Date of Award
Fall 2018
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Advisor
Weiss, Marianne E.
Second Advisor
Yakusheva, Olga
Third Advisor
Bobay, Kathleen
Abstract
Background: Home Health Care (HHC), the most commonly used bridge strategy for transitioning from hospital to home-based care, is expected to contribute to ongoing readmission avoidance efforts. However, evidence suggests HHC patients are readmitted more frequently than patients without HHC. Determining the effectiveness of HHC as a readmission reduction strategy requires a comparison sample of patients with similar characteristics referred and not referred to HHC. Methods: For this matched-sample comparative study, the available sample (n=18,774) included 3,629 patients referred to HHC and 15,145 non-HHC patients, from which 2,718 pairs matched 1:1 were obtained using exact and Mahalanobis distance matching. Unadjusted two-sample test of proportion followed by multinomial logit regression analysis adjusting for residual sample differences compared, post-discharge return to hospital for readmissions and Emergency Department [ED]/Observation visits within 30 and 60-days post-discharge. Post-hoc analyses using the same approach stratified the sample using the Elixhauser Comorbidity Index into high and low-comorbidity groups. Results: No statistically significant difference in readmissions or ED/Observation visits between HHC and non-HHC patients was observed, except for HHC-referred low-comorbidity patients who had 2.2% higher 30-day ED/Observation visit rates. Conclusions: Similarities in post-discharge utilization in this matched sample analysis is an improvement over prior observation studies where rates for HHC patients were at least 5 percentage points higher than non-HHC patients. The study results raise the question of why HHC services did not produce evidence of lower post-discharge return to hospital rates. Focused attention by HHC programs on strategies to reduce readmissions is needed.