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Davila H, Mayfield B, Mengeling MA, Holcombe A, Miell KR, Jaske E, Iverson W, Walkner T, Stewart G, Solimeo S. Home health utilization in the Veterans Health Administration: Are there rural and urban differences? J Rural Health 2025; 41:e12865. [PMID: 39075777 PMCID: PMC11635398 DOI: 10.1111/jrh.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 06/04/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Growing numbers of older adults need home health care, yhese services may be more difficult to access for rural Veterans, who represent one-third of Veterans Health Administration (VA) enrollees. Our objective was to examine whether home health use differs within VA based on rurality. METHODS We examined national VA administrative data for 2019-2021 (January 1, 2019 to December 31, 2021) among Veterans ages ≥65 years. Using descriptive and multivariable analyses, we assessed whether rural versus urban Veterans differed in (1) the likelihood of using any home health and (2) for those who received ≥1 visit, number of visits received. RESULTS Among home health users (n = 107,229, 33.1% rural), rural and urban Veterans were similar in age (77.0 vs. 77.2 years). Rural Veterans were less likely to be highly frail (38.9% rural vs. 40.4% urban) or diagnosed with dementia (13.5% vs. 17.6%). After adjusting for Veterans' characteristics, rural Veterans were more likely to receive any home health (odds ratio: 1.10; 95% confidence interval [CI]: 1.07, 1.13). Among Veterans who received ≥1 home health visit, rurality was associated with considerably fewer expected visits (incident rate ratio: 0.70; 95% CI: 0.68, 0.72). CONCLUSIONS Although rural Veterans were more likely than urban Veterans to receive any home health services, they received considerably fewer home health visits. This difference may represent an access issue for rural Veterans. Future research is needed to identify reasons for these differences and develop strategies to ensure rural Veterans' care needs are equitability addressed.
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Affiliation(s)
- Heather Davila
- Primary Care Analytics Team—Iowa CityVeterans Health Administration (VA) Office of Primary CareIowa CityIowaUSA
- Veterans Rural Health Resource Center—Iowa CityVA Office of Rural HealthIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Bradely Mayfield
- Primary Care Analytics Team—SeattleVA Office of Primary Care, VA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Michelle A. Mengeling
- Veterans Rural Health Resource Center—Iowa CityVA Office of Rural HealthIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Andrea Holcombe
- Veterans Rural Health Resource Center—Iowa CityVA Office of Rural HealthIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Kelly R. Miell
- Veterans Rural Health Resource Center—Iowa CityVA Office of Rural HealthIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Erin Jaske
- Primary Care Analytics Team—SeattleVA Office of Primary Care, VA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - William Iverson
- Primary Care Analytics Team—Iowa CityVeterans Health Administration (VA) Office of Primary CareIowa CityIowaUSA
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Department of Primary CareIowa City VA Health Care SystemIowa CityIowaUSA
| | - Tammy Walkner
- Veterans Rural Health Resource Center—Iowa CityVA Office of Rural HealthIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Greg Stewart
- Primary Care Analytics Team—Iowa CityVeterans Health Administration (VA) Office of Primary CareIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
- Tippie College of BusinessUniversity of Iowa, Iowa CityIowa CityIowaUSA
| | - Samantha Solimeo
- Primary Care Analytics Team—Iowa CityVeterans Health Administration (VA) Office of Primary CareIowa CityIowaUSA
- Veterans Rural Health Resource Center—Iowa CityVA Office of Rural HealthIowa CityIowaUSA
- Center for Access & Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
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Langton-Frost N, Lavezza A, Wilkins S, Moscirella M, Zaghlula N, Reider L, Turnbull A, Young DL, Friedman M, Hoyer EH. A Novel Approach of Enhanced, Multidisciplinary Rehabilitation Services in the Hospital to Facilitate Home Discharge: The Rehab2Home Program. Arch Phys Med Rehabil 2024:S0003-9993(24)01366-2. [PMID: 39608478 DOI: 10.1016/j.apmr.2024.