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. 2020 Apr;21(4):519-524.e3.
doi: 10.1016/j.jamda.2019.09.012. Epub 2019 Nov 14.

Dementia Severity Associated With Increased Risk of Potentially Preventable Readmissions During Home Health Care

Sara Knox  1 , Brian Downer  2 , Allen Haas  3 , Addie Middleton  4 , Kenneth J Ottenbacher  2
Affiliations

Dementia Severity Associated With Increased Risk of Potentially Preventable Readmissions During Home Health Care

Sara Knox et al. J Am Med Dir Assoc. 2020 Apr.

Abstract

Objectives: Approximately 14% of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30% of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia severity at admission to home health care and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity scale from Outcome and Assessment Information Set (OASIS) items based on the Functional Assessment Staging Tool (FAST).

Design: Retrospective cohort study.

Setting and participants: Home health care; 126,292 Medicare beneficiaries receiving home health care (July 1, 2013-June 1, 2015) diagnosed with dementia (ICD-9 codes).

Measures: 30-day PPR during home health care. Dementia severity categorized into 6 levels (nonaffected to severe).

Results: The overall rate of 30-day PPR was 7.6% [95% confidence interval (CI) 7.4, 7.7] but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratio (OR) for dementia severity category 6 was 1.37 (95% CI 1.29, 1.46) and the OR for category 7 was 1.94 (95% CI 1.64, 2.31) as compared to dementia severity category 1/2.

Conclusions and implications: Dementia severity in the later stages is associated with increased risk for potentially preventable readmissions. Our findings suggest that individuals admitted to home health during the later stages of Alzheimer's disease and related dementias may require greater supports and specialized care to minimize negative outcomes such as readmissions. Development of a dementia severity scale based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing potentially preventable readmissions of individuals with severe dementia who receive home health care. Future research is also needed to validate the proposed dementia severity categories used in this study.

Keywords: Potentially preventable readmissions; dementia; home health care.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart depicting cohort selection at each step as exclusion criteria were applied. Percentages represent percent remaining from previous step. *First admission was selected if patient had more than 1 between 7/01/2013 and 6/01/2015. †“Study period” refers to the 1 year prior to the index hospitalization through the 32 days postdischarge for each index hospitalization. ‡Percentages indicate the percentage of the cohort that remained after application of the identified exclusion criteria.
Fig. 2.
Fig. 2.
Crosswalk depicting the alignment of FAST Stage and corresponding descriptions to OASIS Items and the levels of OASIS items used to create dementia severity categories.
See this image and copyright information in PMC

References

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