Demographics Most Likely to Be Rehospitalized During Home Healthcare

Chase

Few studies have explored racial/ethnic differences in healthcare outcomes among patients receiving home healthcare, despite known differences in other care settings; however, a study published in the Journal of Applied Gerontology, aimed to do just that.

“There is research that suggests that patients from racial/ethnic minority groups have higher rates of rehospitalization and ER use, but there is limited research specific to the home healthcare setting,” says lead study author aid Jo-Ana Chase, an assistant professor in the University of Missouri’s Sinclair School of Nursing.

Chase and colleagues analyzed EHRs from more than 22,000 patients ages 65 and older who received home healthcare from a large nonprofit certified agency in New York City after hospitalization from 2013 to 2014. Researchers controlled for several diverse individual-level characteristics in the analyses.

Researchers found that specifically, during the post-acute home healthcare episode, black patients had a 45% higher likelihood of an ER visit and a 34% higher likelihood of rehospitalization compared to non-Hispanic whites. Hispanic patients had a 26% higher likelihood of an ER visit compared to non-Hispanic whites.

In addition, older home healthcare patients in the study experienced overall low rates of rehospitalization and ER visits. Finally, individual characteristics (e.g., demographics, living arrangement, availability of a caregiver, and diverse health-related factors) only explained a small proportion of the differences in rehospitalization and ER visits we observed in the study.

“Home healthcare service after hospitalization is beneficial for older adults who need it,” says Chase. “Home healthcare services may prevent costs related to rehospitalization and ER use. Second, further examination on how care is delivered or how variations in care delivery might be needed in the home healthcare setting is warranted.”

Based on the study, Chase offers healthcare executives three things to know about home healthcare:

• Home healthcare may help reduce rehospitalization and ER visit rates for clinically complex older adults transitioning from hospital to home.
• Assessment of patient care needs during discharge planning and into the first home healthcare visit may be helpful in providing the best, tailored care for these older, high-risk patients
• Involving caregivers is essential during the transition from hospital to home. “Clinicians in the hospital and home healthcare setting could assess caregivers’ training and support needs to help them manage the complex care of these older, high-risk patients,” Chase says.

The study was funded in part by the National Institutes of Health/National Institute of Nursing Research and the Frank Morgan Jones Fund through the University of Pennsylvania.