Effect of home care agency providers and visits of heart failure patient outcomes

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DESCRIPTION (provided by applicant): Heart failure (HF) is a high burden condition for Americans and the health care system serving them-heart failure is the leading cause of hospitalization for patients over 65 with rates of rehospitalization as high as 65% within 6 months of the index hospital stay. Patients with heart failure also have progressive decline in functional status. Post-acute follow up in the home is one strategy to reduce the burden of heart failure on the US health care system. Home health care agencies are the most common type of post-acute care provider for patients with heart failure. Yet there is little evidence on the most effective ways to reduce rehospitalization and improve functional status outcomes for HF patients receiving home health care. In home health care, little research has been done on the relationship between the numbers of visits and outcomes and the results have been equivocal. Thus, the purpose of the present study is to determine factors predictive of rehospitalization and functional decline in HF patients receiving home health care and identify whether specific approaches to delivery of care (higher visit intensity) is associated with lower rehospitalization and functional status decline, potentially reducing the burden of HF on individual patients and the health care system. The Andersen Behavioral Model provides the conceptual framework. The study employs a large data base design linking home health care clinical data (OASIS) with claims data (home health and hospital), county level (numbers of nursing homes, home health care agencies, and hospitals and location for determining urban-rural nature) and agency level (profit status and hospital affiliation) data for patients with Medicare. Hospital data will include 6 months prior to and 6 months following the initiation home health care services, providing a more comprehensive view of hospital use. The linked data set will allow us to determine the patient factors associated with rehospitalization and functional status decline and examine whether higher visit intensity is associated with less rehospitalization, fewer rehospitalization days, longer time to rehospitalization and less functional status decline. Based on 2003 figures, we anticipate 100,000 eligible subjects with HF, 11.000 of whom will be rehospitalized and 20,000 of whom will have a functional status decline. Analysis will use a multi-level modeling approach because of the nested nature of the data. This study is innovative in that it uses national data for all HF patients receiving Medicare home health care and uses county level and agency level data in addition to patient level data which has not been done before in this population. Sub-sample analysis will include the oldest old (>85 years) and minority ethnicity. The clinical application of information from this study, then, is directly relevant to home health care practitioners in designing care practices (how many visits) and for physicians and hospitals who order home health care for HF patients.