Does Home Health Care Increase the Probability of 30-Day Hospital Readmissions? Interpreting Coefficient Sign Reversals, or Their Absence, in Binary Logistic Regression Analysis

Abstract

Data for 30-day readmission rates in American hospitals often show that patients that receive Home Health Care (HHC) have a higher probability of being readmitted to hospital than those that did not receive such services, but it is expected that when control variables are included in a regression we will obtain a “sign reversal” of the treatment effect. We map the real-world situation to the binary logistic regression model, and we construct a counterfactual probability metric that leads to necessary and sufficient conditions for the sign reversal to occur, conditions that show that logistic regression is an appropriate tool for this research purpose. This metric also permits us to obtain evidence related to the criteria used to assign HHC treatment. We examine seven data samples from different USA hospitals for the period 2011–2017. We find that in all cases the provision of HHC increased the probability of readmission of the treated patients. This casts doubt on the appropriateness of the 30-day readmission rate as an indicator of hospital performance and a criterion for hospital reimbursement, as it is currently used for Medicare patients.