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Skilled Nursing Facility Patients Discharged to Home Health Agency Services Spend More Days at Home
Author(s) -
Simning Adam,
Orth Jessica,
Wang Jinjiao,
Caprio Thomas V.,
Li Yue,
TemkinGreener Helena
Publication year - 2020
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.16457
Subject(s) - medicine , receipt , logistic regression , odds , odds ratio , emergency medicine , skilled nursing facility , retrospective cohort study , cohort , demography , gerontology , sociology , world wide web , computer science
OBJECTIVES To investigate the association of the utilization of Medicare‐certified home health agency (CHHA) services with post‐acute skilled nursing facility (SNF) discharge outcomes that included home time, rehospitalization, SNF readmission, and mortality. DESIGN Retrospective cohort study. SETTING New York State fee‐for‐service Medicare beneficiaries aged 65 years and older admitted to SNFs for post‐acute care and discharged to the community in 2014. PARTICIPANTS A total of 25,357 older adults. MEASUREMENTS The outcomes included days spent alive in the community (“home time”), rehospitalization, SNF readmission, and mortality within 30‐ and 90‐day post‐SNF discharge periods. The primary independent variables were SNF five‐star overall quality rating and receipt of CHHA services within 7 days of SNF discharge. Zero‐inflated negative binomial regression and logistic regression models characterized the association of CHHA linkage with home time and other outcomes, respectively. RESULTS Following SNF discharge, 17,657 (69.6%) patients received CHHA services. In analyses that adjusted for patient‐, market‐, and other SNF‐level factors, older adults discharged from higher quality SNFs were more likely to receive CHHA services. In analyses that adjusted for patient‐ and market‐level factors, receipt of post‐SNF CHHA services was associated with 2.03 and 4.17 ( P < .001) more days in the community over 30‐ and 90‐day periods. Receiving CHHA services was also associated with decreased odds for rehospitalization (odds ratio [OR] = .68; P < .001; OR = .91; P = .008), SNF readmission (OR = .36; P < .001; OR = .62; P < .001), and death (OR = .34; P < .001; OR = .63; P < .001) over 30‐ and 90‐day periods, respectively. CONCLUSION Among older adults discharged from a post‐acute SNF stay, those who received CHHA services had better discharge outcomes. They were less likely to experience admissions to institutional care settings and had a lower mortality risk. Future efforts that examine how the type and intensity of CHHA services affect outcomes would build on this work. J Am Geriatr Soc 68:1573‐1578, 2020.