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 10/19/2024] [Accepted: 10/25/2024] [Indexed: 11/30/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of an early, targeted, individualized, intensive rehabilitation program called Rehab2Home, designed to transition surgical patients directly from acute care to home. DESIGN The Rehab2Home program was implemented using a quality improvement (QI) approach between March 2023 and June 2023. The outcomes of the program were compared with a historical cohort of similar patients. SETTING Academic medical center. PARTICIPANTS Postsurgical patients (n=74) included were aged 18 years or older, recommended for subacute rehabilitation by physical therapy or occupational therapy, had some level of support at home, mild to no cognitive impairments, and moderate mobility impairments. INTERVENTIONS Patients received an enhanced rehabilitation therapy program from physical therapy, occupational therapy, speech-language pathology, and consultations with a physiatrist emphasizing readiness for discharge home. The team also conducted weekday interdisciplinary huddles. MAIN OUTCOME MEASURE(S) The primary outcome for the evaluation of the program was discharge location from the hospital. Secondary outcomes included the length of hospital stay and emergency department visits and potentially avoidable utilization (PAU) within 30 days of hospital discharge. RESULTS Seventy-four patients were included in the Rehab2Home program, with 66% discharging home compared to 47% in the historical controls. The program resulted in a 1.4 (95% CI, 1.1-1.6) times greater likelihood of discharging home and decreased the proportion of patients with potentially avoidable health care utilization by 63% (Risk Ratio: 0.37, 95% CI, 0.1-0.7), without a significant increase in length of stay (-0.6 days, 95% CI, -2.2 to 1.9). CONCLUSIONS The Rehab2Home program for postsurgical patients successfully facilitated home discharges and reduced postdischarge utilization. This model of rehabilitation shows promise for improving transitions of care from the hospital in this population.
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Affiliation(s)
- Nicole Langton-Frost
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Department of Physical Medicine and Rehabilitation, Baltimore, MD; Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD
| | - Annette Lavezza
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Department of Physical Medicine and Rehabilitation, Baltimore, MD; Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD
| | - Shannon Wilkins
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Department of Physical Medicine and Rehabilitation, Baltimore, MD
| | - Marybeth Moscirella
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Department of Physical Medicine and Rehabilitation, Baltimore, MD
| | - Noor Zaghlula
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Department of Physical Medicine and Rehabilitation, Baltimore, MD
| | - Lisa Reider
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - Alison Turnbull
- Johns Hopkins School of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Epidemiology, Baltimore, MD
| | - Daniel L Young
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD; Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV
| | - Michael Friedman
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD
| | - Erik H Hoyer
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD.
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3
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Burke RE, Chatterjee P. Breaking hospital discharge gridlock through policy reforms. J Hosp Med 2024. [PMID: 39360365 DOI: 10.1002/jhm.13519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/20/2024] [Accepted: 09/20/2024] [Indexed: 10/04/2024]
Affiliation(s)
- Robert E Burke
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Hospital Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion; Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paula Chatterjee
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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4
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Webster-Dekker KE, Lu Y, Perkins SM, Ellis J, Gates M, Otis L, Winton R, Hacker E. Factors associated with change in activities of daily living performance in home health care patients with diabetes. Geriatr Nurs 2024; 59:543-548. [PMID: 39153463 DOI: 10.1016/j.gerinurse.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/27/2024] [Accepted: 07/14/2024] [Indexed: 08/19/2024]
Abstract
Older adults with diabetes are at risk for impairments in activities of daily living (ADL) performance. Home health (HH) services help patients regain their ability to perform ADLs following hospitalization, but there may be disparities in ADL improvement. We aimed to identify factors associated with change in ADL performance from the start of HH care to discharge in HH patients with diabetes age ≥65. This secondary analysis used Outcome and Assessment Information Set-D data collected by a HH agency. The sample (n = 1350) had a mean age of 76.3 (SD 7.3). Black/African American race and bowel incontinence/ostomy were associated with less ADL improvement. The following factors were associated with greater ADL improvement: having a caregiver who needed training/support, surgical wounds, pain that interfered with activity, confusion, and better scores in prior functioning. Overall, most patients improved their ADL performance while receiving HH care, but there are disparities that should be addressed.
