title: Reducing Readmissions among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up.
abstract: To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care.
  
  
  
  National Medicare administrative, claims, and patient assessment data.
  
  
  
  Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality. An extension of instrumental variables methods for nonlinear statistical models corrects for nonrandom selection of patients into treatment categories. Our instruments are the index hospital's rate of early aftercare for non-HF patients and hospital discharge day of the week.
  
  
  
  All hospitalizations for a HF principal diagnosis with discharge to home health care between July 2009 and June 2010 were identified from source files.
  
  
  
  Neither treatment by itself has a statistically significant effect on hospital readmission. In combination, however, they reduce the probability of readmission by roughly 8 percentage points (p < .001; confidence interval = -12.3, -4.1). Results are robust to changes in implementation of the nonlinear IV estimator, sample, outcome measure, and length of follow-up.
  
  
  
  Our results call for closer coordination between home health and medical providers in the clinical management of HF patients immediately after hospital discharge.
authors.affiliation: VNSNY Center for Home Care Policy and Research, 1250 Broadway, 7th Floor, New York, 10001, NY.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Murtaugh
authors.affiliation: Department of Economics, Hunter College and the Graduate Center, City University of New York, New York, NY.|NBER, Cambridge, MA.
authors.forename: Partha
authors.initials: P
authors.lastname: Deb
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.|James J. Peters VA Medical Center, Bronx, NY.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Center for Home Care Policy and Research and Business Intelligence and Outcomes, Visiting Nurse Service of New York, New York, NY.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Peng
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.
authors.forename: Shivani
authors.initials: S
authors.lastname: Shah
authors.affiliation: Bonny Doon, CA.
authors.forename: Stanley M
authors.initials: SM
authors.lastname: Moore
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.|School of Nursing, University of Pennsylvania, Philadelphia, PA.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jill
authors.initials: J
authors.lastname: Kalman
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.
authors.forename: Penny H
authors.initials: PH
authors.lastname: Feldman
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.|James J. Peters VA Medical Center, Bronx, NY.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006699:Home Care Services; D006801:Humans; D008297:Male; D009739:Nursing Services; D010351:Patient Discharge; D010359:Patient Readmission / Q000639:trends*; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D000069341:Transitional Care
keywords: Heart failure; home health care; hospital readmission; instrumental variable; transitional care