Home health care can prevent repeat hospital stays

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Older adults who receive one to two hours of in-home physical therapy are up to 82 percent less likely to face hospital readmission 60 days after discharge, research finds.

For the study, which appears in the Journal of the American Medical Directors Association, researchers examined the impact of specific services in Medicare-certified home health care (HHC) programs, such as physical therapy, occupational therapy, and skilled nursing, on subsequent re-hospitalization among older patients.

Each year, more than 3.3 million hospital readmissions occur in the United States, costing more than $41 billion. Older patients are particularly at risk for post-discharge functional decline and re-hospitalization, which occur in one-third of Medicare patients within 90 days of hospital discharge.

To prevent unplanned re-hospitalization, medical personnel refer older patients with high medical complexity to post-acute services, such as HHC.

Previous research shows that HHC improves physical function and reduces health care costs, but the current study is the first to systematically examine the relationships between specific services to find the threshold, or minimally effective, “dose” to avoid re-hospitalization.

“This finding highlights the complex medical and functional conditions in HHC patients, thus the need of ‘precision HHC,'” says Jinjiao Wang, an assistant professor in the University of Rochester School of Nursing.

“Currently, the dose of HHC is primarily determined based on personal experience and agency protocols. In light of the recent Medicare value-based purchasing model that penalizes HHC agencies with above-average re-hospitalization rates, a systematic approach should be developed to individualize HHC intensity and ensure that enough HHC services are provided for persons at risk for re-hospitalization.

“The study examined more than 1,300 patients age 65 or older admitted into an HHC program within 48 hours of hospital discharge. Among them, 11.5 percent returned to the hospital during 60 days.

Both physical therapy and skilled nursing helped patients avoid re-hospitalization.

During the 60 days’ post-hospitalization period, a threshold of one physical therapy visit per week lowered the risk of hospitalization by 82 percent. An average dose of two skilled nursing visits per week lowered the patients’ risk by 48 percent.

The intensity of home health aide and occupational therapy visits did not significantly relate to re-hospitalization.

Wang cautions the sample was based on one HHC agency and the analysis did not include patients with severe dementia or cancer.

Source: University of Rochester