Association Between Hospital Participation in Value-Based Programs and Timely Initiation of Post-Acute Home Health Care, Functional Recovery, and Hospital Readmission After Joint Replacement

Author:

Roy Indrakshi1,Karmarkar Amol M23,Lininger Monica R4,Jain Tarang4,Martin Brook I5,Kumar Amit67

Affiliation:

1. Department of Health Sciences, Center for Health Equity Research, Northern Arizona University , Flagstaff, Arizona , USA

2. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine , Richmond, Virginia , USA

3. Sheltering Arms Institute , Richmond, Virginia , USA

4. Department of Physical Therapy and Athletic Training, Northern Arizona University , Flagstaff, Arizona , USA

5. Department of Orthopedics, University of Utah , Salt Lake City, Utah , USA

6. Department of Physical Therapy and Athletic Training, College of Health, University of Utah , Salt Lake City, Utah , USA

7. Department of Population Health Sciences, University of Utah , Salt Lake City, Utah , USA

Abstract

Abstract Objectives This study examined the association between hospital participation in Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) and the timely initiation of home health rehabilitation services for lower extremity joint replacements. Furthermore, this study examined the association between the timely initiation of home health rehabilitation services with improvement in self-care, mobility, and 90-day hospital readmission. Method This retrospective cohort study used Medicare inpatient claims and home health assessment data from 2016 to 2017 for older adults discharged to home with home health following hospitalization after joint replacement. Multilevel multivariate logistic regression was used to examine the association between hospital participation in BPCI or CJR programs and timely initiation of home health rehabilitation service. A 2-staged generalized boosted model was used to examine the association between delay in home health initiation and improvement in self-care, mobility, and 90-day risk-adjusted hospital readmission. Results Compared with patients discharged from hospitals that did not have BPCI or CJR, patients discharged from hospitals with these programs had a lower likelihood of delayed initiation of home health rehabilitation services for both knees and hip replacement. Using propensity scores as the inverse probability of treatment weights, delay in the initiation of home health rehabilitation services was associated with lower improvement in self-care (odds ratio [OR] = 1.23; 95% CI = 1.20–1.26), mobility (OR = 1.15; 95% CI = 1.13–1.18), and higher rate of 90-day hospital readmission (OR = 1.19; 95% CI = 1.15–1.24) for knee replacement. Likewise, delayed initiation of home health rehabilitation services was associated with lower improvement in self-care (OR = 1.16; 95% CI = 1.13–1.20) and mobility (OR = 1.26; 95% CI = 1.22–1.30) for hip replacement. Conclusion Hospital participation in BPCI or comprehensive CJR was associated with early home health rehabilitation care initiation, which was further associated with significant increases in functional recovery and lower risks of hospital readmission. Impact Policy makers may consider incentivizing health care providers to initiate early home health services and care coordination in value-based payment models.

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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