After hospital discharge, slow initiation of home health care increases the risk of rehospitalization

Avoiding the patient or delaying care are common reasons for delays in home health care, the authors said.

Patients discharged from the hospital are at higher risk of readmission if they experience a delay in starting home health care after discharge, according to a new study.

The study, published in Journal of the American Association of Medical Directors, shows that the risk of rehospitalization or an emergency department (ED) visit jumps by 12% when patients wait more than 2 days to begin their care at home.

More than 6 million Americans receive home health care each year, the study authors noted. In many cases, these home visits follow hospital discharge. Home health care providers can perform a range of services, including clinical assessments, wound care and medication reconciliation, the authors said. Previous research has shown that home health care visits after hospitalization can reduce the risk of readmission, especially for certain conditions, such as sepsis and heart failure.

CMS requires that the patient’s initial home visits be made within 48 hours of referral or after the patient returns home, unless otherwise directed by the patient’s physician. However, the researchers said no study has yet looked at whether the timing of such visits affects patient outcomes.

They decided to examine the records of an urban home health agency in the northeastern United States to see if the agency’s success or failure in initiating care within 48 hours had a significant impact on patient outcomes.

The researchers analyzed a dataset of 49,141 home health care visits obtained from 45,390 patients who were discharged from the hospital in 2019 and referred for follow-up at home. They compared the timing of home health care initiation with 30-day hospitalizations and ED visits to see if timing affected outcomes and if there were any differences based on factors such as race/ethnicity, age, insurance type, and clinical status.

In total, about one-third of the initial home health episodes in the data set were delayed, meaning they did not occur within 48 hours. Previous research by the authors of the present study suggests that patients who do not answer the door or delay visits are among the most common reasons for such delays.

Of those 34% of cases where care was delayed, 14% of those delays resulted in a readmission or emergency room visit within 30 days. And this translates into a 12% higher risk of readmission or ED visit for patients whose home health care was not initiated within 2 days compared to those who received timely initiation of home services.

The authors say the study results demonstrate the importance of eliminating delays in initiating care and that patient education should be an important part of this goal, as better-informed patients may be less likely to delay or tend to avoid home care.

“We also found that ‘administrative or scheduling issues’ caused an 18% delay in care initiation visits, suggesting that home health agencies have an opportunity to identify and resolve some of the existing administrative and scheduling issues so to be prepared to see patients shortly after discharge from the hospital,” they added.

The researchers also found that patients with public health insurance were more likely to have a 30-day readmission or ED visit. Thus, they said, more research needs to be done to identify and address the causes of this problem.

They acknowledged that their study was based on a single home health agency and therefore the findings may not match those of other agencies. However, they said that their study population was broadly similar to the characteristics of inpatient populations in national studies. They also noted that their study did not separate ED visits and readmissions, instead treating them in one category. Further studies could take a closer look at how timely initiation of home health care affects each readmission category separately.

However, the authors conclude that their data clearly show that the efficacy of home health care in preventing readmissions is significantly influenced by the ability of home health agencies to rapidly initiate care at home.

reference

Topaz M, Barrón Y, Song J, et al. The risk of rehospitalization or emergency department visit was significantly higher for patients who received their first home health care visit later than 2 days after hospital discharge. J Am Med Dir Assoc. 2022; 23 (10): 1642-1647. doi:10.1016/j.jamda.2022.07.001

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