Abstract
Objective
The purpose of this study was to determine the association between mobility, self-care,
cognition, and caregiver support and 30-day potentially preventable readmissions (PPR)
for individuals with dementia.
Design
This retrospective study derived data from 100% national Centers for Medicare and
Medicaid Services data files from July 1, 2013, through June 1, 2015.
Participants
Criteria from the Home Health Claims-Based Rehospitalization Measure and the Potentially
Preventable 30-Day Post Discharge Readmission Measure for the Home Health Quality
Reporting Program were used to identify a cohort of 118,171 Medicare beneficiaries.
Main Outcome Measure
The 30-day PPR rates with associated 95% CIs were calculated for each patient characteristic.
Multilevel logistic regression was used to study the relationship between mobility,
self-care, caregiver support, and cognition domains and 30-day PPR during home health,
adjusting for patient demographics and clinical characteristics.
Results
The overall rate of 30-day PPR was 7.6%. In the fully adjusted models, patients who
were most dependent in mobility (odds ratio [OR], 1.59; 95% CI, 1.47-1.71) and self-care
(OR, 1.73; 95% CI, 1.61-1.87) had higher odds for 30-day PPR. Patients with unmet
caregiving needs had 1.11 (95% CI, 1.05-1.17) higher odds for 30-day PPR than patients
whose caregiving needs were met. Patients with cognitive impairment had 1.23 (95%
CI, 1.16-1.30) higher odds of readmission than those with minimal to no cognitive
impairment.
Conclusions
Decreased independence in mobility and self-care tasks, unmet caregiver needs, and
impaired cognitive processing at admission to home health are associated with risk
of 30-day PPR during home health for individuals with dementia. Our findings indicate
that deficits in mobility and self-care tasks have the greatest effect on the risk
for PPR.
Keywords
List of abbreviations:
ADRD (Alzheimer disease and related dementias), CMS (Centers for Medicare and Medicaid Services), ICD-9 (International Classification of Diseases, 9th Revision), OASIS (Outcome and Assessment Information Set), OR (odds ratio), PPR (potentially preventable readmissions)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 Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
The Medicare Payment Advisory Commission. A databook: healthcare spending and the Medicare program. 2019. Available at: http://www.medpac.gov/docs/default-source/data-book/jun19_databook_entirereport_sec.pdf?sfvrsn=0. Accessed November 12, 2019.
- Patient preferences for stroke rehabilitation.Top Stroke Rehabil. 2010; 17: 394-400
- Why older adults may decline offers of post-acute care services: a qualitative descriptive study.Geriatr Nurs. 2017; 38: 238-243
- Home health providers.(Available at:)https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/HHAs.htmlDate accessed: February 16, 2018
- 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. 2016; 3: 1-105
- Implicit memory and familiarity among elders with dementia.J Nurs Scholarsh. 2002; 34: 263-267
- Rise of post-acute care facilities as a discharge destination of US hospitalizations.JAMA Intern Med. 2015; 175: 295-296
- Home health care expenditures in the United States from 1960 to 2016.In: US Department of Health and Human Services., 2018 (Available at:) (Accessed August 14, 2019)
- Home health compare.(Available at:)http://www.medicare.gov/HHCompare/Home.aspDate accessed: June 10, 2019
Acumen, LLC. Home health claims-based rehospitalization measures technical report. 2017. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures. Accessed June 10, 2019.
