Effect of a restorative model of posthospital home care on hospital readmissions.

OBJECTIVES

To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care.

DESIGN

Quasiexperimental; matched and unmatched.

SETTING

Community, home care.

PARTICIPANTS

Seven hundred seventy individuals receiving care from a large home care agency after hospitalization.

INTERVENTION

A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory.

MEASUREMENTS

Hospital readmission, length of home care episode.

RESULTS

Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43-1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses.

CONCLUSION

Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign.