title: Does paid versus unpaid supplementary caregiving matter in preventable readmissions?
abstract: OBJECTIVE
  To examine the impact of paid and unpaid supplementary caregiving on preventable readmissions among Medicare home health beneficiaries with diabetes.
  
  
  METHODS
  A retrospective cohort study with a home health episode as the unit of analysis.
  
  
  METHODS
  We gathered multiple 2009 Medicare data and national datasets (eg, Area Health Resources File). We used propensity score matching based on beneficiaries' predisposing, enabling, and health need factors to create matched cohorts for episodes solely assisted by paid supplementary caregivers versus those solely assisted by unpaid supplementary caregivers. We applied Cox regression on the matched cohorts to estimate the 30-day preventable readmissions, including diabetes-related conditions, heart disease-related conditions, chronic obstructive pulmonary disease, urinary tract infection (UTI), pneumonia, and dehydration.
  
  
  RESULTS
  Among beneficiaries (81,481) who received assistance several times during the day and night or several times during only the day, 7.34% were solely assisted by paid supplementary caregivers and 86.34% were solely assisted by unpaid supplementary caregivers. In the matched cohorts, we found that beneficiaries with paid supplementary caregivers had 68% higher hazards of readmission due to UTIs than those with unpaid supplementary caregivers.
  
  
  CONCLUSIONS
  The Medicare program is moving toward value-based purchasing and penalizing home health agencies with poor quality of care. It is critical for home health professionals to invite paid and unpaid supplementary caregivers to initiate care plans and assess their competence. Policies that support unpaid supplementary caregivers can also assist caregivers to care for their loved ones and prevent them from using expensive hospital resources.
authors.affiliation: Department of Health Policy and Management, University of Arkansas for Medical Sciences 4301 West Markham St, Mail Slot 820-12 Little Rock, AR 72205. E-mail: hchen@uams.edu.
authors.forename: Hsueh-Fen
authors.initials: HF
authors.lastname: Chen
authors.forename: Taiye
authors.initials: T
authors.lastname: Oluyomi Popoola
authors.forename: Sumihiro
authors.initials: S
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics*; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D010359:Patient Readmission / Q000706:statistics & numerical data*; D057216:Propensity Score; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States; D062505:Value-Based Purchasing