Hospital Readmissions in Medicare Home Healthcare: What Are the Leading Risk Indicators?

Abstract

A large sample of all 2011 home healthcare users in traditional Medicare was analyzed to identify the risk indicators at start-of-care that were associated with the highest probability of readmission (N = 597,493). Thirty-five patient characteristics found in Outcome and Assessment Information Set, claims history, or other administrative data were associated with a 30-day readmission risk 30% to 100% above the average in the sample. Most of these characteristics were associated with a 30-day readmission probability of approximately 1 in 5, and several were associated with a readmission probability approaching 1 in 10 during the first 7 days. A majority of the high-risk characteristics were uncommon, and they tended not to occur together, suggesting they can be useful flags for clinicians in prioritizing cases to reduce readmissions. Readmission risk grows most quickly early in the episode of care; typically one-third of the readmissions in the first 30 days occurred by the end of 7 days. High-risk markers at 7 and 30 days were substantially the same, illustrating the importance of the early days at home in influencing the 30-day outcome. A variety of domains and characteristics are represented among the highest-risk markers, suggesting challenges to home healthcare clinicians in maintaining the knowledge and skills needed to address readmission prevention. We suggest possible responses to this problem as strategies to consider, and also discuss implications for assessment practices in home healthcare.