People with heart failure and home health care resource use and outcomes

Abstract

Aims and objectives: Patients with heart failure represent a common patient population in home health care, yet little is known about their outcomes.

Background: Patients with heart failure, regardless of site of care, experience substantial numbers of rehospitalisations in the United States. Home health care is a common postacute care service for patients with heart failure.

Design: Retrospective analysis.

Methods: The study employed a large administrative data base from 2003 - the Outcomes and Assessment Information Set, which is required for all US Medicare and Medicaid patients receiving home health care.

Participants: There were 145 191 patients with a primary diagnosis of heart failure represented in the data set. The outcomes of interest were the trajectory of care (point of entry and discharge from home health care), hospitalisation, length of stay and change in functional status.

Results: Almost three-quarters (73.9%) of patients entered home health care following a hospital stay. Nearly two-thirds (64%) remained at home at discharge from home health care. Approximately 15% of patients are hospitalised during the home health care episode, most often for symptoms consistent with exacerbation of the heart failure, if a reason could be identified. The average length of stay in home health care was 44 days. There was only a small improvement in functional status: 0.50 points for activities of daily living and 0.57 points for instrumental activities of daily living. Similar small improvement occurred in depressive symptoms, 0.68.

Relevance to clinical practice: There may be room for improvement in these outcomes with more recent evidence that suggests strategies for reducing hospitalisation and improving patient functional status abilities. Yet, the chronic progressive nature of heart failure may also provide a limiting factor in the outcomes that can be attained.