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Affiliation(s)
| | - Yvonne Lu
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46220, USA.
| | - Susan M Perkins
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, 410W. 10th Street, Indianapolis, IN 46202, USA.
| | - Jennifer Ellis
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Maria Gates
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Laurie Otis
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Rebecca Winton
- CenterWell Home Health, 3350 Riverwood Parkway SE #1400, Atlanta, GA 30339, USA
| | - Eileen Hacker
- The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77230, USA.
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Luo D, Ouayogodé MH, Mullahy J, Cao Y(J. Regional variation in length of stay for stroke inpatient rehabilitation in traditional Medicare and Medicare Advantage. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae089. [PMID: 39071107 PMCID: PMC11282463 DOI: 10.1093/haschl/qxae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/04/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
Regional variation in health care use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans, which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term health care equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (SD = 0.26 vs 0.24 days; 11% relative difference). In 2020, across-region variation for MA further increased, but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity = 0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in health care use.
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Affiliation(s)
- Dian Luo
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI 53726, United States
| | - Mariétou H Ouayogodé
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI 53726, United States
- Center for Demography and Health of Aging, University of Wisconsin–Madison, Madison, WI 53726, United States
| | - John Mullahy
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI 53726, United States
- Center for Demography and Health of Aging, University of Wisconsin–Madison, Madison, WI 53726, United States
| | - Ying (Jessica) Cao
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI 53726, United States
- Center for Demography and Health of Aging, University of Wisconsin–Madison, Madison, WI 53726, United States
- Health Innovation Program, University of Wisconsin–Madison, Madison, WI 53726, United States
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Russell AM, Bonham M, Lovett R, Pack A, Wolf MS, O’Conor R. Characterizing Caregiver Roles and Conflict in Health Management Support to Older People With Multiple Chronic Conditions. J Appl Gerontol 2024; 43:386-395. [PMID: 37982673 PMCID: PMC10922419 DOI: 10.1177/07334648231211456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Caregivers provide critical support for older adults managing multiple chronic conditions (MCCs), but few studies describe the assistance caregivers provide or identify factors influencing their provision of support. We conducted qualitative interviews with 25 caregivers to older adults with MCCs to describe caregivers' roles and identify the factors that influence caregivers' ability to carry out these roles. Transcripts were analyzed using the Framework Method. Caregivers supported the management of MCCs in several ways, including monitoring conditions, communicating with clinicians, and tracking health information. Disagreement, or conflicted relationships, between caregivers and older adults over health and behaviors influenced the provision of support, resulting in less involved and less effective caregivers. Caregivers in conflicted relationships were more challenged by resistance from older adults. Greater agreement, or collaboration, between caregivers and older adults resulted in more involved and effective caregivers. Addressing health-related conflict may enhance caregivers' capacity to support older adults with MCCs.
