Impact of Frontloading of Skilled Nursing Visits on the Incidence of 30-day Hospital Readmission

2.50
Hdl Handle:
http://hdl.handle.net/10755/266675
Category:
Abstract
Type:
Research Study
Title:
Impact of Frontloading of Skilled Nursing Visits on the Incidence of 30-day Hospital Readmission
Author(s):
O'Connor, Melissa; Bowles, Kathryn; Hanlon, Alexandra
Lead Author STTI Affiliation:
Xi
Author Details:
Melissa O'Connor, PhD, MBA, RN, COS-C omelissa@nursing.upenn.edu; Kathryn H. Bowles, PhD, RN, FAAN; Alexandra Hanlon, PhD
Abstract:
Due to a statistical error, the “Summary of Findings” section of this abstract was corrected and replaced by the submitting author on 3 June, 2013.

Background:  Frontloading of skilled nursing visits is considered a fundamental best practice for reducing hospitalization occurring during home health services by the Home Health Quality Improvement National Campaign, a special project supported by the West Virginia Medical Institute who is under contract with the Centers for Medicare and Medicaid Services (CMS) (West Virginia Medical Institute, 2010) This recommendation is the result of only one study (Rogers, Perlic & Madigan, 2007) that tested frontloading on heart failure and diabetes home health recipients but was found to be effective for heart failure patients only. Despite this finding, the best practice and recommendation persists for all home health recipients regardless of diagnosis. Frontloading and its influence on 30-day readmissions are poorly understood.

Project Aim:  The purpose of this study was to evaluate the impact frontloading of skilled home health nursing visits has on the incidence of 30-day hospital readmission among Medicare-reimbursed home health recipients.

Methods, Procedures and Sampling:  For the purposes of this study, frontloading was defined as providing five or more skilled nursing visits within the first 14 days of skilled home health.  A retrospective analysis of five Centers for Medicare and Medicaid-owned national data sets from 2009 was conducted (Outcomes Assessment Information Set, Home Health Agency Standard Analytic File, Medicare Provider and Analysis Review File, Beneficiary Summary and Provider of Services file).  A hospital admission within 30 days of admission to home health was required to be eligible for this study. Propensity score analysis was applied prior to logistic regression analysis. An independent, randomized sample of Medicare-reimbursed home health recipients (n=4,500) was employed for this analysis.

Summary of findings: Despite the Home Health Quality Improvement National Campaign, only 40% of the sample was frontloaded. Overall, 3.89% of the sample experienced a hospital readmission 15 to 30 days following hospital discharge. Of those who had a 30-day readmission, 53% were NOT frontloaded, 47% were frontloaded. Frontloading skilled nursing visits was not predictive of 30-day hospital readmissions (p=0.741).

Recommendations: Frontloading could be an effective tool in reducing the need for hospital readmission within 30 days of hospital discharge but additional study is imperative to further advance geriatric home health nursing practice. Specifically, additional research is required to further refine the definition of frontloading, and to develop decision-support best practices to determine most appropriate time to discharge from skilled home health services. 

Keywords:
home health; home health care
Repository Posting Date:
23-Jan-2013
Date of Publication:
23-Jan-2013
Sponsors:
Sigma Theta Tau International
Note:
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.; This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryAbstracten
dc.typeResearch Studyen
dc.titleImpact of Frontloading of Skilled Nursing Visits on the Incidence of 30-day Hospital Readmissionen_US
dc.contributor.authorO'Connor, Melissa-
dc.contributor.authorBowles, Kathryn-
dc.contributor.authorHanlon, Alexandra-
dc.contributor.departmentXien
dc.author.detailsMelissa O'Connor, PhD, MBA, RN, COS-C omelissa@nursing.upenn.edu; Kathryn H. Bowles, PhD, RN, FAAN; Alexandra Hanlon, PhDen
dc.identifier.urihttp://hdl.handle.net/10755/266675-
dc.description.abstractDue to a statistical error, the “Summary of Findings” section of this abstract was corrected and replaced by the submitting author on 3 June, 2013.<br /><p><strong>Background:  </strong>Frontloading of skilled nursing visits is considered a fundamental best practice for reducing hospitalization occurring during home health services by the Home Health Quality Improvement National Campaign, a special project supported by the West Virginia Medical Institute who is under contract with the Centers for Medicare and Medicaid Services (CMS) (West Virginia Medical Institute, 2010) This recommendation is the result of only one study (Rogers, Perlic & Madigan, 2007) that tested frontloading on heart failure and diabetes home health recipients but was found to be effective for heart failure patients only. Despite this finding, the best practice and recommendation persists for all home health recipients regardless of diagnosis. Frontloading and its influence on 30-day readmissions are poorly understood.</p> <p><strong>Project Aim:</strong>  The purpose of this study was to evaluate the impact frontloading of skilled home health nursing visits has on the incidence of 30-day hospital readmission among Medicare-reimbursed home health recipients.</p> <p><strong>Methods, Procedures and Sampling:  </strong>For the purposes of this study, frontloading was defined as providing five or more skilled nursing visits within the first 14 days of skilled home health.  A retrospective analysis of five Centers for Medicare and Medicaid-owned national data sets from 2009 was conducted (Outcomes Assessment Information Set, Home Health Agency Standard Analytic File, Medicare Provider and Analysis Review File, Beneficiary Summary and Provider of Services file).  A hospital admission within 30 days of admission to home health was required to be eligible for this study. Propensity score analysis was applied prior to logistic regression analysis. An independent, randomized sample of Medicare-reimbursed home health recipients (n=4,500) was employed for this analysis.</p> <p><strong>Summary of findings:</strong> Despite the Home Health Quality Improvement National Campaign, only 40% of the sample was frontloaded. Overall, 3.89% of the sample experienced a hospital readmission 15 to 30 days following hospital discharge. Of those who had a 30-day readmission, 53% were NOT frontloaded, 47% were frontloaded. Frontloading skilled nursing visits was not predictive of 30-day hospital readmissions (p=0.741).</p> <p><strong>Recommendations:</strong> Frontloading could be an effective tool in reducing the need for hospital readmission within 30 days of hospital discharge but additional study is imperative to further advance geriatric home health nursing practice. Specifically, additional research is required to further refine the definition of frontloading, and to develop decision-support best practices to determine most appropriate time to discharge from skilled home health services. </p>en_GB
dc.subjecthome healthen_GB
dc.subjecthome health careen_GB
dc.date.available2013-01-23T14:15:28Z-
dc.date.issued2013-01-23-
dc.date.accessioned2013-01-23T14:15:28Z-
dc.description.sponsorshipSigma Theta Tau Internationalen
dc.description.noteThe Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.en
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.-
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