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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- June 2018 Databook: Health Care Spending and the Medicare Program.MedPAC, Washington, DC2018
- An all-payer view of hospital discharge to postacute care, 2013.(HCUP Statistical Brief #205. Available at:) (2016)
- Home Health Providers.(Available at:)https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/HHAs.htmlDate accessed: February 16, 2018
- Chapter 9: Home Health Services. Medicare Payment Policy.MedPAC, Washington, DC2018
- Medicare and Medicaid Programs; CY 2018 home health prospective payment system rate update and CY 2019 case-mix adjustment methodology refinements; home health value-based purchasing model; and home health quality reporting requirements.Fed Regist. 2017; 82 (To be codified at 42 CFR §484. Available at:): 51676-51752
- Home health claims-based rehospitalization measures technical report.(2017. Available at:)
- Rehospitalization in a national population of home health care patients with heart failure.Health Serv Res. 2012; 47: 2316-2338
- The impact of rurality on 30-day preventable readmission, illness severity, and risk of mortality for heart failure Medicare home health beneficiaries.J Rural Health. 2016; 32: 176-187
- Measure specifications for measures in the CY 2017 HH QRP final rule.(Available at:)
- Potentially preventable events: An actionable set of measures for linking quality improvement and cost savings.Qual Manag Health Care. 2012; 21: 213-219
- Care transitions in a changing healthcare environment.JAAPA. 2015; 28: 29-35
- Alzheimer disease in the United States (2010-2050) estimated using the 2010 census.Neurology. 2013; 80: 1778-1783
- Transitions in care for older adults with and without dementia.J Am Geriatr Soc. 2012; 60: 813-820
- Medicare utilization and expenditures before and after the diagnosis of dementia.Alzheimers Dementia. 2015; 11: P180
- Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014.Vital Health Stat 3. 2016; : x-xii
- Transitions in care in a nationally representative sample of older Americans with dementia.J Am Geriatr Soc. 2015; 63: 1495-1502
- Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders.Alzheimers Dement. 2013; 9: 30-38
- Dementia and hospital readmission rates: A systematic review.Dement Geriatr Cogn Dis Extra. 2017; 7: 346-353
- Association of dementia with early rehospitalization among Medicare beneficiaries.Arch Gerontol Geriatr. 2014; 59: 162-168
- Outcome and Assessment Information Set. OASIS-D Guidance Manual. 2018.(Available at:)
- Functional Assessment Staging (FAST) in Alzheimer's disease: Reliability, validity, and ordinality.Int Psychogeriatr. 1992; 4: 55
- Psychiatric assessment in medical long-term care facilities: Reliability of commonly used rating scales.Int J Geriatr Psychiatry. 1988; 3: 229-233
- The accuracy of Medicare claims data in identifying Alzheimer's disease.J Clin Epidemiol. 2002; 55: 929-937
- The GDS/FAST staging system.Int Psychogeriatr. 1997; 9: 167
- Functional Assessment Staging (FAST).Psychopharmacol Bull. 1988; 24: 653-659
- Evaluation of the CMS-HCC risk adjustment model. Final report.(Available at:) (2011. Accessed June 1, 2019)
- CMAJ. 2018; 190: E1124-E1133
- Outcomes of dementia: Systematic review and meta-analysis of hospital administrative database studies.Arch Gerontol Geriatr. 2016; 66: 198-204
- End-of-life transitions among nursing home residents with cognitive issues.N Engl J Med. 2011; 365: 1212-1221
- Hospitalization in community-dwelling persons with Alzheimer’s disease: Frequency and causes.J Am Geriatr Soc. 2010; 58: 1542-1548
- Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients.Int J Geriatr Psychiatry. 2009; 24: 283-291
- Delirium accelerates cognitive decline in Alzheimer disease.Neurology. 2009; 72: 1570-1575
- Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease.Ann Intern Med. 2012; 156: 848-856
- Dementia, medication and transitions of care.Res Social Adm Pharm. 2016; 12: 450-460
- Delirium and long-term cognitive trajectory among persons with dementia.Arch Intern Med. 2012; 172: 1324-1331
- Dementia as a moving target.J Am Geriatr Soc. 2012; 60: 980-982
- Alzheimers Dementia. 2017; 13: P1562-P1563
- An empirical evaluation of the Global Deterioration Scale for staging Alzheimer's disease.Am J Psychiatry. 1992; 149: 190-194
- Pain and delirium in people with dementia in the acute general hospital setting.Age Ageing. 2018; 47: 841-846
- Five items differentiate mild to severe dementia from normal to minimal cognitive impairment—Using the Global Deterioration Scale.J Clin Gerontol Geriatr. 2016; 7: 1-5
- Retooling for an Aging America: Building the Health Care Workforce.The National Academies Press, Washington, DC2008
- Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers.Geriatr Nurs. 2016; 37: 200-206
- Functional status is associated with 30-day potentially preventable readmissions following home health care.Med Care. 2019; 57: 145-151
Article info
Publication history
Published online: November 13, 2019
Footnotes
This study was supported by the National Institutes of Health (R01HD069443; P2CHD065702; K01AG058789; U54GM104941) and the Foundation for Physical Therapy's Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant.
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