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Affiliation(s)
- Andrea M. Russell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Morgan Bonham
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebecca Lovett
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allison Pack
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel O’Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Cao YJ, Luo D. Post-Acute Care in Inpatient Rehabilitation Facilities Between Traditional Medicare and Medicare Advantage Plans Before and During the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:868-875.e5. [PMID: 37148906 PMCID: PMC10073583 DOI: 10.1016/j.jamda.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Compare post-acute care (PAC) utilization and outcomes in inpatient rehabilitation facilities (IRF) between beneficiaries covered by Traditional Medicare (TM) and Medicare Advantage (MA) plans during the COVID-19 pandemic relative to the previous year. DESIGN This multiyear cross-sectional study used Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) data to assess PAC delivery from January 2019 to December 2020. SETTING AND PARTICIPANTS Inpatient rehabilitation for stroke, hip fracture, joint replacement, and cardiac and pulmonary conditions among Medicare beneficiaries 65 years or older. METHODS Patient-level multivariate regression models with difference-in-differences approach were used to compare TM and MA plans in length of stay (LOS), payment per episode, functional improvements, and discharge locations. RESULTS A total of 271,188 patients were analyzed [women (57.1%), mean (SD) age 77.8 (0.06) years], among whom 138,277 were admitted for stroke, 68,488 hip fracture, 19,020 joint replacement, and 35,334 cardiac and 10,069 pulmonary conditions. Before the pandemic, MA beneficiaries had longer LOS (+0.22 days; 95% CI: 0.15-0.29), lower payment per episode (-$361.05; 95% CI: -573.38 to -148.72), more discharges to home with a home health agency (HHA) (48.9% vs 46.6%), and less to a skilled nursing facility (SNF) (15.7% vs 20.2%) than TM beneficiaries. During the pandemic, both plan types had shorter LOS (-0.68 day; 95% CI: 0.54-0.84), higher payment (+$798; 95% CI: 558-1036), increased discharges to home with an HHA (52.8% vs 46.6%), and decreased discharges to an SNF (14.5% vs 20.2%) than before. Differences between TM and MA beneficiaries in these outcomes became smaller and less significant. All results were adjusted for beneficiary and facility characteristics. CONCLUSIONS AND IMPLICATIONS Although the COVID-19 pandemic affected PAC delivery in IRF in the same directions for both TM and MA plans, the timing, time duration, and magnitude of the impacts were different across measures and admission conditions. Differences between the 2 plan types shrank and performance across all dimensions became more comparable over time.
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Affiliation(s)
- Ying Jessica Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
| | - Dian Luo
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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8
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Turbow SD, Ali MK, Culler SD, Rask KJ, Perkins MM, Clevenger CK, Vaughan CP. Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults. JAMA Netw Open 2023; 6:e2313592. [PMID: 37191959 PMCID: PMC10189568 DOI: 10.1001/jamanetworkopen.2023.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Importance When an older adult is hospitalized, where they are discharged is of utmost importance. Fragmented readmissions, defined as readmissions to a different hospital than a patient was previously discharged from, may increase the risk of a nonhome discharge for older adults. However, this risk may be mitigated via electronic information exchange between the admission and readmission hospitals. Objective To determine the association of fragmented hospital readmissions and electronic information sharing with discharge destination among Medicare beneficiaries. Design, Setting, and Participants This cohort study retrospectively examined data from Medicare beneficiaries hospitalized for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, syncope, urinary tract infection, dehydration, or behavioral issues in 2018 and their 30-day readmission for any reason. The data analysis was completed between November 1, 2021, and October 31, 2022. Exposures Same hospital vs fragmented readmissions and presence of the same health information exchange (HIE) at the admission and readmission hospitals vs no information shared between the admission and readmission hospitals. Main Outcomes and Measures The main outcome was discharge destination following the readmission, including home, home with home health, skilled nursing facility (SNF), hospice, leaving against medical advice, or dying. Outcomes were examined for beneficiaries with and without Alzheimer disease using logistic regressions. Results The cohort included 275 189 admission-readmission pairs, representing 268 768 unique patients (mean [SD] age, 78.9 [9.0] years; 54.1% female and 45.9% male; 12.2% Black, 82.1% White, and 5.7% other race and ethnicity). Of the 31.6% fragmented readmissions in the cohort, 14.3% occurred at hospitals that shared an HIE with the admission hospital. Beneficiaries with same hospital/nonfragmented readmissions tended to be older (mean [SD] age, 78.9 [9.0] vs 77.9 [8.8] for fragmented with same HIE and 78.3 [8.7] years for fragmented without HIE; P < .001). Fragmented readmissions were associated with 10% higher odds of discharge to an SNF (adjusted odds ratio [AOR], 1.10; 95% CI, 1.07-1.12) and 22% lower odds of discharge home with home health (AOR, 0.78; 95% CI, 0.76-0.80) compared with same hospital/nonfragmented readmissions. When the admission and readmission hospital shared an HIE, beneficiaries had 9% to 15% higher odds of discharge home with home health (patients without Alzheimer disease: AOR, 1.09 [95% CI, 1.04-1.16]; patients with Alzheimer disease: AOR, 1.15 [95% CI, 1.01-1.32]) compared with fragmented readmissions where information sharing was not available. Conclusions and Relevance In this cohort study of Medicare beneficiaries with 30-day readmissions, whether a readmission is fragmented was associated with discharge destination. Among fragmented readmissions, shared HIE across admission and readmission hospitals was associated with higher odds of discharge home with home health. Efforts to study the utility of HIE for care coordination for older adults should be pursued.
