Home Health Rehabilitation Utilization Among Medicare Beneficiaries Following Critical Illness

Abstract

Objectives: Medicare beneficiaries recovering from a critical illness are increasingly being discharged home instead of to post-acute care facilities. Rehabilitation services are commonly recommended for intensive care unit (ICU) survivors; however, little is known about the frequency and dose of home-based rehabilitation in this population.

Design: Retrospective analysis of 2012 Medicare hospital and home health (HH) claims data, linked with assessment data from the Medicare Outcomes and Assessment Information Set.

Setting: Participant homes.

Participants: Medicare beneficiaries recovering from an ICU stay longer than 24 hours, who were discharged directly home with HH services within 7 days of discharge and survived without readmission or hospice transfer for at least 30 days (n = 3,176).

Measurements: Count of rehabilitation visits received during HH care episode.

Results: A total of 19,564 rehabilitation visits were delivered to ICU survivors over 118,145 person-days in HH settings, a rate of 1.16 visits per week. One-third of ICU survivors received no rehabilitation visits during HH care. In adjusted models, those with the highest baseline disability received 30% more visits (rate ratio [RR] = 1.30; 95% confidence interval [CI] = 1.17-1.45) than those with the least disability. Conversely, an inverse relationship was found between multimorbidity (Elixhauser scores) and count of rehabilitation visits received; those with the highest tertile of Elixhauser scores received 11% fewer visits (RR = .89; 95% CI = .81-.99) than those in the lowest tertile. Participants living in a rural setting (vs urban) received 6% fewer visits (RR = .94; 95% CI = .91-.98); those who lived alone received 11% fewer visits (RR = .89; 95% CI = .82-.96) than those who lived with others.

Conclusion: On average, Medicare beneficiaries discharged home after a critical illness receive few rehabilitation visits in the early post-hospitalization period. Those who had more comorbidities, who lived alone, or who lived in rural settings received even fewer visits, suggesting a need for their consideration during discharge planning. J Am Geriatr Soc 68:1512-1519, 2020.

Keywords: critical illness; home health; occupational therapy; physical therapy; post-hospital rehabilitation.

FIGURE 1:

Distribution of rehabilitation visits over the first episode of home health for 3176 Medicare beneficiaries who survived an ICU stay and discharged directly home

FIGURE 2:

Unadjusted count of rehabilitation visits per home health episode for Medicare beneficiaries who survived an ICU stay and discharged directly home, presented by Census Bureau region.

Figure 3:

Adjusted negative binomial regression results presented as rate ratios (RRs) for the impact of each variable on rehabilitation utilization. RRs greater than 1 indicate a positive impact on number of rehabilitation visits received, and RRs less than 1 indicate a negative impact. Model was adjusted for all figure variables, and additionally for Census Bureau region and county-level count of home health agencies per 100,000 population.