ABOUT THE STUDY
The burden on the health system from heart failure (HF) is substantial: in 2005, patients with HF will cost the American health care system $27.9 billion. The incidence of HF increases with age, close to 10 persons per 1000 after age 65. HF is the leading cause of hospitalization in those 65 and older, hospitalization rates for HF have increased 157% from 1979 to 2002, and HF patients have extensive rates of rehospitalization--up to 65% of patients are rehospitalized in a one year period. Patients with HF also face substantial and progressive decline in functional status. Post-acute follow up in the home is one strategy to reduce the burden of HF on the US health care system. Home health care is the most common type of post-acute care for patients with HF and most often uses registered nurses to provide services in the home in the form of periodic visits (up to several times per week for ~45 minutes per visit). HF patients receiving home health care have, on average, 26 home visits with a mean length of home health care stay of 41 days, thus home health care is not a long-term care service.
There is little evidence on the most effective ways to reduce rehospitalization and prevent functional status decline for HF patients receiving home health care. Simple questions, such as the factors that place patients most at risk for rehospitalization and functional status decline and the optimal care delivery patterns, are unanswered. Little research has been done to determine the relationship between the numbers of home health care visits and patient outcomes and the results have been equivocal.
Agencies differ in their approaches to providing care. Home health care use is influenced by variations in the numbers of home health agencies and nursing homes in the community. Since 1999, home health care agencies have been required to use the Outcomes and Assessment Information Set (OASIS) to collect a standard set of data on all adult home health care patients at multiple time points for outcomes evaluation. This allows us to examine the national population of HF patients receiving home health care under Medicare, and link OASIS with administrative claims, county, and agency level data.
Study Purpose:
The purpose of the present study is to determine county level, agency level and patient level factors predictive of rehospitalization and functional decline in HF patients receiving home health care and identify whether higher visit intensity (number of visits/duration of care) can reduce rehospitalization and functional status decline, potentially reducing the burden of HF on individual patients and the health care system.
Research Questions:
- What patient, county and agency level factors present on initiation of home health care are associated with a). rehospitalization, b) length of stay for rehospitalization, c) time to rehospitalization, and d). functional status decline for HF patients receiving home health care?
- Is higher visit intensity (no. of visits/duration of care) associated with fewer rehospitalizations, shorter rehospitalization lengths of stay, longer time to rehospitalization, and less functional status decline, after controlling for county, agency, and other patient factors?
The study uses home health care clinical data (OASIS) and claims data (home health and hospital) for patients with Medicare linked with county level (Area Resource File--ARF) and agency level data (Online Survey Certification and Recertification Point of Service—OSCAR-POS). The 2005 national OASIS data for HF patients receiving home health care will be linked at the patient level with the home health care standard analytic file (SAF) and the hospital based Medicare Provider and Analysis Review (MedPAR) file. The patient’s county of residence will be used to retrieve county-specific variables (i.e. number of nursing homes, home health care agencies and hospitals, degree of rurality), from the ARF and the home health care agency provider number will serve as the linking variable with the OSCAR-POS as the source for agency factors (i.e. profit status and association with a hospital). The linked data set will allow us to determine the county and agency level factors, as well as patient factors associated with rehospitalization and functional decline, and examine whether greater intensity of home visits is associated with less rehospitalization, fewer rehospitalization days, longer time to rehospitalization, and less functional status decline. |
