Home Health & Hospice Week

Can you name the diagnosis that is the strongest predictor of trouble?

Medicare's push for pay-for-performance is likely to bring scrutiny to your rates of rehospitalization. Can you take the heat?

If you're not sure, you're not alone. The national average on the Home Health Compare measure "Patients who had to be admitted to the hospital" has not budged from 28 percent since the public reporting of quality measures began. But the top 7.5 percent of agencies have rates of 18 percent or less, the National Association for Homecare and Hospice reports.

To determine what makes these agencies different, NAHC, Briggs Corp, headquartered in West Des Moines, IA, and Fazzi Associates, based in Northampton, MA, launched a study of these top 560 agencies.

Meanwhile, previous studies of rehospitalizations provide information to help you tackle your own quality improvement project. One study of nearly 7,400 home health patients who had been rehospitalized at least once (defined as high risk) showed some common characteristics among the patients.

Watch for: A diagnosis of congestive heart failure was the strongest predictor of rehospitalizations, according to the report. Identifying CHF patients as high risk and implementing disease management can prevent poor outcomes, the study's authors concluded.

Besides the CHF diagnosis, home care patients in this study were also more likely to be rehospitalized when they:

• were poorer and lived alone.
• came to home care from an inpatient facility.
• had higher functional deficits in activities of daily living.
• had difficulty managing medications.
• experienced difficulty breathing.
• had more than two secondary diagnoses.
• were admitted to home care with diagnoses of diabetes, HIV/AIDS or chronic skin ulcers. Home health agencies that focus on these risk factors may improve the effectiveness and efficiency of their efforts to prevent rehospitalization, the study predicts. Note: The study "Risk Factors for Repeated Hospitalizations Among Homecare Recipients" is in the Journal for Healthcare Quality at www.nahq.org/journal/ce/article.html?article_id=147.