eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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5/2018
vol. 14
 
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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
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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

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