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Quality of Care/Patient Safety

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Factors that predict rehospitalization of home health care patients should be targeted by home health providers

A recent study (Agency for Healthcare Research and Quality grants HS11962 and HS13694) concludes that factors pertaining to living situation, clinical status, and daily functioning affect a home health care patient's risk of rehospitalization and should be targeted by home health providers to improve home care quality. Researchers from the Visiting Nurse Service of New York used outcomes assessment data from a large home health agency to identify 7,393 patients (average age of 70) who had been rehospitalized at least once. They considered the 5,227 patients who had two or fewer unplanned rehospitalizations as low-risk and the 2,166 with three or more as high-risk.

Home care patients at high risk for rehospitalization were white or Hispanic women, either received Medicaid or both Medicaid and Medicare benefits (dually eligible), and lacked informal care (by family and friends). Even though the high-risk group needed more help than the low-risk group with bathing, dressing, and other activities of daily living (ADLs), and with shopping, housekeeping, and other instrumental activities of daily living (IADLs), fewer of them received help with these activities from their primary caregivers.

Home health care patients in the high-risk group generally lived alone, were admitted into home care from inpatient settings, and had chronic conditions such as coronary heart failure, diabetes, HIV/AIDS, chronic skin ulcers, and chronic obstructive pulmonary disease, and they were more likely to have had more secondary diagnoses than the low-risk group (average of 3.82 vs. 3.43). Patients in the high-risk group also needed more help with taking medications compared with patients in the low-risk group.

These factors, which can predict the probability of rehospitalization, are evident at intake and should be used in developing home care plans that may prevent rehospitalizations, conclude the researchers.

See "Risk factors for repeated hospitalizations among home healthcare recipients," by Robert J. Rosati, Ph.D., Liping Huang, M.A., Maryam Navaie-Waliser, Dr.P.H., and Penny H. Feldman, Ph.D., in the March 2003 Journal for Healthcare Quality 25(2), pp. 4-10.

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