eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
5/2018
vol. 14
 
Share:
Share:
more
 
 
abstract:
Clinical research

Discharge home health services referral and 30-day all-cause readmission in older adults with heart failure

Cherinne Arundel, Helen Sheriff, Donna M. Bearden, Charity J. Morgan, Paul A. Heidenreich, Gregg C. Fonarow, Javed Butler, Richard M. Allman, Ali Ahmed

Arch Med Sci 2018; 14, 5: 995–1002
Online publish date: 2018/08/13
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Introduction
Heart failure (HF) is the leading cause of hospital readmission. Medicare home health services provide intermittent skilled nursing care to homebound Medicare beneficiaries. We examined whether discharge home health referral is associated with a lower risk of 30-day all-cause readmission in HF.

Material and methods
Of the 8049 Medicare beneficiaries hospitalized for acute HF and discharged alive from 106 Alabama hospitals, 6406 (76%) patients were not admitted from nursing homes and were discharged home without discharge hospice referrals. Of these, 1369 (21%) received a discharge home health referral. Using propensity scores for home health referral, we assembled a matched cohort of 1253 pairs of patients receiving and not receiving home health referrals, balanced on 33 baseline characteristics.

Results
The 2506 matched patients had a mean age of 78 years, 61% were women, and 27% were African American. Thirty-day all-cause readmission occurred in 28% and 19% of matched patients receiving and not receiving home health referrals, respectively (hazard ratio (HR) = 1.52; 95% confidence interval (CI): 1.29–1.80; p < 0.001). Home health referral was also associated with a higher risk of 30-day all-cause mortality (HR = 2.32; 95% CI: 1.58–3.41; p < 0.001) but not with 30-day HF readmission (HR = 1.28; 95% CI: 0.99–1.64; p = 0.056). HRs (95% CIs) for 1-year all-cause readmission, all-cause mortality, and HF readmission are 1.24 (1.13–1.36; p < 0.001), 1.37 (1.20–1.57; p < 0.001) and 1.09 (0.95–1.24; p = 0.216), respectively.

Conclusions
Hospitalized HF patients who received discharge home health services referral had a higher risk of 30-day and 1-year all-cause readmission and all-cause mortality, but not of HF readmission.

keywords:

home health care, 30-day all-cause readmission, mortality, Medicare, heart failure

