Predictors of hospital admission for congestive heart failure patients (CHF) from a home health agency

Abstract

The purpose of this study was to examine the factors that were most predictive of hospital admission for Congestive Heart Failure (CHF) patients admitted to a large urban home care organization. The Andersen Behavioral Model of Health Services Use served as the conceptual framework for the study. A retrospective design using administrative data from the OASIS instrument investigated client characteristics measured at admission (predisposing, enabling and need) and resource utilization that were predictive of hospital admission from a home health episode. This secondary data analysis included 710 CHF patients, of whom 150 or 21% were admitted to the hospital during a home health episode. A logistic hierarchical regression was performed to determine predictors of hospital admission. Four questions were tested to determine predictors. Three measures--increase in dyspnea, fewer physical therapy visits and higher visit intensity--predicted hospital admission. Chi-square and t-tests were conducted to determine if there was a difference between those hospitalized and those not hospitalized. Patients were more likely to be hospitalized if they: had Medicaid as their primary payer; had increased shortness of breath with activity; had a higher acuity level as measured by symptom control; required more assistance in upper body dressing; needed more assistance in ambulating; had difficulty transferring; were more dependent in all Activities of Daily Living; had significantly fewer physical therapy visits; and had a higher intensity of visits per day. The findings demonstrate the value of using OASIS for a specific disease, CHF, in examining the outcome of hospitalization from a home care agency. Findings provide information for nurses on the importance of the assessment of dyspnea during the first home care visit, the use of physical therapy services and the role of the visit intensity during a home care episode. Further research needs to explore the restrictive policies of the state Medicaid programs that may contribute to the significantly higher hospitalization rates of these CHF patients.