US – Association Quality of Care and Outcomes Research Scientific Sessions.
“Since hospital readmissions are costly due to the expenses associated with hospitalization, using home health care after discharge for heart attack patients can reduce health care costs for patients and medical systems,” Muhammad Adil Sheikh, MBBS, clinical assistant professor and hospitalist at the University of Michigan Medical School in Ann Arbor, said in a press release.
Researchers analyzed data from 406,237 patients from the National Readmission Database who were treated for acute MI and discharged from the hospital with or without home health care. A regression model was developed to identify the probability of receiving home health care for each patient. The endpoint of interest was readmission.
Of the patients in the study, 9.4% received home health care after hospital discharge. Compared with patients who did not receive home health care, those who did were more likely to be women (53.6% vs. 26.9%) and older (77 years vs. 60 years; P < .001 for all). These patients were also more likely to have congestive HF (5.7% vs. 0.5%), cancer (3.7% vs. 1.3%), chronic kidney disease (26.9% vs. 6.9%), chronic pulmonary disease (23.2% vs. 12.7%), hypertension (70.7% vs. 64.8%), diabetes (35.6% vs. 26.7%) and peripheral vascular disease (14.6% vs. 6.4%: P for all < .001).
Patients who were readmitted after MI were more likely to be older and have chronic HF (RR = 5.89; 95% CI, 5.55-6.26), diabetes (RR = 1.42; 95% CI, 1.37-1.48) or chronic obstructive pulmonary disease (RR = 1.59; 95% CI, 1.52-1.65).
At 30 days, the unadjusted readmission rate was 20.9% of patients who received home health care and 8.2% for those who did not receive it.
Researchers performed propensity-weighted adjustment for covariates, which resulted in 36,979 patients discharged with home health care and 37,785 patients who were not discharged with it. Patients who were discharged with home health care had a significantly lower risk for readmission (RR = 0.89; 95% CI, 0.82-0.96) compared with those who did not receive it at discharge (RR = 1.12; 95% CI, 1.04-1.21).
“We found that home health care after hospital discharge was associated with lower 30-day readmission rates, and patients who received home health care are older, female or have underlying medical conditions,” Sheikh said in the press release. “These patients are likely to benefit the most from home health care, and this service should be utilized more often to potentially reduce hospital readmission rates.”