Froedtert Hospital, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.
Department of Economics, St. Ambrose University, McMullen Hall 124A 518 W. Locust St.Davenport, IA 52803, USA.
Int J Nurs Stud. 2021 Jul;119:103946. doi: 10.1016/j.ijnurstu.2021.103946. Epub 2021 Apr 20.
Home health care, a commonly used bridge strategy for transitioning from hospital to home-based care, is expected to contribute to readmission avoidance efforts. However, in studies using disease-specific samples, evidence about the effectiveness of home health care in reducing readmissions is mixed.
To examine the effectiveness of home health care in reducing return to hospital across a diverse sample of patients discharged home following acute care hospitalization.
Secondary analysis of a multi-site dataset from a study of discharge readiness assessment and post-discharge return to hospital, comparing matched samples of patients referred and not referred for home health care at the time of hospital discharge.
Acute care, Magnet-designated hospitals in the United States PARTICIPANTS: The available sample (n = 18,555) included hospitalized patients discharged from medical-surgical units who were referred (n = 3,579) and not referred (n = 14,976) to home health care. The matched sample included 2767 pairs of home health care and non- home health care patients matched on patient and hospitalization characteristics using exact and Mahalanobis distance matching.
Unadjusted t-tests and adjusted multinomial logit regression analyses to compare the occurrence of readmissions and Emergency Department/Observation visits within 30 and 60-days post-discharge.
No statistically significant differences in readmissions or Emergency Department /Observation visits between home health care and non-home health care patients were observed.
Home health care referral was not associated with lower rates of return to hospital within 30 and 60 days in this US sample matched on patient and clinical condition characteristics. This result raises the question of why home health care services did not produce evidence of lower post-discharge return to hospital rates. Focused attention by home health care programs on strategies to reduce readmissions is needed.
家庭保健是从医院过渡到家庭护理的常用桥梁策略，预计将有助于避免再次入院。然而，在使用特定疾病样本的研究中，家庭保健在减少再入院方面的有效性的证据参差不齐。
在一个多样化的患者样本中，研究家庭保健在减少返回医院方面的有效性，这些患者在急性护理住院后出院回家。
对一项出院准备评估和出院后返回医院研究的多地点数据集进行二次分析，比较在出院时转诊和未转诊接受家庭保健的患者的匹配样本。
美国急性护理、磁铁指定医院
可用样本（n=18555）包括从内科-外科病房出院的住院患者，他们被转诊（n=3579）和未转诊（n=14976）接受家庭保健。匹配样本包括 2767 对家庭保健和非家庭保健患者，使用精确和马哈拉诺比斯距离匹配按患者和住院特征进行匹配。
使用未调整的 t 检验和调整后的多项逻辑回归分析比较出院后 30 天和 60 天内的再入院和急诊/观察就诊的发生情况。
未观察到家庭保健和非家庭保健患者之间再入院或急诊/观察就诊的发生率存在统计学差异。
在这个按患者和临床特征匹配的美国样本中，家庭保健转诊与 30 天和 60 天内返回医院的比率较低无关。这一结果提出了一个问题，即为什么家庭保健服务没有产生较低的出院后返回医院率的证据。家庭保健计划需要关注减少再入院的策略。
