Having vulnerable patients receive home health services is one approach to reducing hospital readmissions. Home health services provide community-based support to assist patients and their families in managing health care needs. Depending on the patient, that can include daily maintenance activities such as bathing, dressing wounds, or coordinating care. Home health providers – they can be nurses, pharmacists, or technicians depending on the patients’ needs – may assist patients and their families in understanding how to fit medication regimens into daily routines. Recently, VHHA was asked about the success of home health services in keeping patients in the home, and the diagnoses that more often lead to patient readmissions. A review of the 2015 discharge database found that 22 percent (99,135) of hospital patients were discharged to home health that year. Overall, 58 percent of patients return home without any additional service, while 17 percent go from hospitalization to post-acute care facility admission. Of those discharged to home health care, just 12 percent (12,285) were readmitted to a hospital. That total is about half the number of readmissions of patients discharged to home. Are there identifiable characteristics from principal diagnoses for the index admission that would predict readmissions? The top 10 diagnoses of the patients from their index hospital admission are listed in Figure 1 (see below). As can be seen in that list, patients are likely to return to the hospital if their index admission principal diagnosis was septicemia, or a worsening of long standing chronic diseases associated with morbidity and mortality (chronic obstructive lung disease, cerebrovascular disease, musculoskeletal issues, and so forth). In many cases, patients will have more than one of the listed conditions. For example, heart failure often coexists with renal failure. Earlier Virginia-specific research found that patients with three or more chronic diseases are most likely to return to the hospital. In short, home health services can reduce readmissions among that population of patients when compared to patients discharged directly to the home. Given the coexistence of chronic diseases, the in-home providers can reinforce hospital discharge instructions and can reassure patients unsettled by being out of the hospital. (9/9)
Figure 1: Top 10 Index Admission DRGs for Patients Discharge to Home Health who returned within 30 days in 2015.