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Publication Date

10-29-2018

Keywords

prevention, older adults, delirium, HELP program, hospital readmission, home care

Abstract

Background: Prevention and early identification of vulnerable older adults’ risk for delirium and functional decline is critical to improving quality of care across the continuum. To our knowledge there are no known studies that examine the impact of a model of care that spans across health care settings (inpatient to skilled home care) on unplanned 30-day readmissions.

Purpose: To examine the impact of the adapted model of care (Bundled HELP) on 30-day unplanned hospital readmission among patients 65 and older who received inpatient hospital care and skilled home care in two rural hospitals and home care in Wisconsin.

Methods: A quantitative, comparative study design was used to compare outcomes between two groups of patients 65 and older who received inpatient care on a medical-surgical unit and were discharged to skilled home care from January 2015 to October 2017. The study sample included 766 patients: 617 control/pre-Bundled HELP; 149 treatment/Bundled HELP. Key elements of the Bundled HELP include deployment of HELP on medical-surgical units, use of the home-care-to-hospital-readmission risk score for 24- or 48-hour home care start of care, and continued provision of HELP protocols to home care patients at each home care visit (RNs, CNAs, PTs, OTs). Descriptive patient variables (ie, age, length of hospital stay, comorbidity) were analyzed using means or frequencies. Multivariate logistic regression was conducted to identify predictors of unplanned 30-day hospital readmission.

Results: The rate of unplanned 30-day hospital readmission after discharge to home care among the pre-Bundled HELP/control group was 28.5% (n = 176); among the Bundled HELP/treatment group, unplanned 30-day readmission rate was 16.7% (n = 25). On multivariate analysis, Bundled HELP (P = 0.02), hospital primary admission diagnosis of cancer (any type) (P = 0.02), and Charlson comorbidity index (P < 0.0001) were predictors of unplanned 30-day readmission. Patients who received Bundled HELP had a 1.72 times reduced risk of readmission compared to patients who did not receive Bundled HELP (odds ratio: 0.59, 95% confidence interval: 0.36–0.95; P = 0.02).

Conclusion: With 20% or more of all inpatients 65 and older discharged from the hospital to skilled home care, the impact of this adapted and bundled model of care is significant. Given average length of hospital stay is 3 days, there is less time to deliver HELP protocols in the hospital setting. The findings of this study provide support for extending this model of care beyond acute care and replicating the study.

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