Purpose: To characterize and compare clients who were readmitted to the hospital during an episode of home health care, before and after the inception of the prospective payment system (PPS).
Design: A longitudinal mixed design was used; replicating a study conducted nine years previously (pre PPS) in the same home care agency.
Methods: Seventy-six closed case medical records from a not-for-profit hospital affiliated home care agency were retrospectively reviewed and compared to pre PPS data. The same data collection tool, the Hospital Readmission Inventory, was used for both pre and post PPS studies. Secondly, nurse administrators at the data collection agency were interviewed concerning comparative results.
Findings: Currently readmitted clients are sicker than those characterized in the prior research report, and are readmitted sooner for a different diagnosis, with less continuity of services.
Conclusions: The home health care industry has undergone a dramatic change in reimbursement for services, moving from a fee-for-service to a PPS. The impact of such organizational change is not clear. Of particular concern is the adverse patient outcome of an unplanned hospital readmission. Prior studies have characterized such patients in home health care, but no reports on the topic were found in a literature search, since the inception of PPS. Findings from this study begin to fill the gap, and suggest that an increased emphasis on cost containment and higher risk clients would appear to be changing established patterns of care delivery.
Session #1204 - Home Care
The 29th Annual MNRS Research Conference (April 1-4, 2005)