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Affiliation(s)
- Sara D. Turbow
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammed K. Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Steven D. Culler
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Molly M. Perkins
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Camille P. Vaughan
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, Georgia
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9
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Emile SH, Horesh N, Freund MR, Garoufalia Z, Gefen R, Silva-Alvarenga E, Wexner SD. A National Cancer Database analysis of the predictors of unplanned 30-day readmission after proctectomy for rectal adenocarcinoma: The CCF RETURN-30 Score. Surgery 2023; 173:342-349. [PMID: 36473745 DOI: 10.1016/j.surg.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/15/2022] [Accepted: 10/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unplanned 30-day readmission is common after major surgery, including rectal cancer surgery. The present study aimed to assess the rate and predictors of unplanned 30-day readmission after proctectomy for rectal cancer. METHODS This was a retrospective case-control study using data from the National Cancer Database. Patients with non-metastatic rectal cancer who underwent proctectomy were included, and patients who required readmission within 30 days after discharge were compared to patients who were not readmitted in regard to patient and treatment baseline factors to determine the predictors of 30-day readmission after proctectomy. The main outcome measures were the rate and predictors of 30-day unplanned readmission and the impact of readmission on short-term mortality and overall survival. RESULTS A total of 55,181 patients (60.9% men) with a mean age of 61.2 years were included. The 30-day readmission rate was 7.07% (95% confidence interval: 6.9-7.3). A Charlson score of 0 (odds ratio: 0.75, P < .001), Medicare insurance (odds ratio: 0.836, P = .04), and private insurance (odds ratio: 0.73, P = .0003) were predictive of a lower likelihood of 30-day readmission, whereas urban living area (odds ratio: 1.18, P = .01), rural living area (odds ratio: 1.65%, P = .0004), neoadjuvant radiation therapy (odds ratio: 1.37, P = .001), pull-through coloanal anastomosis (odds ratio: 1.37, P = .0005), conversion to open surgery (odds ratio: 1.25, P = .001), and hospital stay ≥6 days (odds ratio: 1.02, P < .001) were predictive of a higher likelihood of 30-day readmission. Readmitted patients had a higher rate of 90-day mortality (3.1% vs 2.1%, P < .001) and a lower 5-year overall survival (67.0% vs 72.7%, P < .001) than non-readmitted patients. Using the weighted ORs of the significant predictors of 30-day readmission, a risk score, the Cleveland Clinic Florida REadmission afTer sUrgery for Rectal caNcer in 30 days (RETURN-30) score, was developed. CONCLUSION Comorbidities, residence in urban or rural areas, neoadjuvant radiation therapy, pull-through coloanal anastomosis, conversion to open surgery, and extended hospital stay were predictive of a higher risk of 30-day readmission. Patients who were readmitted had a higher rate of 90-day mortality and a lower 5-year overall survival.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, Mansoura University Hospitals, Egypt. https://twitter.com/dr_samehhany81
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Israel. https://twitter.com/nirhoresh
| | - Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel. https://twitter.com/mikifreund
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ZGaroufalia
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem. https://twitter.com/RachelGefen
| | - Emanuela Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/EmanuelaSilvaA1
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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10
