Factors Influencing 30‐Day Readmission to the Hospital during Home Health Services

Abstract

Research ObjectiveOur purpose was to investigate agency‐level and clinical variables that influence 30‐day hospital readmissions during home health (HH) services. The objective was exploration of variables that predict or protect against 30‐day hospital readmission, from real‐world HH operations data.Study DesignThis retrospective cohort study used one, northern California HH agency’s de‐identified electronic health record to investigate variables relating to 30‐day hospital readmissions during HH services. Binary logistic regression was used to build the most parsimoniously fitted model, with no more than 3 predictors in the model due to sample size. Fit criteria included statistical significance of predictors, little multicollinearity among the predictors, a significant omnibus model test, a nonsignificant Hosmer‐Lemeshow statistic for goodness of fit, and clinical meaningfulness of the predictors to benefit HH organizations in their attempts to reduce preventable 30‐day readmissions. t tests and chi‐square tests were used to compare characteristics differentiating readmission and nonreadmission cohorts.Population StudiedThe final, eligible sample consisted of 130 discharged patients seen between July 2016 and January 2018; 55 patients had a 30‐day hospital readmission and 75 patients did not have a 30‐day hospital readmission during HH services.Principal FindingsA significant model emerged with two variables associated with risk, and one variable protective against, 30‐day hospital readmission during HH services: 1) full code status designation (AOR = 3.324, P = .004); 2) the difference between nursing visits made and ordered (AOR = 0.779, P = .000); 3) speech ability (the M1230 OASIS form item for HH developed by the Centers for Medicare and Medicaid services) (AOR = 1.621, P = .031). Patients with full code status designations in place were more than 3 times more likely to have a readmission to the hospital within 30 days of starting HH services than those with DNR and no code status recorded combined. Patients with 30‐day readmission had significantly fewer nursing visits than originally ordered at the beginning of their HH episode, than patients without 30‐day hospital readmission (t = ‐3.374, P = 0.001). For every one more nursing visit made, there was a 22% lesser chance for a patient to experience 30‐day hospital readmission during their HH service. The proportion of patients having experienced 30‐day hospital readmission during HH services were scored as having significantly more speech disability than the proportion of patients not having experienced 30‐day hospital readmission during HH services (χ2 = 11.124, P = .025). In regression, for every incremental increase in severity of speech disability as scored on the OASIS M1230, patients were 1.6 times more likely to experience a 30‐day hospital readmission during their HH service than patients with less severe speech disability.ConclusionsHH agencies can potentially improve quality to reduce 30‐day hospital readmissions, by adhering to nursing visits, and care planning with patients/families to reduce risks of readmission such as speech disability and full code designation.Implications for policy or practiceFuture studies can validate these predictor variables and increase sample size and generalizability through more HH study sites. Quality improvement activities in HH agencies can enhance reduction of 30‐day hospital readmission during HH services by focusing on risks and protectors of readmission.