Home Health Discharges and Total Joint Replacement Readmission Rates

In an effort to reduce readmissions, hospital staff can choose to send a patient to a post-acute care provider for additional assistance during total joint replacement (TJR) recovery. Medicare patients discharged to home health care often are assumed to have greater readmission rates than patients given other discharge options. To examine this notion, we summarized the discharge distributions of all TJR admissions and readmitted patients within 30 days post discharge (see Figure 1 below). As you can see, more than 50 percent of all Medicare discharges for TJR are sent to home health care. Nearly half of those patients (48 percent) are readmitted from a home health care setting.

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The next step in the analysis is to look at hospital-specific data. If Medicare patients discharged to home health care are more likely to return within 30 days, then do hospitals with high home health care discharge rates have higher readmission rates? VHHA tested this claim by using logistic regression to plot each hospital’s home health care discharge rate in relation to their risk adjusted readmission rate (RSRR). We used the RSRR to control for patient acuity. The results: No statistically significant correlation was found (see Figure 2 below). What does this finding mean for clinicians? First, reducing patients discharged to home health care is not likely to reduce a hospital’s readmission rates. Instead, hospital staff and the home health care providers should work together to develop care protocols for discharge, transfer, and beyond so patients don’t feel the need to return to hospitals. This includes patient care protocols for post-surgical patients with several chronic diseases, and complex medication regimens to manage them. Another potential option: troubleshooting meetings between the two organizations when patients are readmitted to address events and conditions leading up to that occurrence. Process improvement involving both organizations offers hope for readmission reductions. (2/26)

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