By Melinda Young
Researchers wanted to know if there is an association between home health and gaps in care coordination among providers. They found patients receiving home healthcare are sicker, experienced more functional dependencies, and reported more preventable drug-drug interactions.1
While home health was not associated with a difference in gaps of care coordination, it was associated with twice the risk of a preventable adverse outcome.
“As a researcher in home health, I investigate how people use home health services and their impact on outcomes in a variety of ways,” says Madeline R. Sterling, MD, MPH, lead study author and an assistant professor of medicine in the division of general internal medicine at Weill Cornell Medicine in New York City. “I’ve been very interested in older adults and those with chronic conditions. They frequently see a number of doctors and often use home health, so you can imagine there might be challenges with care coordination among those providers.”
Sterling and colleagues studied care coordination and adverse events from the patient’s perspective. They surveyed patients about their ED visits, medical discrepancies, and communication across providers. They used data on 4,296 Medicare beneficiaries from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. They had completed a survey on care coordination from 2017 to 2018.
“The outcome of interest was a gap in care coordination. The second outcome was preventable adverse events,” Sterling notes. “We had over 4,000 [Medicare] participants from across the United States, and the population was diverse in race and economic status. Overall, one in 10 received home care in the study period.”
Those who received home care were more likely to be older, experience more medical problems, and report more comorbidities than those who did not receive home care.
“One of the missions of home health is to put providers in the home and coordinate the care,” Sterling explains. “We didn’t see it was associated with gaps in care coordination, but in the overall study population, one in three participants did report a gap in care coordination.”
This means that a large percentage of all study participants reported a gap in care coordination. Those who received home health services were not more or less likely to be among those experiencing care coordination issues.
“The point is that this is a problem regardless of whether you have home health,” Sterling says. “This is a problem affecting everyone.”
When participants were asked whether they visited an ED or were hospitalized, and whether these could have been prevented by better communication among providers, both home health patients and those not in home health were about as likely to say “yes.” The findings suggest care coordinators and providers need ways to optimize aspects of communication.
“Recognize that if you have an older adult Medicare beneficiary, they’re probably at risk for issues of care coordination, so you need to figure out ways to target those at the highest risk,” Sterling explains. “There’s ongoing work in clinical trials, looking at this for certain conditions.”
Communication is an important issue for all patient care, even if home care is not involved. For example, an intervention could ensure the hospital’s medication list is sent to home health providers.
“Reconciling medications when they leave the hospital and get admitted to home health could be a very important target,” Sterling says.
Sterling and colleagues found home health patients reported more adverse events and ED visits, particularly related to medication problems. This could be related to trained professionals in the home who recognized patients’ medication reactions quickly and recommended they visit the ED.
“That might have been clinically appropriate. It’s hard to adjust for what’s an appropriate visit to the ED or what’s not. It’s complicated,” Sterling says.
Also, a care coordinator could speak with patients and their loved ones about the challenges they are experiencing to ensure there are no gaps in communication and care.
“In so many of these interventions, they don’t include the patient’s perspective of what’s helpful, so this study adds to that knowledge,” Sterling says.
REFERENCE
- Sterling MR, Lau J, Rajan M, et al. Self-reported gaps in care coordination and preventable adverse outcomes among older adults receiving home health care. J Am Geriatr Soc 2022;Dec 5. doi: 10.1111/jgs.18135. [Online ahead of print].