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Western Journal of Nursing Research
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Risk Factors for Hospitalization Among Medicare Home Care Patients

Richard H. Fortinsky

University of Connecticut Health Center

Elizabeth A. Madigan

Case Western Reserve University

T. Joseph Sheehan

University of Connecticut Health Center

Susan Tullai-McGuinness

Case Western Reserve University

Juliane R. Fenster

University of Connecticut

This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.

Key Words: Medicare home health care • hospitalization • rehospitalization • OASIS data

Western Journal of Nursing Research, Vol. 28, No. 8, 902-917 (2006)
DOI: 10.1177/0193945906286810
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