Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care

Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic c...

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Veröffentlicht in:Population health management 2016-06, Vol.19 (3), p.163-170
Hauptverfasser: Jackson, Carlos, Kasper, Elizabeth W., Williams, Christianna, DuBard, C. Annette
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container_issue 3
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container_title Population health management
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creator Jackson, Carlos
Kasper, Elizabeth W.
Williams, Christianna
DuBard, C. Annette
description Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P  
doi_str_mv 10.1089/pop.2015.0074
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Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P  &lt; 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. 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Annette</creatorcontrib><title>Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care</title><title>Population health management</title><addtitle>Popul Health Manag</addtitle><description>Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P  &lt; 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. ( Population Health Management 2016;19:163–170)</description><subject>Adult</subject><subject>Chronic Disease</subject><subject>Female</subject><subject>House Calls</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multiple Chronic Conditions</subject><subject>North Carolina</subject><subject>Original</subject><subject>Original Articles</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patient Readmission - trends</subject><subject>Regression Analysis</subject><subject>Transitional Care</subject><issn>1942-7891</issn><issn>1942-7905</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>1-M</sourceid><sourceid>EIF</sourceid><recordid>eNqFkc2P1SAUxYnROB-6dGtYuukTKC1lY6LV-UjGaMzollB6-x6GQgXeTFz6n0t9MxNduQLu_XHugYPQC0o2lHTy9RKWDSO02RAi-CN0TCVnlZCkeXy_7yQ9QicpfSek5S1pnqIj1vKasqY5Rr8uvYkwg8_a4XfgYbIZhwlrfBFmwN9sKuez4Fy4tX6L39tkdjpuAU8h4s8623Iz4Vubd_jj3mW7OMD9LgZvDe6DH222wSf8BQzYm1XhOmqf_lTLwF5HeIaeTNoleH63nqKvZx-u-4vq6tP5Zf_2qjLFa664HqdRCm5aAGHKA1nXcj1QMfFOkqkWdBxKmw1mFLrmXTtqzUCMrGWcToLVp-jNQXfZDzOMphiP2qkl2lnHnypoq_7teLtT23CjuKQ1l7wIvLoTiOHHHlJWc_kNcE57CPukqJC1JLTtREGrA2piSCnC9DCGErXGpkpsao1NrbEV_uXf3h7o-5wKUB-Atay9dxYGiPk_sr8ByNen9g</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Jackson, Carlos</creator><creator>Kasper, Elizabeth W.</creator><creator>Williams, Christianna</creator><creator>DuBard, C. 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Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P  &lt; 0.01). 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source MEDLINE; Alma/SFX Local Collection
subjects Adult
Chronic Disease
Female
House Calls
Humans
Male
Middle Aged
Multiple Chronic Conditions
North Carolina
Original
Original Articles
Outcome Assessment (Health Care)
Patient Readmission - trends
Regression Analysis
Transitional Care
title Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care
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