KNG Health Consulting, Rockville, MD, USA.
Trella Health, Atlanta, GA, USA.
J Am Med Dir Assoc. 2021 May;22(5):1022-1028.e1. doi: 10.1016/j.jamda.2020.11.039. Epub 2021 Jan 6.
Patients who are referred to home health care after an acute care hospitalization may not receive home health care, resulting in incomplete home health referrals. This study examines the prevalence of incomplete referrals to home health, defined as not receiving home health care within 7 days after an initial hospital discharge, and investigates the relationship between home health referral completion and patient outcomes.
Retrospective cohort study.
Medicare beneficiaries who are discharged from short-term acute care hospitals between October 2015 and December 2016 with a discharge status code on the hospital claim indicating home health care.
Patient characteristics and outcomes were compared between Medicare beneficiaries with complete and incomplete home health referrals after hospital discharge. The outcomes included mortality, readmission rate, and total spending over a 1-year episode following hospitalization. These outcomes were risk-adjusted using patient demographic, socioeconomic, clinical characteristic, hospital characteristic, and state fixed effects.
Approximately 29% of the 724,700 hospitalizations in the analytic dataset had incomplete home health referrals after discharge. The rate of incomplete home health referrals varied among clinical conditions, ranging from 17% among joint/musculoskeletal patients and 38% among digestive/endocrine patients. Risk-adjusted 1-year mortality and readmission rates were 1.4 and 2.4 percentage points lower and total spending was $1053 higher among patients with complete home health referrals as compared with those with incomplete home health referrals after hospital discharge.
The analysis revealed that almost 1 in 3 patients discharged from a hospital with a discharge status of home health does not receive home health care. In addition, complete home health referrals are associated with lower mortality and readmission rates and higher spending. As home health care utilization increases, policymakers should pay attention to the tradeoff between quality and cost when implementing alternative policies and payment models.
急性病住院后的患者可能无法接受家庭保健服务，导致家庭保健转介不完整。本研究调查了家庭保健转介不完整（即初始出院后 7 天内未接受家庭保健服务）的流行率，并探讨了家庭保健转介完成情况与患者结局之间的关系。
回顾性队列研究。
2015 年 10 月至 2016 年 12 月期间，从短期急性护理医院出院的 Medicare 受益人，出院状态代码在医院索赔上表示家庭保健服务。
比较出院后家庭保健转介完整和不完整的 Medicare 受益人的患者特征和结局。结果包括死亡率、再入院率和住院后 1 年期间的总支出。使用患者人口统计学、社会经济、临床特征、医院特征和州固定效应对这些结果进行风险调整。
在分析数据集的 724700 次住院中，约有 29%的患者出院后家庭保健转介不完整。不完整的家庭保健转介率因临床情况而异，范围从关节/肌肉骨骼患者的 17%到消化/内分泌患者的 38%。与出院后接受不完整家庭保健转介的患者相比，接受完整家庭保健转介的患者 1 年死亡率和再入院率分别低 1.4 和 2.4 个百分点，总支出高 1053 美元。
分析显示，近 1/3 从医院出院的患者出院时状态为家庭保健，但实际上并未接受家庭保健服务。此外，完整的家庭保健转介与较低的死亡率和再入院率以及较高的支出相关。随着家庭保健服务利用率的增加，政策制定者在实施替代政策和支付模式时，应注意质量和成本之间的权衡。
