Abstract
Using the Outcome and Assessment Information Set (OASIS), this study examined the feasibility of using OASIS items to identify direct and indirect factors contributing to rehospitalization among elderly patients receiving home health care. The outcomes revealed that being male, having a median level of cognitive impairment, a lower level of functional ability, and the absence of support, such as environmental support, psychosocial support, or facilitated medical care directly contributed to rehospitalization. While being older, obese, having a poorer clinical status, receiving ADL and/or IADL and less frequent informal care contributed to rehospitalization indirectly through decreased functional ability. Home health care providers may take full advantage of OASIS data, assessing both the direct and indirect factors leading to rehospitalization to identify patients at risk and intervene when needed.
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