title: Association of discharge home with home health care and 30-day readmission after pancreatectomy.
abstract: BACKGROUND
  We sought to determine if discharge home with home health care (HHC) is an independent predictor of increased readmission after pancreatectomy.
  
  
  METHODS
  We examined 30-day readmissions in patients undergoing pancreatectomy using the Healthcare Cost and Utilization Project State Inpatient Database for California from 2009 to 2011. Readmissions were categorized as severe or nonsevere using the Modified Accordion Severity Grading System. Multivariable logistic regression models were used to examine the association of discharge home with HHC and 30-day readmission using discharge home without HHC as the reference group. Propensity score matching was used as an additional analysis to compare the rate of 30-day readmission between patients discharged home with HHC with patients discharged home without HHC.
  
  
  RESULTS
  Of 3,573 patients who underwent pancreatectomy, 752 (21.0%) were readmitted within 30 days of discharge. In a multivariable logistic regression model, discharge home with HHC was an independent predictor of increased 30-day readmission (odds ratio = 1.37; 95% CI, 1.11-1.69; p = 0.004). Using propensity score matching, patients who received HHC had a significantly increased rate of 30-day readmission compared with patients discharged home without HHC (24.3% vs 19.8%; p < 0.001). Patients discharged home with HHC had a significantly increased rate of nonsevere readmission compared with those discharged home without HHC, by univariate comparison (19.2% vs 13.9%; p < 0.001), but not severe readmission (6.4% vs 4.7%; p = 0.08). In multivariable logistic regression models, excluding patients discharged to facilities, discharge home with HHC was an independent predictor of increased nonsevere readmissions (odds ratio = 1.41; 95% CI, 1.11-1.79; p = 0.005), but not severe readmissions (odds ratio = 1.31; 95% CI, 0.88-1.93; p = 0.18).
  
  
  CONCLUSIONS
  Discharge home with HHC after pancreatectomy is an independent predictor of increased 30-day readmission; specifically, these services are associated with increased nonsevere readmissions, but not severe readmissions.
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital, St Louis, MO; Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Sanford
authors.affiliation: Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.affiliation: Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Bommarito
authors.affiliation: Department of Neurosurgery, Barnes-Jewish Hospital, St Louis, MO; Department of Neurosurgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Manish
authors.initials: M
authors.lastname: Shah
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital, St Louis, MO; Department of Surgery, Washington University School of Medicine, St Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital, St Louis, MO; Department of Surgery, Washington University School of Medicine, St Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.affiliation: Department of Surgical Services, Barnes-Jewish Hospital, St Louis, MO.
authors.forename: David P
authors.initials: DP
authors.lastname: Jaques
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital, St Louis, MO; Department of Surgery, Washington University School of Medicine, St Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO. Electronic address: linehand@wudosis.wustl.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult