干旱区生态环境知识资源中心(Arid): Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults

Arid

DOI	10.1016/j.jamda.2018.10.021
	Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults
	Wang, Jinjiao 1; Liebel, Dianne V.1; Yu, Fang 2; Caprio, Thomas V.3,4,5; Shang, Jingjing 6
通讯作者	Wang, Jinjiao
来源期刊	JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
ISSN	1525-8610
EISSN	1538-9375
出版年	2019
卷号	20 期号:6 页码:736-742
英文摘要	Objectives: (1) To examine the impact of specific services [skilled nursing (SN), physical therapy (PT), occupational therapy (OT), and home health aide (HA)] in Medicare-certified home health care (HHC) on subsequent rehospitalization among older patients during a 60-day HHC episode and (2) to test the moderating effect of functional limitation on these services. Design: Secondary analysis of data from the Outcome and Assessment Information Set (OASIS) and HHC administrative records of a statewide not-for-profit HHC agency fromJanuary 1, 2016, to December 31, 2016. Setting and Participants: Participants were >= 65 years old and were admitted to HHC within 48 hours of hospital discharge. Measures: Outcome was time to rehospitalization during the 60-day HHC episode (ie, number of days). Independent variables were visit intensity (number of visits/week) of SN, PT, OT, and HA, respectively. Functional limitation was measured by a composite score generated from 9 OASIS items on physical function. Multivariate Cox Proportional hazard analyses were conducted. Subgroup analysis (high vs low functional limitation) was conducted to examine the moderating effect of functional limitation on specific HHC services. Ad hoc analysis was conducted to examine potential interaction between specific HHC services that were significantly related to rehospitalization. Results: The sample included 1377 participants, among whom 11.5% were rehospitalized during the 60-day HHC episode. At the threshold dose of 1 PT or 2 SN visits/week, higher visit intensity significantly reduced the hazard of rehospitalization in these patients by up to 82% for PT (2.30 visits/week; hazard ratio [HR] = 0.18, P value < .001) and 48% for SN visits (2.51 visits/week; HR = 0.52, P value < .05). The effect of PT on reducing the risk of rehospitalization was more pronounced in patients with low versus high functional limitation (2.30 visits/week, HR = 0.08 vs 0.24, both P < .001). SN was only effective in reducing the hazard of rehospitalization in the low functional limitation group (1.70 visits/week, HR = 0.41, P < .05; 2.51 visits/week, HR = 0.29, P < .05), but not in the high functional limitation group (P > .05 at all intensity levels). Visit intensity of HA or OT was not significantly related to rehospitalization. Conclusions/Relevance: At a threshold of 1 PT visit or 2 SN visits/week, HHC lowered the risk of rehospitalization in older patients by up to 82% and 48%, respectively. Both PT and SN were more effective in avoiding rehospitalization in patients with low functional limitation than in those with high functional limitation. Older patients should receive enough HHC services (especially PT and SN) to avoid rehospitalizations with consideration of their functional limitation. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
英文关键词	Home health person-centered care rehospitalization hospital readmission
类型	Article
语种	英语
国家	USA
收录类别	SCI-E ; SSCI
WOS记录号	WOS:000468893500015
WOS关键词	ASSESSMENT INFORMATION SET ; RISK-FACTORS ; OUTCOMES ; READMISSIONS ; POPULATION ; PREVALENCE ; IMPACT
WOS类目	Geriatrics & Gerontology
WOS研究方向	Geriatrics & Gerontology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/217359
作者单位	1.Univ Rochester, Sch Nursing, Rochester, NY USA; 2.Univ Minnesota, Sch Nursing, Minneapolis, MN 55455 USA; 3.Univ Rochester, Med Ctr, Rochester, NY 14642 USA; 4.Univ Rochester Med Home Care, Rochester, NY USA; 5.Finger Lakes Geriatr Educ Ctr, Rochester, NY USA; 6.Columbia Univ, Sch Nursing, New York, NY USA
推荐引用方式 GB/T 7714	Wang, Jinjiao,Liebel, Dianne V.,Yu, Fang,et al. Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults[J],2019,20(6):736-742.
APA	Wang, Jinjiao,Liebel, Dianne V.,Yu, Fang,Caprio, Thomas V.,&Shang, Jingjing.(2019).Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults.JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION,20(6),736-742.
MLA	Wang, Jinjiao,et al."Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults".JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 20.6(2019):736-742.