Date Presented 04/04/19
Using 1,216 stroke surveys and propensity score matching methods, we examined the influence of home-health prescription on the resource use and risk of 90-day hospital readmissions after inpatient stroke rehabilitation.
Primary Author and Speaker: Ickpyo Hong
Additional Authors and Speakers: Loree Pryor, Meredith Shields, Samantha Wimberly
PURPOSE: Rehospitalization doubles the cost per episode for patients with conditions commonly treated in post-acute care (PAC) settings and is associated with increased risk of 1-year mortality in community-dwelling older adults (Lum, Studenski, Degenholtz, & Hardy, 2012). In addition, hospital readmission has been used as one of the quality indicators to reflect quality of care among acute and post-acute settings. Therefore, the purpose of this study was to examine post discharge hospitalization and resource use among patients with stroke with and without home health prescription at 90 days after discharge from inpatient rehabilitation facilities (IRFs).
DESIGN: A secondary data analysis of a longitudinal study.
METHOD: We retrieved 1,216 records of adults who received stroke rehabilitation contained in the 2005-2006 database, Stroke Recovery in Undeserved Populations (Ostir, Ottenbacher, & Kuo, 2016). A logistic regression model with and without Propensity score inverse probability weighting (PS-IPTW) method (Rosenbaum & Rubin, 1983) were used to evaluate the resource use and risk of 90-day hospital readmission. Eighteen patient and clinical characteristics (i.e., race, age, length of stay, stroke type and comorbidities, etc.) at baseline were balanced by a logistic regression model and PS-IPTW method.
RESULTS: The mean age of the study sample was 68.4 years (SD=13.3). The majority of the study sample was hon-Hispanic white (n=918, 75.3%), having ischemic stroke (n=891, 73.0%), and female (n=624, 51.3%). Among the study sample, 720 subjects (59.1%) were discharged with home health prescription. The baseline differences were balanced by the PS-IPTW method (all p > 0.05). Traditional regression models and PS-IPTW methods indicated that patients with stroke who discharged to home health prescription had low risk of hospital readmission at 90 days after discharge (Odds Ratio [OR]= 0.325, 0.407, all p <0.05, respectively). Similarly, those who discharged with home health prescription had low risk of resource use (OR=0.459, 0.512, all p < 0.05, respectively).
CONCLUSION: This study indicated that individuals with stroke discharged with a prescription for home health services had lower risks of 90-day hospital readmission than those who did not receive a home health prescription after rehabilitation. Similarly, stroke patients discharged with home health prescription had lower risk of resource use than patients who did not receive home health prescription at 90 days post-discharge.
IMPACT STATEMENT: Findings suggest the need for research on processes of care in home health and increased clinical efforts to improve the quality of stroke rehabilitation for patients not discharged with a prescription for home health services.
References
Lum, H. D., Studenski, S. A., Degenholtz, H. B., & Hardy, S. E. (2012). Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. Journal of General Internal Medicine, 27(11), 1467–1474. doi: 10.1007/s11606-012-2116-3.
Ostir, G., Ottenbacher, K. J., & Kuo, Y-F. Stroke Recovery in Underserved Populations 2005-2006 [United States]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2016-05-03. https://doi.org/10.3886/ICPSR36422.v1
Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observataionl studies for causal effects. Biometrica, 70(1), 41-55.
