Adam Simning1,2, Jessica Orth2, Jinjiao Wang3, Thomas V Caprio4, Yue Li2, Helena Temkin-Greener2. 1. Department of Psychiatry, University of Rochester, Rochester, New York, USA. 2. Department of Public Health Sciences, University of Rochester, Rochester, New York, USA. 3. School of Nursing, University of Rochester, Rochester, New York, USA. 4. Division of Geriatrics & Aging, Department of Medicine, University of Rochester, Rochester, New York, USA.
Abstract
OBJECTIVES: To investigate the association of the utilization of Medicare-certified home health agency (CHHA) services with post-acute skilled nursing facility (SNF) discharge outcomes that included home time, rehospitalization, SNF readmission, and mortality. DESIGN: Retrospective cohort study. SETTING: New York State fee-for-service Medicare beneficiaries aged 65 years and older admitted to SNFs for post-acute care and discharged to the community in 2014. PARTICIPANTS: A total of 25,357 older adults. MEASUREMENTS: The outcomes included days spent alive in the community ("home time"), rehospitalization, SNF readmission, and mortality within 30- and 90-day post-SNF discharge periods. The primary independent variables were SNF five-star overall quality rating and receipt of CHHA services within 7 days of SNF discharge. Zero-inflated negative binomial regression and logistic regression models characterized the association of CHHA linkage with home time and other outcomes, respectively. RESULTS: Following SNF discharge, 17,657 (69.6%) patients received CHHA services. In analyses that adjusted for patient-, market-, and other SNF-level factors, older adults discharged from higher quality SNFs were more likely to receive CHHA services. In analyses that adjusted for patient- and market-level factors, receipt of post-SNF CHHA services was associated with 2.03 and 4.17 (P < .001) more days in the community over 30- and 90-day periods. Receiving CHHA services was also associated with decreased odds for rehospitalization (odds ratio [OR] = .68; P < .001; OR = .91; P = .008), SNF readmission (OR = .36; P < .001; OR = .62; P < .001), and death (OR = .34; P < .001; OR = .63; P < .001) over 30- and 90-day periods, respectively. CONCLUSION: Among older adults discharged from a post-acute SNF stay, those who received CHHA services had better discharge outcomes. They were less likely to experience admissions to institutional care settings and had a lower mortality risk. Future efforts that examine how the type and intensity of CHHA services affect outcomes would build on this work. J Am Geriatr Soc 68:1573-1578, 2020.
OBJECTIVES: To investigate the association of the utilization of Medicare-certified home health agency (CHHA) services with post-acute skilled nursing facility (SNF) discharge outcomes that included home time, rehospitalization, SNF readmission, and mortality. DESIGN: Retrospective cohort study. SETTING: New York State fee-for-service Medicare beneficiaries aged 65 years and older admitted to SNFs for post-acute care and discharged to the community in 2014. PARTICIPANTS: A total of 25,357 older adults. MEASUREMENTS: The outcomes included days spent alive in the community ("home time"), rehospitalization, SNF readmission, and mortality within 30- and 90-day post-SNF discharge periods. The primary independent variables were SNF five-star overall quality rating and receipt of CHHA services within 7 days of SNF discharge. Zero-inflated negative binomial regression and logistic regression models characterized the association of CHHA linkage with home time and other outcomes, respectively. RESULTS: Following SNF discharge, 17,657 (69.6%) patients received CHHA services. In analyses that adjusted for patient-, market-, and other SNF-level factors, older adults discharged from higher quality SNFs were more likely to receive CHHA services. In analyses that adjusted for patient- and market-level factors, receipt of post-SNF CHHA services was associated with 2.03 and 4.17 (P < .001) more days in the community over 30- and 90-day periods. Receiving CHHA services was also associated with decreased odds for rehospitalization (odds ratio [OR] = .68; P < .001; OR = .91; P = .008), SNF readmission (OR = .36; P < .001; OR = .62; P < .001), and death (OR = .34; P < .001; OR = .63; P < .001) over 30- and 90-day periods, respectively. CONCLUSION: Among older adults discharged from a post-acute SNF stay, those who received CHHA services had better discharge outcomes. They were less likely to experience admissions to institutional care settings and had a lower mortality risk. Future efforts that examine how the type and intensity of CHHA services affect outcomes would build on this work. J Am Geriatr Soc 68:1573-1578, 2020.
Authors: Debra Saliba; Joan Buchanan; Maria Orlando Edelen; Joel Streim; Joseph Ouslander; Dan Berlowitz; Joshua Chodosh Journal: J Am Med Dir Assoc Date: 2012-07-15 Impact factor: 4.669
Authors: Janice L Palmer; Joanne C Langan; Jean Krampe; Mary Krieger; Rebecca A Lorenz; Joanne K Schneider; Judith M Smith; Helen W Lach Journal: Res Theory Nurs Pract Date: 2014 Impact factor: 0.688
Authors: Christine D Jones; Jason Falvey; Edward Hess; Cari R Levy; Eugene Nuccio; Anna E Barón; Frederick A Masoudi; Jennifer Stevens-Lapsley Journal: J Am Geriatr Soc Date: 2019-08-29 Impact factor: 5.562
Authors: Jennifer L Carnahan; James E Slaven; Christopher M Callahan; Wanzhu Tu; Alexia M Torke Journal: J Am Med Dir Assoc Date: 2017-06-21 Impact factor: 4.669
Authors: Manjula Kurella Tamura; Kenneth E Covinsky; Glenn M Chertow; Kristine Yaffe; C Seth Landefeld; Charles E McCulloch Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: Shi-Yi Wang; Tatyana A Shamliyan; Kristine M C Talley; Rema Ramakrishnan; Robert L Kane Journal: Arch Gerontol Geriatr Date: 2013-04-08 Impact factor: 3.250
Authors: Adam Simning; Jessica Orth; Thomas V Caprio; Yue Li; Jinjiao Wang; Helena Temkin-Greener Journal: J Am Med Dir Assoc Date: 2020-10-26 Impact factor: 4.669