Shauen Howard, Kendall Law, Dmitri Poltavski and William R Mills
Background: Despite increasing momentum for both skilled and non-skilled home care as value-add services for high risk populations, the hospitalization rate among recipients of non-skilled home care has not been previously characterized. We aimed to determine the hospitalization rate for chronically ill recipients of nonskilled home care, and to assess the feasibility of using a nurse-led standardized assessment care management program that is not dependent on simultaneous use of home health care.
Methods: Hospitalizations were tracked using multiple data sources, and entered into a home care census tracking database. Hospitalization rate per 1,000 managed months per year was calculated using standard methodology. We developed a novel standardized assessment tool (PREDICS) and used it to perform in-person nursing assessments of a cohort of home care recipients. We calculated hospitalization rates in this group, and compared it to a group receiving standard home care only.
Results: Home care recipients were hospitalized at an overall rate of 520 hospitalizations per 1,000 managed patients per year. Patients in the study group had lower mean rate of hospitalization (507 hospitalizations per 1,000 managed patients per year) compared to the control group (536 hospitalizations per 1,000 managed patients per year), but this difference was not statistically significant (p=0.37).
Conclusions: We report a method of calculating hospitalization rates among recipients of non-skilled home care, and we found home care recipients with a chronic medical diagnosis had an average hospitalization rate of 520 hospitalizations per 1,000 per year. We also demonstrated the feasibility of applying a nurse-led care management program to non-skilled home care recipients with a serious medical diagnosis, without simultaneous skilled home healthcare. Whether or not the model influences hospitalization rate in non-skilled home care recipients requires additional study.
