A new study by researchers at Vanderbilt University Medical Center found that hospitals with more local home health agencies were associated with increased readmissions.
According to the study’s senior author, one of the reasons that readmission rates were higher in these regions may be due to frequent staff changes and other interruptions in care.
“Part of this could be because different types of patients are being referred to home care compared to other facilities,” Kevin Griffith, assistant professor in the department of health policy at Vanderbilt University Medical Center, told Home Health Care News. “But one thing that’s been noted in other research, as well as ours, is that in home health agencies, you’re more likely to have frequent staff changes.”
Hospital readmissions are regularly considered an indicator of the quality of care received by patients. The Centers for Medicare & Medicaid Services (CMS) calculates annual readmission rates, and if those rates are higher than national averages, hospitals are financially penalized.
However, the CMS does not consider whether a patient’s risk of readmission is influenced by the availability of follow-up care after the patient’s discharge in their geographic area.
“The quality and type of care you receive after leaving hospital depends a lot on where you live,” Griffith said. “If you live in a remote rural area, you may have no choice but to return to the emergency room if you have had complications. Yet the federal government currently ignores this when deciding which hospitals should receive penalties for excessive readmissions.
Griffith and his co-authors took a closer look at this relationship by linking county-level data on healthcare workforce and infrastructure to 30-day readmission rates for heart attack, heart failure, and pneumonia in hospitals from 2013 to 2019.
On average, the surrounding area of a hospital in the study contained more than 620 SNF beds, about 25 primary care physicians, 49 nurse practitioners, 19 licensed nursing home beds, and about four home health agencies per 100 000 inhabitants.
Study results showed lower 30-day readmission rates in hospitals that operated a palliative care service or had a greater local supply of primary care physicians, residential care beds qualified nurses and licensed nursing home beds.
For home health agencies, it was a different story.
“Most of the results made sense to us,” Griffith said. “We were a little surprised that for home health agencies and the supply of nurse practitioners in an area, these were associated with higher hospital readmissions.”
Griffith hypothesized that when there is a discontinuity of care — as is common in home care — the risk of rehospitalization increases.
“When you have a patient recovering from a hospital stay, it’s always best to have the same person looking after them with the same team,” Griffith said. “With home care, you are more likely to have that person switched than if you are in a skilled nursing facility or your care is managed by your primary care physician. This provides plenty of opportunities for the ball to be dropped.
Another aspect of higher readmission rates could be the familiarity a caregiver has with a patient once they are discharged.
“When you get to know a patient, you are better able to discern what is a potentially worrisome complication versus what is more normal for that patient,” Griffith said. “We believe there is also a level of risk aversion. If you are a new nurse sent to see a patient for the first time and you see something concerning, you can send him to the emergency room. Someone who has worked with them for a long time might know that this is more normal and not necessarily a cause for concern.
Ultimately, the study found that CMS can penalize or reward hospitals in part based on the communities they serve, as opposed to the quality of care they provide.
“The findings also suggest that hospitals may benefit from work to improve local access to care or from hospital-community partnerships to improve continuity of care after a patient is discharged,” the authors write.
For home health agencies, Griffith suggested leaders should better track readmission rates and find ways to reduce them.
Like hospitals and skilled nursing facilities, home health agencies could soon see increased federal oversight, especially since the sector has grown so much, Griffith said.
Tracking the data itself could be a key to solving the problem.
“What gets measured gets done,” Griffith said. “If it’s something you don’t even follow, it’s problematic. The results show that perhaps the industry could dig a little deeper and ask, “What about those patients? What could we change in the way home health care is delivered to reduce these unwanted readmissions? »