Madeline R Sterling1, Lisa M Kern2, Monika M Safford2, Christine D Jones3, Penny H Feldman4, Gregg C Fonarow5, Shubin Sheng6, Roland A Matsouaka7, Adam D DeVore7, Barbara Lytle7, Haolin Xu7, Larry A Allen3, Anita Deswal8, Clyde W Yancy9, Nancy M Albert10. 1. Weill Cornell Medicine, New York, New York, USA. Electronic address: mrs9012@med.cornell.edu. 2. Weill Cornell Medicine, New York, New York, USA. 3. University of Colorado School of Medicine, Aurora, Colorado, USA. 4. Visiting Nurse Service of New York, New York, New York, USA. 5. University of California Los Angeles, Los Angeles, California, USA. 6. Duke Clinical Research Institute, Durham, North Carolina, USA. 7. Duke University, Durham, North Carolina, USA. 8. University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 9. Northwestern University, Chicago, Illinois, USA. 10. Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
OBJECTIVES: This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates. BACKGROUND: After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied. METHODS: This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes. RESULTS: From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC. CONCLUSIONS: Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.
OBJECTIVES: This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates. BACKGROUND: After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied. METHODS: This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes. RESULTS: From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC. CONCLUSIONS: Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.
Authors: Dawon Baik; Peggy B Leung; Madeline R Sterling; David Russell; Lizeyka Jordan; Ariel F Silva; Ruth M Masterson Creber Journal: Palliat Med Date: 2021-03-17 Impact factor: 4.762
Authors: Madeline R Sterling; Joanna Bryan Ringel; Laura C Pinheiro; Monika M Safford; Emily B Levitan; Erica Phillips; Todd M Brown; Oanh K Nguyen; Parag Goyal Journal: Circ Heart Fail Date: 2021-12-06 Impact factor: 8.790
Authors: Austin S Kilaru; Nicholas Illenberger; Zachary F Meisel; Peter W Groeneveld; Manqing Liu; Angira Mondal; Nandita Mitra; Raina M Merchant Journal: Circ Cardiovasc Qual Outcomes Date: 2022-09-08
Authors: Madeline R Sterling; Crystal W Cené; Joanna Bryan Ringel; Ariel C Avgar; Erin E Kent Journal: J Rural Health Date: 2022-03-30 Impact factor: 5.667