Key result
Early home health nursing and physician follow-up linked to ~7% lower 30-day hospital readmission.
Why the study?
Little evidence guides the care of sepsis survivors after hospital discharge despite high hospital readmission rates.
Does early home health nursing and early physician follow-up reduce 30-day all-cause hospital readmission in Medicare sepsis survivors discharged to home health care?
Observational (n=170,571)
Yes
Does early home health nursing and early physician follow-up reduce 30-day all-cause hospital readmission in Medicare sepsis survivors discharged to home health care?
Effect estimate: Absolute reduction 7 percentage points (95% CI 2-12)
p-value: p=0.006
Early postdischarge care by both home health and medical providers significantly reduces 30-day hospital readmissions for sepsis survivors.
Supports combined early postdischarge care to lower readmissions in sepsis survivors; hypothesis-generating pending randomized confirmation.
BACKGROUND: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission. OBJECTIVE: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors. DESIGN: A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis. SUBJECTS: Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care. MEASURES: The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission. RESULTS: Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12). CONCLUSIONS: Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.
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Deb et al. (2019) conducted an observational in Sepsis (n=170,571). Early home health nursing and early physician follow-up vs. Neither protocol or single protocol alone was evaluated on 30-day all-cause hospital readmission (Absolute reduction 7 percentage points, 95% CI 2-12, p=0.006). Combined early home health nursing and early physician follow-up reduced the probability of 30-day all-cause hospital readmission by 7 percentage points (95% CI 2-12; P=0.006).
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