- Functional status outperforms comorbidities in predicting acute care readmissions in medically complex patients.J Gen Intern Med. 2015; 30: 1688-1695
- The prevalence, reasons, and risk factors for hospital readmissions among home health care patients: a systematic review.Home Health Care Manag Pract. 2018; 30: 83-92
- Factors associated with accelerated hospitalization and re-hospitalization among Medicare home health patients.J Gerontol A Biol Sci Med Sci. 2018; 73: 1280-1286
- Hospitalization risk factors of older cohorts of home health care patients: a systematic review.Home Health Care Serv Q. 2019; 38: 111-152
- Motor and cognitive functional status are associated with 30-day unplanned rehospitalization following post-acute care in Medicare fee-for-service beneficiaries.J Gen Intern Med. 2016; 31: 1427-1434
- IMPACT Act of 2014 data standardization and cross setting measures.(Available at:)
- Risk factors for repeated hospitalizations among home healthcare recipients.J Healthc Qual. 2003; 25: 1-11
- Utilizing home healthcare electronic health records for telehomecare patients with heart failure: a decision tree approach to detect associations with rehospitalizations.Comput Inform Nurs. 2016; 34: 175-182
- A model for hospital discharge preparation: from case management to care transition.J Nurs Adm. 2015; 45: 606-614
- 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 Dement. 2015; 11: 180
- Hospitalizations for ambulatory care sensitive conditions and unplanned readmissions among Medicare beneficiaries with Alzheimer's disease.Alzheimers Dement. 2017; 13: 1174-1178
- Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders.Alzheimers Dement. 2013; 9: 30-38
- Association of dementia with early rehospitalization among Medicare beneficiaries.Arch Gerontol Geriatr. 2014; 59: 162-168
- Dementia and hospital readmission rates: a systematic review.Dement Geriatr Cogn Dis Extra. 2017; 7: 346-353
- Outcome and Assessment Information Set (OASIS): a review of validity and reliability.Home Health Care Serv Q. 2012; 31: 267-301
- Measure specifications for measures in the CY 2017 HH QRP final rule.(Available at:)
- The accuracy of medicare claims data in identifying Alzheimer's disease.J Clin Epidemiol. 2002; 55: 929-937
- Impact of dementia on payments for long-term and acute care in an elderly cohort.Med Care. 2013; 51: 575-581
- 2015 Alzheimer's disease facts and figures.Alzheimers Dement. 2015; 11: 332-384
- Monetary costs of dementia in the United States.N Engl J Med. 2013; 368: 1326-1334
- Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries.Arch Phys Med Rehabil. 2018; 99: 1067-1076
- Functional status is associated with 30-day potentially preventable readmissions following home health care.Med Care. 2019; 57: 145-151
- Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.J Am Med Dir Assoc. 2018; 19: 348-354
- Potentially preventable within-stay readmissions among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation.PM R. 2017; 9: 1095-1105
- 2019 Alzheimer's disease facts and figures.Alzheimers Dement. 2019; 15: 321-387
- The GDS/FAST staging system.Int Psychogeriatr. 1997; 9: 167
- Effectiveness of caregiver interventions on patient outcomes in adults with dementia or Alzheimer's disease: a systematic review.Gerontol Geriatr Med. 2015; 1 (2333721415595789)
- Readmissions reduction program.(Availabe at:)http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.htmlDate accessed: January 16, 2016
- Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the Better Effectiveness After Transition -- Heart Failure (BEAT-HF) randomized clinical trial.JAMA Int Med. 2016; 176: 310-318
- Impact of a multidisciplinary heart failure post-hospitalization program on heart failure readmission rates.Ann Pharmacother. 2015; 49: 1189-1196
- Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis.Ann Intern Med. 2014; 160: 774-784
- Diagnosis and management of urinary tract infection in older adults.Infect Dis Clin North Am. 2014; 28: 75-89
- Cause of death in patients with dementia disorders.Eur J Neurol. 2009; 16: 488-492
- Hospitalization in community-dwelling persons with Alzheimer’s disease: frequency and causes.J Am Geriatr Soc. 2010; 58: 1542-1548
- The clinical course of advanced dementia.N Engl J Med. 2009; 361: 1529-1538
- Identifying dementia cases with routinely collected health data: a systematic review.Alzheimers Dement. 2018; 14: 1038-1051
Article info
Publication history
Published online: February 05, 2020
Footnotes
Supported by the National Institutes of Health (grant nos. R01HD069443, P2CHD065702, K01AG058789, U54GM104941), National Institute of Aging (grant no. K01AG058789), and the Foundation for Physical Therapy’s Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
