Risk factors for hospitalization in a national sample of Medicare home health care patients

The Medicare home health care (HHC) benefit provides nursing, rehabilitation therapy, and supervised aide services to treat patients with acute conditions or acute exacerbations of chronic conditions to avoid hospitalizations whenever possible. Yet little evidence exists from national data to inform public health decision makers about the most important modifiable risk factors for hospitalization among Medicare HHC patients. Therefore, this study determined the most important modifiable health-related factors present at admission to Medicare HHC associated with hospitalization after starting that HHC episode. Data from the Outcome Assessment and Information Set were linked with Medicare inpatient claims data in a 20% national stratified random sample of Medicare HHC patients with a complete episode of care during 2002. This sample (n=374,123) was 63.9% female, mean age=76.5+ 10.8 years, 82.3% were White, 10.5% Black, and 4.2% Hispanic. Based on published findings in smaller samples, predictor variables included selected acute and chronic conditions, functional status, shortness of breath severity, frequency of pain, cognitive status, depressive symptoms, and clinician-judged rehabilitation prognosis. We found that 17% of sample patients were hospitalized. Multivariate logistic regression analysis revealed that the most important risk factors for hospitalization (all p<.001) were: skin ulcer or wound (adjusted odds ratio (AOR)=1.55); guarded rehabilitation prognosis (AOR=1.51); congestive heart failure (AOR=1.48); presence of depressive symptoms (AOR=1.24); shortness of breath severity (AOR=1.22); and diabetes (AOR=1.13). Initiatives that focus on improving care of identified high-risk chronic conditions, and increased recognition and treatment of depressive symptoms during HHC, might help reduce hospitalizations in the Medicare population.