Home health care is associated with an increased risk of readmission and cost of care without reducing risk of complication following shoulder arthroplasty: a propensity-score analysis

Abstract

BackgroundHome health services provide patients with additional professional care and supervision following discharge from the hospital to theoretically reduce the risk of complication and reduce healthcare utilization. The aim of this investigation was to determine if patients assigned home health services following total shoulder arthroplasty (anatomic (TSA) and reverse (RSA)) exhibited lower rates of medical complications, lower healthcare utilization, and lower cost of care compared to patients not receiving these services. MethodsA national insurance database was retrospectively reviewed to identify all patients undergoing primary anatomic and reverse total shoulder arthroplasty from 2010 to 2019. Patients who received home health services were matched using a propensity score algorithm to a set of similar patients who were discharged home without services. We compared medical complication rates, emergency department (ED) visits, readmissions, and 90-day cost of care between the groups. Multivariate regression analysis was performed to determine the independent effect of home health services on all outcomes. Results1,119 patients received home health services and were matched to 11,190 patients who were discharged home without services. There was no significant difference in patients who received home health services compared to those who did not receive home health services with respect to rates of ED visits within 30 days (OR 1.293; p = 0.0328) and 90 days (OR 1.215; P = 0.0378), while the home health group demonstrated increased readmissions within 90 days (OR 1.663; P<0.001). For all medical complications, there was no difference between cohorts. Episode-of-care costs for home health patients were higher than those discharged without these services ($12,521.04 vs $9,303.48; P < .001). ConclusionPatients assigned home health care services exhibited higher cost of care and readmission rates without a reduction in the rate of complication or early return to the ED. These findings suggest that home healthcare services should be strongly analyzed on a case-by-case basis to determine if a patient may benefit from its implementation.