The relationship between home health services utilization and patient outcomes in Medicare beneficiaries

Medicare certified home health care reimbursement policy changed in 1988. As a result, reimbursable home care visits increased. The purpose of this study was to determine the relationship between home health services and patient outcomes before (pre-Staggers) and after (post-Staggers) the policy change and to examine the use of home health services and patient outcomes during the two periods to identify changes in service and outcomes. The study was retrospective and descriptive in design. Data were collected from a sample of 319 patient records from the pre-Staggers period and 603 patient records from the post-Staggers period. The relationship between utilization and patient discharge status was analyzed using a forced entry logistic regression model. Five independent factors were associated with the patient discharge status in the pre-Staggers sample. They included the home health agency (HHA) length of stay, number of skilled nursing and speech therapy visits, the Health Status Scale (HSS) score, and the hospital length of stay. Five independent factors were associated with the patient discharge status in the post-Staggers sample. They included the HHA length of stay, number of home health aide visits, home care visits per day, HSS score and primary diagnosis. Dramatic increases were noted in the utilization of services in the post-Staggers period for skilled nursing visits (t = 9.2, df = 864, p $\u3c$.001) and home health aide visits (t = 6.0, df = 808, p $\u3c$.001). There was, however, no change in patient outcomes in the post-Staggers period. The use of home health services, measured by duration, intensity, and type of provider, influenced the discharge outcome. The illness level, HSS score and primary diagnosis, also influenced the relationship between utilization and discharge outcome. Although home care visits increased dramatically in the post-Staggers period, no change was noted in the patient outcomes