After Hospital Discharge, Slow Home Health Care Initiation Increases Risk of Rehospitalization

Patient avoidance or postponement of care are common reasons for home health care delays, the authors said.

Patients discharged from the hospital are at a higher risk of rehospitalization if they experience a delay in postdischarge home health care initiation, according to a new study.

The study, published in Journal of the American Medical Directors Association, shows the risk of a rehospitalization or emergency department (ED) visit jumps by 12% when patients wait more than 2 days for their at-home care to start.

More than 6 million Americans receive home health care each year, noted the study’s authors. In many cases, those home visits follow discharge from a hospital. Home health care providers can perform a range of services, including clinical assessments, wound management, and medication reconciliation, the authors said. Previous research shows that home health care visits following hospitalization can reduce the risk of readmission, especially for certain conditions, such as sepsis and heart failure.

CMS requires that initial at-home patient visits take place within 48 hours of referral or of the patient’s return home, unless otherwise stated by the patient’s physician. However, the investigators said no study has yet looked at whether the timing of such visits has an impact on patient outcomes.

They decided to examine the records of an urban home health care agency in the northeastern United States in order to see whether the agency’s success or failure in initiating care within 48 hours had a meaningful impact on patient outcomes.

The investigators analyzed a data set of 49,141 home health care visits received by 45,390 patients who were discharged from the hospital during 2019 and referred for at-home follow-up. They compared the timing of home health care initiation with 30-day hospitalizations and ED visits to see whether the timing affected outcomes and whether there were any disparities based on factors such as race/ethnicity, age, insurance type, and clinical status.

In total, about one-third of initial home health care episodes in the data set were delayed, meaning they did not happen within 48 hours. Previous research by the present study’s authors suggest that patients not answering the door or postponing visits were among the most common reasons for such delays.

Of those 34% of cases in which care was delayed, 14% of those delays resulted in a rehospitalization or ED visit within 30 days. And that translated into a 12% higher risk of rehospitalization or ED visit for patients whose home health care was not started within 2 days vs those who received timely initiation of home services.

The authors said the study findings demonstrate the importance of eliminating delays in care initiation and that patient education should be an important part of that goal, since better-informed patients might be less likely to postpone or seek to avoid home care.

“We also found that ‘administrative or scheduling issues’ caused 18% of start-of-care visit delays, suggesting home health care agencies have an opportunity to identify and resolve some of the existing administrative and scheduling issues so as to be prepared to see patients shortly after hospital discharge,” they added.

The investigators also found that patients on government health insurance were more likely to have a 30-day rehospitalization or ED visit. Thus, they said, more research should be done to identify and address causes of that issue.

They conceded that their study was based on a single home health care agency and thus the findings may not match those of other agencies. However, they said their study population was broadly similar to the characteristics of home health care patient populations in national studies. They also noted that their study did not separate out ED visits and rehospitalizations, instead treating them one category. Further studies could look more closely at how the timeliness of home health care initiation affects each category of readmission individually.

The authors concluded, however, that their data make clear that the efficacy of home health care in terms of preventing readmission is significantly impacted by the ability of home health care agencies to quickly begin at-home care.


Topaz M, Barrón Y, Song J, et al. Risk of rehospitalization or emergency department visit is significantly higher for patients who receive their first home health care nursing visit later than 2 days after hospital discharge. J Am Med Dir Assoc. 2022;23(10):1642-1647. doi:10.1016/j.jamda.2022.07.001

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