Discharge home health services referral and 30-day all-cause readmission in older adults with heart failure
| Autor: | Helen Sheriff, Cherinne Arundel, Javed Butler, Charity J. Morgan, Gregg C. Fonarow, Ali Ahmed, Paul A. Heidenreich, Donna M. Bearden, Richard M. Allman |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Aging Referral home health care Clinical Sciences lcsh:Medicine heart failure 8.1 Organisation and delivery of services Discharge home 030204 cardiovascular system & hematology Lower risk Medicare Cardiovascular 03 medical and health sciences Health services 0302 clinical medicine Clinical Research General & Internal Medicine Medicine 030212 general & internal medicine business.industry Hazard ratio lcsh:R General Medicine Health Services medicine.disease mortality Confidence interval 3. Good health Heart Disease Good Health and Well Being Heart failure Emergency medicine Propensity score matching 30-day all-cause readmission business Health and social care services research |
| Zdroj: | Archives of medical science : AMS, vol 14, iss 5 Archives of Medical Science, Vol 14, Iss 5, Pp 995-1002 (2018) Archives of Medical Science : AMS |
| Popis: | Author(s): Arundel, Cherinne; Sheriff, Helen; Bearden, Donna M; Morgan, Charity J; Heidenreich, Paul A; Fonarow, Gregg C; Butler, Javed; Allman, Richard M; Ahmed, Ali | Abstract: IntroductionHeart 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 methodsOf 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.ResultsThe 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 l 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 l 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 l 0.001), 1.37 (1.20-1.57; p l 0.001) and 1.09 (0.95-1.24; p = 0.216), respectively.ConclusionsHospitalized 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|