Home Health Unplanned Readmission Across Metro and Rural Areas following Stroke and Joint Replacement.

Research Objectives: Explore national geographic differences in unplanned readmission after accounting for patient-level admission factors and area-level post-acute care availability for individuals receiving home health services following stroke or lower-extremity joint replacement (JR).

Design: Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) home health claims records and the Outcome and Assessment Information Set (OASIS). Using Rural-Urban Continuum Codes (RUCC) we classified all US counties into metro, metro-adjacent rural, and non-metro-adjacent rural areas and examined the availability of other post-acute care (PAC) provider types (long-term care hospitals, skilled nursing (SNF), and inpatient rehabilitation facilities) in each. We conducted multilevel logistic regressions to show the association between county classification and the odds of an unplanned readmission.

Setting: We examined acute care discharges to home health agencies.

Participants: The population included 100% Medicare records from 2013–2015 fee-for-service beneficiaries >65 years. The cohort included 21,395 stroke records and 160,287 JR records.

Interventions: N/A

Main Outcome Measures: Odds of an unplanned readmission for individuals who received home health services following stroke or JR

Results: Overall, 11.0% of stroke and 3.4% of JR had an unplanned readmission. For those >65 with JR, unplanned readmissions increased as age (range 2.6–5.4%) and length of stay (2.9–13%) increased. PAC availability other than home health varied across county groups. For metro counties, >50% were SNF-only; only 20% had all PAC provider types, whereas 80% of metro-adjacent rural counties were SNF-only with < 2% with all PAC provider types. Compared to metro areas, residing in a rural area was protective of readmission for those with stroke (metro-adjacent rural OR=0.887 (95CI 0.751–1.047), metro non-adjacent rural OR=0.789 (0.634–0.982). There was no significant effect of rural area on JR unplanned readmission.

Conclusions: Residing in rural counties is protective against unplanned readmission following home health services for stroke care. Further research should characterize social and contextual factors in rural areas that contribute to community-dwelling individuals’ health.

Author(s) Disclosures: This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711. Authors declare no conflicts.