Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study

Published:November 24, 2017DOI:



      As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population.


      A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with “self-care” were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates.


      Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p < 0.0001). Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p < 0.0001) and death (HR 0.80, p < 0.0001). Subgroup analyses revealed that home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p < 0.01), Heart & Vascular (adjusted savings of $11,453, p < 0.0001), Medicine (readmission HR 0.71, p < 0.0001), and Neurological (readmission HR 0.67, p < 0.0001) Institutes.


      Discharge with home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hines A.
        • Barrett M.
        • Jiang H.
        • Steiner C.
        Conditions with the Largest Number of Adult Hospital Readmissions by Payer, 2011.
        (HCUP Statistical Brief #172) Agency for Healthcare Research and Quality, Rockville, MD2014 (Available at:)
        • Naylor M.D.
        Transitional care of older adults.
        Annu Rev Nurs Res. 2002; 20: 127-147
        • Bowles K.H.
        • Naylor M.D.
        • Foust J.B.
        Patient characteristics at hospital discharge and a comparison of home care referral decisions.
        J Am Geriatr Soc. 2002; 50: 336-342
        • Auerbach A.D.
        • Kripalani S.
        • Vasilevskis E.E.
        • et al.
        Preventability and causes of readmissions in a national cohort of general medicine patients.
        JAMA Intern Med. 2016; 176: 484-493
        • Hernandez A.F.
        • Greiner M.A.
        • Fonarow G.C.
        • et al.
        Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.
        JAMA. 2010; 303: 1716-1722
        • Mor V.
        • Besdine R.W.
        Policy options to improve discharge planning and reduce rehospitalization.
        JAMA. 2011; 305: 302-303
        • Nyweide D.J.
        • Anthony D.L.
        • Bynum J.P.W.
        • et al.
        Continuity of care and the risk of preventable hospitalization in older adults.
        JAMA Intern Med. 2013; 173: 1879
        • Sharma G.
        • Fletcher K.E.
        • Zhang D.
        • Kuo Y.-F.
        • Freeman J.L.
        • Goodwin J.S.
        Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults.
        JAMA. 2009; 301: 1671-1680
        • Helbing C.
        • Sangl J.A.
        • Silverman H.A.
        Home health agency benefits.
        Health Care Financ Rev Annu Suppl. 1992; : 125-148
        • Forum on Aging Disability and Independence, Board on Health Sciences Policy, Division on Behavioral and Social Sciences and Education, Institute of Medicine, National Research Council
        The Future of Home Health Care: Workshop Summary.
        National Academies Press (US), Washington, DC2015
        • Jones A.L.
        • Harris-Kojetin L.
        • Valverde R.
        Characteristics and use of home health care by men and women aged 65 and over.
        Natl Health Stat Report. 2012; 52: 1-7
        • Prvu Bettger J.
        • McCoy L.
        • Smith E.E.
        • Fonarow G.C.
        • Schwamm L.H.
        • Peterson E.D.
        Contemporary trends and predictors of postacute service use and routine discharge home after stroke.
        J Am Heart Assoc. 2015; 4
        • Welch H.G.
        • Wennberg D.E.
        • Welch W.P.
        The use of Medicare home health care services.
        N Engl J Med. 1996; 335: 324-329
        • Jones C.D.
        • Wald H.L.
        • Boxer R.S.
        • et al.
        Characteristics associated with home health care referrals at hospital discharge: results from the 2012 National Inpatient Sample.
        Health Serv Res. 2016; 52: 879-894
        • Rich M.W.
        • Beckham V.
        • Wittenberg C.
        • Leven C.L.
        • Freedland K.E.
        • Carney R.M.
        A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.
        N Engl J Med. 1995; 333: 1190-1195
        • Stewart S.
        • Pearson S.
        • Horowitz J.
        Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care.
        Arch Intern Med. 1998; 158: 1067-1072
        • Stewart S.
        • Vandenbroek A.J.
        • Pearson S.
        • Horowitz J.D.
        Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure.
        Arch Intern Med. 1999; 159: 257-261
