Abstract
BackgroundThe purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. In particular, discharge destination and length of stay have not been studied using a data mining approach which may provide insights not obtained through traditional statistical analyses.MethodsThe data were obtained from the 2000 National Home and Hospice Care Survey data for three specific conditions (chronic obstructive pulmonary disease, heart failure and hip replacement), representing nearly 580 patients from across the US. The data mining approach used was CART (Classification and Regression Trees). Our aim was twofold: 1) determining the drivers of home healthcare service outcomes (discharge destination and length of stay) and 2) examining the applicability of induction through data mining to home healthcare data.ResultsPatient age (85 and older) was a driving force in discharge destination and length of stay for all three conditions. There were also impacts from the type of agency, type of payment, and ethnicity.ConclusionPatients over 85 years of age experience differential outcomes depending on the condition. There are also differential effects related to agency type by condition although length of stay was generally lower for hospital-based agencies. The CART procedure was sufficiently accurate in correctly classifying patients in all three conditions which suggests continuing utility in home health care.
Highlights
The purpose of this research is to understand the performance of home healthcare practice in the US
COPD (n = 206) For patients with COPD, the findings from CART indicate that age at admission is the key discriminating variable influencing reasons for being discharged
The results improved further with a larger training set (e.g. 66%, n = 136): in that case, CART found a perfect hit more than 11% of the time, it identified similar outcomes for 59% of the sample
Summary
The purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. Home healthcare is the provision of patient care delivered in the home. In the US in the 1990s, there was a paradigm shift in the financing of home healthcare services by Medicare. A significant decline in the use of home healthcare services took place after the reforms of the Balanced Budget Act (BBA) of 1997. As a consequence of these changes, both the quality and quantity of home healthcare services have been impacted [2,3,4,5]. After the change in Medicare policy, the focus of the US home healthcare industry shifted from various medical and (page number not for citation purposes)
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