As health care cost control efforts dig in across America, a significant target is preventing hospital readmissions. New research suggests social environmental factors play a role in the readmissions.
Knowledge of why readmissions occur is timely as on October 1, Medicare began penalizing hospitals when an individual is readmitted to the hospital within 30 days after being discharged for a diagnosis of heart attack, heart failure or pneumonia.
The law was drafted to combat the finding that nearly one in five Medicare patients return to the hospital within a month of discharge, costing the government an extra $17.5 billion in 2010.
Government pays a lump sum for hospital-based care for Medicare recipients derived from an individual’s diagnostic grouping and not on the length of time a person stays in the hospital. Many believe this payment method incentivizes hospitals to prematurely discharge patients.
The new study suggests that understanding how social environmental factors contribute to re-hospitalization of home health care patients would improve care for those patients, while at the same time managing Medicare spending.
The study, by Hong Tao, R.N., Ph.D., of University of Wisconsin – Milwaukee and colleagues, is found in the journal Advances in Nursing Science.
Researchers looked at factors affecting the risk of repeated hospital admissions among 1,268 elderly patients receiving home health care.
Using data from routine, Medicare-required assessments, the researchers focused on the importance of social environmental factors: such as whether the patient lived alone or with others, whether he or she had a primary informal caregiver, and the type and frequency of informal care provided.
Overall, nearly 21 percent of patients in the study were rehospitalized, most within the first 20 days of being discharged from the hospital to home healthcare.
Rehospitalizations — defined as readmission to the hospital within 60 days after being released from the hospital to home care — are an important indicator of the quality of care.
The study found some significant associations between social environmental factors, and suggested some pathways by which these effects occur. Patients’ functional ability — their ability to take care of themselves — was influenced by their living arrangements and by the type and frequency of informal care they received.
The greater the difference between the patients’ clinical condition and functional status, the greater the risk of rehospitalization.
Social environmental factors contributed to the risk of repeated hospital admission by altering the balance between the patient’s need for and ability to provide self-care.
Changes in clinical condition placed increased demands on the patient’s ability to care for himself or herself, while at the same time making it more difficult to provide self-care. The resulting “self-care deficit” was linked to an increased risk of rehospitalization.
The amount of care and assistance received from informal caregivers had an important impact on self-care ability and rehospitalization risk.
Other patient characteristics linked to self-care deficit included obesity and cognitive (intellectual) ability. Patients living alone were less likely to be rehospitalized—perhaps because those choosing to live alone were better able to functional independently and care for themselves.
Few previous studies have looked at how social environmental factors in general, and informal caregivers in particular, affect patient outcomes.
“Rehospitalizations are costly and in many cases preventable,” Tao and colleagues said.
The researchers believe their study has implications for strategies to reduce unnecessary rehospitalizations and improve the quality of home health care.
“[Our] findings may help home healthcare nurses to recognize those patients who are in need of certain services that may reduce hospitalization, such as those that lack the support of the patient’s family or assistance from paid informal caregivers,” they write.
Patients with good social environmental support are “more likely to have a higher functional ability and thus remain in their homes, the first choice of most patients.”
The study also reaffirms the important role of informal caregivers in maintaining home health care patients. The authors added, “Informal caregivers are part of the solution in preventing unnecessary hospitalizations and more attention needs to be given to how these caregivers are supported in their roles.”
Source: Wolters Kluwer Health