        • Stewart S.
        • Marley J.E.
        • Horowitz J.D.
        Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study.
        Lancet. 1999; 354: 1077-1083
        • Jaarsma T.
        • Halfens R.
        • Huijer Abu-Saad H.
        • et al.
        Effects of education and support on self-care and resource utilization in patients with heart failure.
        Eur Heart J. 1999; 20: 673-682
        • Naylor M.D.
        • Brooten D.A.
        • Campbell R.L.
        • Maislin G.
        • McCauley K.M.
        • Schwartz J.S.
        Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial.
        J Am Geriatr Soc. 2004; 52: 675-684
        • Madigan E.A.
        People with heart failure and home health care resource use and outcomes.
        J Clin Nurs. 2008; 17: 253-259
        • Murtaugh C.M.
        • Deb P.
        • Zhu C.
        • et al.
        Reducing readmissions among heart failure patients discharged to home health care: effectiveness of early and intensive nursing services and early physician follow-up.
        Health Serv Res. 2017; 52: 1445-1472
        • Shepperd S.
        • Iliffe S.
        • Doll H.A.
        • et al.
        Admission avoidance hospital at home.
        Cochrane Database Syst Rev. 2016; (CD007491)
        • Ticona L.
        • Schulman K.A.
        Extreme home makeover—the role of intensive home health care.
        N Engl J Med. 2016; 375: 1707-1709
        • Porter M.E.
        What is value in health care?.
        N Engl J Med. 2010; 363: 2477-2481
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
        • Chen L.M.
        • Jha A.K.
        • Guterman S.
        • Ridgway A.B.
        • Orav E.J.
        • Epstein A.M.
        Hospital cost of care, quality of care, and readmission rates: penny wise and pound foolish?.
        Arch Intern Med. 2010; 170: 340-346
        • Center for Medicare and Medicaid Services
        Provider Specific Data for Public Use in Text Format.
        U.S. Centers for Medicare & Medicaid Services, Baltimore, MD2015
        • R Core Team
        R: A Language and Environment for Statistical Computing.
        R Foundation for Statistical Computing, Vienna, Austria2017
        • Rubin D.B.
        Multiple Imputation for Nonresponse in Surveys. Vol. 81. John Wiley & Sons, Inc., Hoboken, NJ2004
        • van Buuren S.
        • Brand J.P.L.
        • Groothuis-Oudshoorn C.G.M.
        • Rubin D.B.
        Fully conditional specification in multivariate imputation.
        J Stat Comput Simul. 2006; 76: 1049-1064
        • van Buuren S.
        • Groothuis-Oudshoorn K.
        Multivariate imputation by chained equations.
        J Stat Softw. 2011; 45: 1-67
        • Ho D.E.
        • Imai K.
        • King G.
        • Stuart E.A.
        MatchIt: nonparametric preprocessing for parametric causal inference.
        J Stat Softw. 2011; 42: 1-28
        • Rosenbaum P.R.
        • Rubin D.B.
        Constructing a control group using multivariate matched sampling methods that incorporate the propensity score.
        Am Stat. 1985; 39: 33-38
        • Orszag P.R.
        • Ellis P.
        The challenge of rising health care costs—a view from the Congressional Budget Office.
        N Engl J Med. 2007; 357: 1793-1795
        • Kruzikas D.
        • Jiang H.
        • Remus D.
        • Barrett M.
        • Coffey R.
        • Andrews R.
        Preventable Hospitalizations: A Window Into Primary and Preventive Care, 2000.
        (AHRQ Publication No. 04-005) Agency for Healthcare Research and Quality, Rockville, MD2004
        • Naylor M.D.
        • Brooten D.
        • Campbell R.
        • et al.
        Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial.
        JAMA. 1999; 281: 613-620
        • Muñoz M.A.
        • Real J.
        • Del Val J.L.
        • et al.
        Determinants of survival and hospitalization in older, heart failure patients receiving home healthcare.
        Int J Cardiol. 2016; 207: 145-149
        • Martin R.C.G.
        • Brown R.
        • Puffer L.
        • et al.
        Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab.
        Ann Surg. 2011; 254: 591-597
        • Sanford D.E.
        • Olsen M.A.
        • Bommarito K.M.
        • et al.
        Association of discharge home with home health care and 30-day readmission after pancreatectomy.
        J Am Coll Surg. 2014; 219 (e1): 875-886