Date of Award

Fall 2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Weiss, Marianne E.

Second Advisor

Yakusheva, Olga

Third Advisor

Bobay, Kathleen


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.

Included in

Nursing Commons