references:
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360: 1418-28.
2. Konstam MA. Heart failure in the lifetime of musca domestica (The Common Housefly). JACC: Heart Failure 2013; 1: 178-80.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011; 155: 520-8.
Feltner C, Jones CD, Cene CW, et al. Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Ann Intern Med 2014; 160: 774-84.
Pierre-Louis B, Rodriques S, Gorospe V, et al. Clinical factors associated with early readmission among acutely decompensated heart failure patients. Arch Med Sci 2016; 12: 538-45.
Aronow WS. Update of treatment of heart failure with reduction of left ventricular ejection fraction. Arch Med Sci Atheroscler Dis 2016; 1: e106-16.
Bourge RC, Fleg JL, Fonarow GC, et al. Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure. Am J Med 2013; 126: 701-8.
Ahmed A, Bourge RC, Fonarow GC, et al. Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure. Am J Med 2014; 127: 61-70.
Sanam K, Bhatia V, Bajaj NS, et al. Renin-angiotensin system inhibition and lower 30-day all-cause readmission in medicare beneficiaries with heart failure. Am J Med 2016; 129: 1067-73.
Desai AS, Claggett BL, Packer M, et al. Influence of sacubitril/valsartan (LCZ696) on 30-day readmission after heart failure hospitalization. J Am Coll Cardiol 2016; 68: 241-8.
Bhatia V, Bajaj NS, Sanam K, et al. Beta-blocker use and 30-day all-cause readmission in medicare beneficiaries with systolic heart failure. Am J Med 2015; 128: 715-21.
Lam PH, Dooley DJ, Inampudi C, et al. Lack of evidence of lower 30-day all-cause readmission in medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone. Int J Cardiol 2017; 227: 462-6.
Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 2007; 50: 768-77.
Kheirbek RE, Fletcher RD, Bakitas MA, et al. Discharge hospice referral and lower 30-day all-cause readmission in medicare beneficiaries hospitalized for heart failure. Circ Heart Fail 2015; 8: 733-40.
Madigan EA, Gordon NH, Fortinsky RH, Koroukian SM, Pina I, Riggs JS. Rehospitalization in a national population of home health care patients with heart failure. Health Serv Res 2012; 47: 2316-38.
Murtaugh CM, Deb P, Zhu C, et al. Reducing readmissions among heart failure patients discharged to home health care: effectiveness of early and intensive nursing services and early physician follow-up. Health Serv Res 2017; 52: 1445-72.
Feller MA, Mujib M, Zhang Y, et al. Baseline characteristics, quality of care, and outcomes of younger and older medicare beneficiaries hospitalized with heart failure: findings from the Alabama Heart Failure Project. Int J Cardiol 2012; 162: 39-44.
Ahmed A, Fonarow GC, Zhang Y, et al. Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease. Am J Med 2012; 125: 399-410.
Rosenbaum PR, Rubin DB. The central role of propensity score in observational studies for causal effects. Biometrika 1983; 70: 41-55.
Rubin DB. Using propensity score to help design observational studies: application to the tobacco litigation. Health Serv Outcomes Res Methodol 2001; 2: 169-88.
Ahmed MI, White M, Ekundayo OJ, et al. A history of atrial fibrillation and outcomes in chronic advanced systolic heart failure: a propensity-matched study. Eur Heart J 2009; 30: 2029-37.
Ahmed A, Husain A, Love TE, et al. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J 2006; 27: 1431-9.
Wahle C, Adamopoulos C, Ekundayo OJ, Mujib M, Aronow WS, Ahmed A. A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults. Arch Gerontol Geriatr 2009; 49: 165-71.
Rosenbaum PR. Sensitivity to hidden bias. In: Observational Studies. Vol. 1. Rosenbaum PR (ed.). Springer-Verlag, New York 2002: 105-70.
Currie CJ, Poole CD, Evans M, Peters JR, Morgan CL. Mortality and other important diabetes-related outcomes with insulin vs other antihyperglycemic therapies in type 2 diabetes. J Clin Endocrinol Metab 2013; 98: 668-77.
Sanford DE, Olsen MA, Bommarito KM, et al. Association of discharge home with home health care and 30-day readmission after pancreatectomy. J Am Coll Surg 2014; 219: 875-86 e871.
Jones CD, Bowles KH, Richard A, Boxer RS, Masoudi FA. High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home. Circ Cardiovasc Qual Outcomes 2017; 10:pii: e003676.
Santomassino M, Costantini GD, McDermott M, Primiano D, Slyer JT, Singleton JK. A systematic review on the effectiveness of continuity of care and its role in patient satisfaction and decreased hospital readmissions in the adult patient receiving home care services. JBI Libr Syst Rev 2012; 10: 1214-59.
O’Connor M, Hanlon A, Naylor MD, Bowles KH. The impact of home health length of stay and number of skilled nursing visits on hospitalization among medicare-reimbursed skilled home health beneficiaries. Res Nurs Health 2015; 38: 257-67.
Edwards ST, Saha S, Prentice JC, Pizer SD. Preventing hospitalization with veterans affairs home-based primary care: which individuals benefit most? J Am Geriatr Soc 2017; 65: 1676-83.
Smolis-Bak E, Rymuza H, Kazimierska B, et al. Improvement of exercise tolerance in cardiopulmonary testing with sustained safety after regular training in outpatients with systolic heart failure (NYHA III) and an implantable cardioverter-defibrillator. Prospective 18-month randomized study. Arch Med Sci 2017; 13: 1094-101.
Fisher SR, Kuo YF, Sharma G, et al. Mobility after hospital discharge as a marker for 30-day readmission. J Gerontol A Biol Sci Med Sci 2013; 68: 805-10.
Clarke R, Shipley M, Lewington S, et al. Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies. Am J Epidemiol 1999; 150: 341-53.
FEATURED PRODUCTS
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe