Home Health Specialization and Postacute Outcomes

Area of Science:

• Health Services Research
• Gerontology
• Public Health

Background:

• Home health agencies (HHAs) are the most common postacute care (PAC) setting for traditional Medicare patients after hospitalization.
• Understanding the impact of specialized HHAs on patient outcomes is crucial for optimizing PAC delivery.

Purpose of the Study:

• To estimate the effects of receiving postacute care from home health agencies (HHAs) that specialize in PAC.
• To compare outcomes between patients treated at specialized HHAs versus non-specialized HHAs.

Main Methods:

• Utilized a cross-sectional study design with an instrumental variables approach.
• Employed differential distance to specialized HHAs as an instrumental variable.
• Analyzed 100% Medicare fee-for-service claims for 853,780 traditional Medicare patients receiving home health care in 2019.

Main Results:

• Patients at specialized HHAs had significantly lower hospitalization risk (-2.1 pp) and skilled nursing facility (SNF) admissions (-0.3 pp) during home health spells.
• Post-discharge, specialized HHAs were associated with reduced hospitalizations (-0.8 pp during discharge week, -0.9 pp at 6 weeks).
• Mortality rates were consistently lower for patients treated at specialized HHAs, both during the discharge week (-1.3 pp) and within 6 weeks post-discharge (-1.1 pp).

Conclusions:

• Specialized HHAs demonstrate improved patient outcomes during PAC episodes.
• Lower mortality rates observed during and after care suggest benefits of specialized HHA care.
• Findings have significant implications for optimizing the delivery of postacute care services.