Identifying the process and agency characteristics associated with poor utilization outcomes in home healthcare

ABSTRACT

This study identified the process and agency characteristics associated with poor utilization outcomes – higher percentages of patients (i) admitted to an acute care organization and (ii) visited an emergency room (ER) unplanned without hospitalization – for home health agencies (HHAs) in the United States. We conducted a secondary analysis of data about HHAs’ various characteristics, process adherence levels, and utilization outcomes collected from disparate public repositories for 2010–2022. We developed descriptive tree-based models using HHAs’ hospital admission or ER visit percentages as response variables. Across the board, hospital admission percentages have steadily improved while ER percentages deteriorated for an extended period. Recently, checking for fall risks and depression was associated with improved outcomes for urban agencies. In general, rural HHAs had worse utilization outcomes than urban HHAs. Targeted investments and improvement initiatives can help rural HHAs close the urban-rural gap in the future.

KEYWORDS:

• Home healthcare
• quality measures
• utilization outcomes
• hospital admissions
• emergency room visits
• tree-based modeling

Disclosure statement

Dr. Koru owns Maryland Health Information Technology LLC and Maryland Data Science and Engineering LLC. Drs. Zhang and Felix have no competing interests to declare.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.