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The Bundled Hospital Elder Life Program—HELP and HELP in Home Care—and Its Association With Clinical Outcomes Among Older Adults Discharged to Home Healthcare
Author(s) -
Simpson Michelle,
Macias Tejada Jonny,
Driscoll Amy,
Singh Maharaj,
Klein Matthew,
Malone Michael
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15979
Subject(s) - medicine , gerontology , health care , home health , association (psychology) , geriatrics , family medicine , psychiatry , philosophy , epistemology , economics , economic growth
OBJECTIVES To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30‐day all‐cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP. DESIGN Matched case‐control study. SETTING Two medical‐surgical units within two midwestern rural hospitals and patient homes (home health). PARTICIPANTS Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non‐Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching. MEASUREMENTS The primary study outcome was 30‐day all‐cause unplanned hospital readmission. Additional outcomes measured were 30‐day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits. RESULTS Fewer cases (16.8%) than controls (28.4%) had a 30‐day all‐cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30‐day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22‐0.77; P < .01). The difference between case (10.8%) and control (15.5%) 30‐day ED visit was not significant ( P = .23). A lower LOS for the case group was shown ( P < .01), while the number of skilled home care visits was not significantly different between groups ( P = .28). CONCLUSION HELP protocol implementation during a patient's hospital stay and as a continued component of home care among older adults at risk for cognitive and/or functional decline appears to be associated with favorable outcomes. Our initial evaluation supports continued study of the Bundled HELP. Further research is needed to confirm the initial findings and to evaluate the impact of the adapted model on functional outcomes and delirium incidence in the home. J Am Geriatr Soc 67:1730–1736, 2019