Dementia Severity Associated With Increased Risk of Potentially Preventable Readmissions During Home Health Care

Sara Knox, Brian Downer, Allen Haas, Addie Middleton, Kenneth J. Ottenbacher

Research output: Contribution to journalArticle

Abstract

Objectives: Approximately 14% of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30% of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia severity at admission to home health care and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity scale from Outcome and Assessment Information Set (OASIS) items based on the Functional Assessment Staging Tool (FAST). Design: Retrospective cohort study. Setting and participants: Home health care; 126,292 Medicare beneficiaries receiving home health care (July 1, 2013–June 1, 2015) diagnosed with dementia (ICD-9 codes). Measures: 30-day PPR during home health care. Dementia severity categorized into 6 levels (nonaffected to severe). Results: The overall rate of 30-day PPR was 7.6% [95% confidence interval (CI) 7.4, 7.7] but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratio (OR) for dementia severity category 6 was 1.37 (95% CI 1.29, 1.46) and the OR for category 7 was 1.94 (95% CI 1.64, 2.31) as compared to dementia severity category 1/2. Conclusions and implications: Dementia severity in the later stages is associated with increased risk for potentially preventable readmissions. Our findings suggest that individuals admitted to home health during the later stages of Alzheimer's disease and related dementias may require greater supports and specialized care to minimize negative outcomes such as readmissions. Development of a dementia severity scale based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing potentially preventable readmissions of individuals with severe dementia who receive home health care. Future research is also needed to validate the proposed dementia severity categories used in this study.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Home Care Services
Dementia
Delivery of Health Care
International Classification of Diseases
Confidence Intervals
Medicare
Odds Ratio
Patient Acceptance of Health Care
Outcome Assessment (Health Care)
Patient Care
Alzheimer Disease
Cohort Studies
Retrospective Studies

Keywords

  • dementia
  • home health care
  • Potentially preventable readmissions

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

@article{9f7d3f8f5ded478ba7833b00537dc63c,
title = "Dementia Severity Associated With Increased Risk of Potentially Preventable Readmissions During Home Health Care",
abstract = "Objectives: Approximately 14{\%} of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30{\%} of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia severity at admission to home health care and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity scale from Outcome and Assessment Information Set (OASIS) items based on the Functional Assessment Staging Tool (FAST). Design: Retrospective cohort study. Setting and participants: Home health care; 126,292 Medicare beneficiaries receiving home health care (July 1, 2013–June 1, 2015) diagnosed with dementia (ICD-9 codes). Measures: 30-day PPR during home health care. Dementia severity categorized into 6 levels (nonaffected to severe). Results: The overall rate of 30-day PPR was 7.6{\%} [95{\%} confidence interval (CI) 7.4, 7.7] but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratio (OR) for dementia severity category 6 was 1.37 (95{\%} CI 1.29, 1.46) and the OR for category 7 was 1.94 (95{\%} CI 1.64, 2.31) as compared to dementia severity category 1/2. Conclusions and implications: Dementia severity in the later stages is associated with increased risk for potentially preventable readmissions. Our findings suggest that individuals admitted to home health during the later stages of Alzheimer's disease and related dementias may require greater supports and specialized care to minimize negative outcomes such as readmissions. Development of a dementia severity scale based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing potentially preventable readmissions of individuals with severe dementia who receive home health care. Future research is also needed to validate the proposed dementia severity categories used in this study.",
keywords = "dementia, home health care, Potentially preventable readmissions",
author = "Sara Knox and Brian Downer and Allen Haas and Addie Middleton and Ottenbacher, {Kenneth J.}",
year = "2019",
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doi = "10.1016/j.jamda.2019.09.012",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
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AU - Knox, Sara

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N2 - Objectives: Approximately 14% of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30% of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia severity at admission to home health care and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity scale from Outcome and Assessment Information Set (OASIS) items based on the Functional Assessment Staging Tool (FAST). Design: Retrospective cohort study. Setting and participants: Home health care; 126,292 Medicare beneficiaries receiving home health care (July 1, 2013–June 1, 2015) diagnosed with dementia (ICD-9 codes). Measures: 30-day PPR during home health care. Dementia severity categorized into 6 levels (nonaffected to severe). Results: The overall rate of 30-day PPR was 7.6% [95% confidence interval (CI) 7.4, 7.7] but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratio (OR) for dementia severity category 6 was 1.37 (95% CI 1.29, 1.46) and the OR for category 7 was 1.94 (95% CI 1.64, 2.31) as compared to dementia severity category 1/2. Conclusions and implications: Dementia severity in the later stages is associated with increased risk for potentially preventable readmissions. Our findings suggest that individuals admitted to home health during the later stages of Alzheimer's disease and related dementias may require greater supports and specialized care to minimize negative outcomes such as readmissions. Development of a dementia severity scale based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing potentially preventable readmissions of individuals with severe dementia who receive home health care. Future research is also needed to validate the proposed dementia severity categories used in this study.

AB - Objectives: Approximately 14% of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30% of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia severity at admission to home health care and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity scale from Outcome and Assessment Information Set (OASIS) items based on the Functional Assessment Staging Tool (FAST). Design: Retrospective cohort study. Setting and participants: Home health care; 126,292 Medicare beneficiaries receiving home health care (July 1, 2013–June 1, 2015) diagnosed with dementia (ICD-9 codes). Measures: 30-day PPR during home health care. Dementia severity categorized into 6 levels (nonaffected to severe). Results: The overall rate of 30-day PPR was 7.6% [95% confidence interval (CI) 7.4, 7.7] but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratio (OR) for dementia severity category 6 was 1.37 (95% CI 1.29, 1.46) and the OR for category 7 was 1.94 (95% CI 1.64, 2.31) as compared to dementia severity category 1/2. Conclusions and implications: Dementia severity in the later stages is associated with increased risk for potentially preventable readmissions. Our findings suggest that individuals admitted to home health during the later stages of Alzheimer's disease and related dementias may require greater supports and specialized care to minimize negative outcomes such as readmissions. Development of a dementia severity scale based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing potentially preventable readmissions of individuals with severe dementia who receive home health care. Future research is also needed to validate the proposed dementia severity categories used in this study.

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KW - Potentially preventable readmissions

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