Readmission Diagnoses of Patients Discharged to Home Health

A recent Research Corner item evaluated index admissions for patients discharged to home health care. Statewide data indicate that fewer patients discharged to home health care return to the hospital in 30 days than patients discharged directly to their home or a post-acute care facility. Common index admission diagnoses of the home health care discharge group include septicemia, heart failure, major joint replacement, pulmonary disease, and renal failure. A follow-up question is: What conditions most commonly result in home health care patients returning to the hospital? Figure 1 (see below) lists the top 10 readmission diagnosis related groups (DRG) for patients discharged to home health who returned to the hospital. The primary reasons for hospital readmission among that population are septicemia, heart failure, then pulmonary disease, findings that are not unlike other readmission groups the VHHA data and research team has studied. Pulmonary disease may be manifested in the form of pneumonia, chronic obstructive pulmonary disease (COPD), or pulmonary edema and respiratory failure secondary to heart failure or septicemia. The readmission diagnoses are very similar to the index admission diagnoses. It appears that a common scenario involves a patient returning, not with new diagnoses, but with worsened long-standing health issues. The exception is readmission caused by esophagitis and gastroenteritis. This condition could be secondary to taking over-the-counter, non-steroidal anti-inflammatory drugs (NSAID) such as naproxen or prescribed drugs with NSAIDs in them following surgery or other procedures. Home health care services provide needed support to frail and complex patients. To make the most of the service, hospital discharge and home health staff can work together to reinforce self-care of chronic conditions and medication regimens. A pre-discharge meeting between the staffs of the hospital and the home health agency, by telephone or in-person, can promote effective care transitions and consistent medication routines. Another potential action is a retrospective review of the index admission for patients who are readmitted with sepsis. The goal of that is to determine if care and treatment for these diagnoses were appropriate during the first admission. Such reviews can lead to further understanding of drivers for readmissions, and can even help strengthen the care given to patients during that index admission. The ultimate goal is fewer hospital readmissions, which are a win-win outcome. (9/23)

Figure 1: Top 10 Index Readmission DRGs for Patients Originally Discharged to Home Health

9-23 Research Corner