Healing at Home: Receipt of Home Health Care and Patient-Centered Outcomes Among Older Adults After Acute Myocardial Infarction.
Academic Article
Overview
abstract
OBJECTIVE: To evaluate the impact of receipt of home health care (HHC) on the patient-centered outcomes of days not at home (DNAH) and risk of decline in physical and mental health status among older adults hospitalized with acute myocardial infarction (AMI). DESIGN: Secondary analysis of data from a national prospective cohort study. SETTING AND PARTICIPANTS: Adults age ≥75 years discharged home after an AMI hospitalization and linked to Medicare data. METHODS: The primary exposure was receipt of HHC by 14 days postdischarge. DNAH within 180 days after discharge was defined as the count of days spent deceased or in a hospital, skilled nursing facility, or inpatient rehab facility. Health status decline was defined as a decrease ≥5 points on the SF-12 from baseline to 180 days. Inverse probability of treatment-weighted generalized linear models was used to evaluate associations between receipt of HHC and these outcomes. RESULTS: A total of 491 of 1846 (26.6%) participants received HHC within 14 days; HHC recipients were older and had greater clinical and functional comorbidity. HHC was not associated with DNAH (incidence rate ratio [IRR], 1.24; 95% CI, 0.99-1.56) nor risk of decline in mental health status (odds ratio [OR], 0.83; 95% CI, 0.64-1.07), but was associated with substantially reduced risk of decline in physical health status (OR, 0.70; 95% CI, 0.56-0.89). CONCLUSIONS AND IMPLICATIONS: More than one-quarter of patients with AMI age ≥75 discharged home received HHC. Patients who received HHC, who were older and sicker on average, were less likely to experience clinically significant declines in physical health status but had similar rates of mental health status decline and DNAH as those who did not receive HHC. This work suggests that providers consider the health outcome goals of older AMI patients and prescribe HHC to those who prioritize preservation of physical health status.
