Hospital readmissions during home care: a pilot study.

The health care delivery system has undergone dramatic shifts in care settings during the past decade. More patients are receiving professional home care following discharge from hospitals, skilled-care facilities and rehabilitation centers. Home care is considered to be an integral part of patient recovery. Skilled nursing care delivered in the patient's home may prevent, forestall, or limit costly readmissions to an inpatient setting. Home care professionals have long questioned whether the unplanned returns of their clients to hospitals are preventable. The literature is replete with information from the acute-care and medical or physician's perspective concerning readmission. However, clients' unplanned returns to an inpatient setting while receiving home care services has not received much attention. The purpose of this pilot study is to describe clients who have unplanned returns to an inpatient setting during the first 31 days of home care service delivery. Using the Hospital Readmission Inventory (HRI), an audit tool with established validity and reliability, medical records for 68 clients from 8 midwestern home care agencies were reviewed. Readmitted patients were elderly, married females with cardiovascular or respiratory problems who were not independent in health care decision making or in self-care. Clients were readmitted to the hospital after approximately 2 weeks of home care service. The characterization of home care clients who are readmitted to the hospital may assist in targeting high-risk patients who could benefit from interventions aimed at minimizing unplanned returns to the acute-care setting.