were more likely to reduce acute care hospitalization (ACH) rates than less engaged agencies.
  
  
  METHODS
  We included all Medicare-certified agencies that accessed Campaign resources in the first month of the Campaign and also responded to an online survey of resource utilization at month two. We used the survey data and item response theory to estimate a latent construct we called engagement with the campaign. ACH rates were calculated from the Centers for Medicare & Medicaid Services Outcome and Assessment Information Set for pre- and post-intervention periods (March-November 2009 and 2010, respectively).
  
  
  RESULTS
  Staff from 1077 agencies accessed resources in the first month of the Campaign. Of these, 382 provided information about resource use and had 10 or more monthly discharges throughout the measurement periods. Dividing these agencies into quartiles based on engagement score, we found an association between engagement and reduction in ACH rates, P=0.049 (χ(2) for trend). Exploratory path analysis revealed the effect of engagement score on reduction in ACH rate to be partially mediated through reduction in average length of service rates.
  
  
  CONCLUSIONS
  We found evidence that early intensity of engagement with the Campaign, as measured through use of activities and resources, was positively associated with improvement. To continue the investigation of this relationship, future work in this and other campaigns should focus on further development of engagement measures.
authors.affiliation: West Virginia Medical Institute and Quality Insights, Harrisburg, PA, USA.
authors.forename: E Eve
authors.initials: EE
authors.lastname: Esslinger
authors.forename: Charles P
authors.initials: CP
authors.lastname: Schade
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Sun
authors.forename: Ying Hua
authors.initials: YH
authors.lastname: Sun
authors.forename: Jill
authors.initials: J
authors.lastname: Manna
authors.forename: Bethany Knowles
authors.initials: BK
authors.lastname: Hall
authors.forename: Shanen
authors.initials: S
authors.lastname: Wright
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hannah
authors.forename: Janet R
authors.initials: JR
authors.lastname: Lynch
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000458:organization & administration*; D006302:Health Services Research; D018574:Home Care Agencies / Q000458:organization & administration*; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010067:Ownership; D058996:Quality Improvement / Q000458:organization & administration*; D012111:Residence Characteristics; D014481:United States
keywords: community networks; health professional; home care agency; patient admission; programme evaluation; quality improvement