Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

Himali Weerahandi 1 2 3, Haikun Bao 4, Jeph Herrin 5, Kumar Dharmarajan 6, Joseph S Ross 4 7, Simon Jones 2 3, Leora I Horwitz 1 2 3

Affiliations

PMID: 31603248
PMCID: PMC6964248
DOI: 10.1111/jgs.16179

Abstract

Background/objective: Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. Here, we examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.

Design: Retrospective cohort study.

Setting: Fee-for-service Medicare data, 2012 to 2015.

Participants: Beneficiaries, aged 65 years and older, hospitalized with HF who were subsequently discharged to SNF and then discharged home.

Measurements: The primary outcome was unplanned readmission within 30 days of discharge to home from SNF. We compared time to readmission between those with and without HHC services using a Cox model.

Results: Of 67 585 HF hospitalizations discharged to SNFs and subsequently discharged home, 13 257 (19.6%) were discharged with HHC, and 54 328 (80.4%) were discharged without HHC. Patients discharged home from SNFs with HHC had lower 30-day readmission rates than patients discharged without HHC (22.8% vs 24.5%; P < .0001) and a longer time to readmission. In an adjusted model, the hazard for readmission was 0.91 (0.86-0.95) with receipt of HHC.

Conclusions: Recipients of HHC were less likely to be readmitted within 30 days vs those discharged home without HHC. This is unexpected, as patients discharged with HHC likely have more functional impairments. Since patients requiring a SNF stay after hospital discharge may have additional needs, they may particularly benefit from restorative therapy through HHC; however, only approximately 20% received such services. J Am Geriatr Soc 68:96-102, 2019.

Keywords: heart failure; home healthcare; readmission; rehabilitation; skilled nursing facility; transitions.

Conflict of interest statement

Conflict of Interest: To the best of our knowledge, no conflict of interest, financial or other, exists.

Conflict of Interest Disclosures:

In the past 36 months, Dr. Ross has received support through Yale University from the Food and Drug Administration as part of the Centers for Excellence in Regulatory Science and Innovation (CERSI) program, from Medtronic, Inc. and the Food and Drug Administration (FDA) to develop methods for postmarket surveillance of medical devices, from Johnson and Johnson to develop methods of clinical trial data sharing, from the Centers of Medicare and Medicaid Services (CMS) to develop and maintain performance measures that are used for public reporting, from the Blue Cross Blue Shield Association to better understand medical technology evaluation, from the Agency for Healthcare Research and Quality (AHRQ), and from the Laura and John Arnold Foundation to support the Collaboration on Research Integrity and Transparency (CRIT) at Yale. At the time this research was conducted, Dr. Horwitz, Dr. Dharmarajan, Dr. Bao, Dr. Herrin, and Dr. Ross worked under contract with CMS to develop and maintain performance measures. Dr. Dharmarajan was also a consultant and scientific advisory board member of Clover Health.