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Cao YJ, Wang Y, Mullahy J, Burns M, Liu Y, Smith M. The Relative Importance of Hospital Discharge and Patient Composition in Changing Post-Acute Care Utilization and Outcomes Among Medicare Beneficiaries. Health Serv Insights 2023; 16:11786329231166522. [PMID: 37077324 PMCID: PMC10108411 DOI: 10.1177/11786329231166522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Background The COVID-19 pandemic changed care delivery. But the mechanisms of changes were less understood. Objectives Examine the extent to which the volume and pattern of hospital discharge and patient composition contributed to the changes in post-acute care (PAC) utilization and outcomes during the pandemic. Research design Retrospective cohort study. Medicare claims data on hospital discharges in a large healthcare system from March 2018 to December 2020. Subjects Medicare fee-for-service beneficiaries, 65 years or older, hospitalized for non-COVID diagnoses. Measures Hospital discharges to Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), and Inpatient Rehabilitation Facilities (IRF) versus home. Thirty- and ninety-day mortality and readmission rates. Outcomes were compared before and during the pandemic with and without adjustment for patient characteristics and/or interactions with the pandemic onset. Results During the pandemic, hospital discharges declined by 27%. Patients were more likely to be discharged to HHA (+4.6%, 95% CI [3.2%, 6.0%]) and less likely to be discharged to either SNF (-3.9%, CI [-5.2%, -2.7%]) or to home (-2.8% CI [-4.4%, -1.3%]). Thirty- and ninety-day mortality rates were significantly higher by 2% to 3% points post-pandemic. Readmission were not significantly different. Up to 15% of the changes in discharge patterns and 5% in mortality rates were attributable to patient characteristics. Conclusions Shift in discharge locations were the main driver of changes in PAC utilization during the pandemic. Changes in patient characteristics explained only a small portion of changes in discharge patterns and were mainly channeled through general impacts rather than differentiated responses to the pandemic.
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Affiliation(s)
- Ying Jessica Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yang Wang
- Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
| | - John Mullahy
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Maureen Smith
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA
- Health Innovation Program, University of Wisconsin-Madison, Madison, WI, USA
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Ankuda CK, Grabowski DC. Is every day at home a good day? J Am Geriatr Soc 2022; 70:2481-2483. [PMID: 35917290 PMCID: PMC9489673 DOI: 10.1111/jgs.17973] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
This Editorial comments on the articles by Freed et al. and Shen et al. in this issue.
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Affiliation(s)
- Claire K Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Onishi R, Hatakeyama Y, Seto K, Hirata K, Matsumoto K, Hasegawa T. Evaluating the Hospital Standardized Home-Transition Ratios for Cerebral Infarction in Japan: A Retrospective Observational Study from 2016 through 2020. Healthcare (Basel) 2022; 10:healthcare10081530. [PMID: 36011186 PMCID: PMC9408795 DOI: 10.3390/healthcare10081530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Discharge to home is considered appropriate as a treatment goal for diseases that often leave disabilities such as cerebral infarction. Previous studies showed differences in risk-adjusted in-hospital mortality and readmission rates; however, studies assessing the rate of hospital-to-home transition are limited. We developed and calculated the hospital standardized home-transition ratio (HSHR) using Japanese administrative claims data from 2016–2020 to measure the quality of in-hospital care for cerebral infarction. Overall, 24,529 inpatients at 35 hospitals were included. All variables used in the analyses were associated with transition to another hospital or facility for inpatients, and evaluation of the HSHR model showed good predictive ability with c-statistics (area under curve, 0.73 standard deviation; 95% confidence interval, 0.72–0.73). All HSHRs of each consecutive year were significantly correlated. HSHRs for cerebral infarction can be calculated using Japanese administrative claims data. It was found that there is a need for support for low HSHR hospitals because hospitals with high/low HSHR were likely to produce the same results in the following year. HSHRs can be used as a new quality indicator of in-hospital care and may contribute to assessing and improving the quality of care.
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Affiliation(s)
| | | | | | | | | | - Tomonori Hasegawa
- Correspondence: ; Tel.: +81-03-3762-4151 (ext. 2415); Fax: +81-03-5493-5417
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