Document Type

Article

Publication Date

8-2019

Publisher

Wiley

Source Publication

Journal of the American Geriatrics Society

Source ISSN

0002-8614

Original Item ID

DOI: 10.1111/jgs.15979

Abstract

OBJECTIVES To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30-day all-cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP. DESIGN Matched case-control study. SETTING Two medical-surgical units within two midwestern rural hospitals and patient homes (home health). PARTICIPANTS Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non-Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching. MEASUREMENTS The primary study outcome was 30-day all-cause unplanned hospital readmission. Additional outcomes measured were 30-day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits. RESULTS Fewer cases (16.8%) than controls (28.4%) had a 30-day all-cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30-day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22-0.77; P <  .01). The difference between case (10.8%) and control (15.5%) 30-day ED visit was not significant (P = .23). A lower LOS for the case group was shown (P <  .01), while the number of skilled home care visits was not significantly different between groups (P = .28). CONCLUSION HELP protocol implementation during a patient's hospital stay and as a continued component of home care among older adults at risk for cognitive and/or functional decline appears to be associated with favorable outcomes. Our initial evaluation supports continued study of the Bundled HELP. Further research is needed to confirm the initial findings and to evaluate the impact of the adapted model on functional outcomes and delirium incidence in the home.

Comments

Accepted version. Journal of the American Geriatrics Society, Vol. 67, No. 8 (August 2019): 1730-1736. DOI. This article is © 2019 The American Geriatrics Society. Used with permission.

Maharaj Singh was affiliated with Aurora Research Institute, Aurora Health Care, Milwaukee, WI at the time of publication.

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