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Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults

IMPORTANCE: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. OBJECTIVE: To examine how often patients ref...

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Autores principales: Li, Jun, Qi, Mingyu, Werner, Rachel M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489821/
https://www.ncbi.nlm.nih.gov/pubmed/32876682
http://dx.doi.org/10.1001/jamanetworkopen.2020.15470
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author Li, Jun
Qi, Mingyu
Werner, Rachel M.
author_facet Li, Jun
Qi, Mingyu
Werner, Rachel M.
author_sort Li, Jun
collection PubMed
description IMPORTANCE: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. OBJECTIVE: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. EXPOSURES: Hospital referral to home health care. MAIN OUTCOMES AND MEASURES: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. RESULTS: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). CONCLUSIONS AND RELEVANCE: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.
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spelling pubmed-74898212020-09-25 Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults Li, Jun Qi, Mingyu Werner, Rachel M. JAMA Netw Open Original Investigation IMPORTANCE: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. OBJECTIVE: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. EXPOSURES: Hospital referral to home health care. MAIN OUTCOMES AND MEASURES: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. RESULTS: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). CONCLUSIONS AND RELEVANCE: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care. American Medical Association 2020-09-02 /pmc/articles/PMC7489821/ /pubmed/32876682 http://dx.doi.org/10.1001/jamanetworkopen.2020.15470 Text en Copyright 2020 Li J et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Li, Jun
Qi, Mingyu
Werner, Rachel M.
Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults
title Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults
title_full Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults
title_fullStr Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults
title_full_unstemmed Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults
title_short Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults
title_sort assessment of receipt of the first home health care visit after hospital discharge among older adults
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489821/
https://www.ncbi.nlm.nih.gov/pubmed/32876682
http://dx.doi.org/10.1001/jamanetworkopen.2020.15470
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