DESCRIPTION (provided by applicant): Rehospitalization among Medicare-reimbursed, home healthcare recipients is currently 29% - an all time high. Nearly 20% of all Medicare beneficiaries discharged from hospitals are rehospitalized within 30 days and 34% are rehospitalized within 90 days. Hospitalization costs incurred by Medicare recipients exceeded 471 billion dollars in 2007. Reducing hospitalizations is a major national objective as hospitalization leads to increased costs for payers and leaves geriatric patients at great risk for adverse events during and after hospitalization. Little is known about the role length of stay (LOS) in home care and number of nursing visits plays in preventing rehospitalization. One or both of these factors could be a significant determinant of rehospitalization unaccounted for in past work and the missing link in avoiding an unnecessary hospitalization. Both are nurse-driven home care processes are therefore amenable to change. The goal of this pre-doctoral training plan is to determine the impact home care LOS and number of nursing visits has on rehospitalization among Medicare-reimbursed home health recipients. The applicant proposes a predictive, secondary analysis of three merged national data sets from 2006: the Outcomes Assessment Information Set; the Home Health Agency Standard Analytic File; and the Hospital Standard Analytic File. The specific aims of this study are to 1.) Examine the relationship between home care LOS on the occurrence of rehospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode; 2.)Examine the relationship between the number of home care nursing visits on occurrence of rehospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode; 3.) Examine the relationship between home care LOS on time to hospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode; 4.) Examine the relationship between the number of home care nursing visits on time to hospitalization within 90 days after home care discharge among heart failure patients who were not hospitalized during the home care episode. Project Relevance: This proposal addresses two nurse driven home healthcare processes, an understudied area of nursing research with few PhD prepared scholars. Findings from this proposed study will inform nursing science in one aspect of reducing acute care hospitalization and addresses three NINR strategic goals: 1.) promoting health, 2.) improving quality of life, and 3.) improving the transition from one care setting to another. PUBLIC HEALTH RELEVANCE: This proposal addresses geriatric home care, an understudied area of nursing research with few PhD prepared scholars. Research conducted through this fellowship will include a secondary analysis of a national data set (The Outcomes Assessment and Information Set) and Medicare hospital and home health claims data to gain an understanding of the impact length of stay in home care and number of home nursing visits on re-hospitalization of geriatric home care recipients. These factors are amenable to change and could be a significant determinant of ACH unaccounted for in past work and the missing link between the identification of risk for rehospitalization upon admission to home care and avoiding an unnecessary hospitalization.

This proposal addresses geriatric home care, an understudied area of nursing research with few PhD prepared scholars. Research conducted through this fellowship will include a secondary analysis of a national data set (The Outcomes Assessment and Information Set) and Medicare hospital and home health claims data to gain an understanding of the impact length of stay in home care and number of home nursing visits on re-hospitalization of geriatric home care recipients. These factors are amenable to change and could be a significant determinant of ACH unaccounted for in past work and the missing link between the identification of risk for rehospitalization upon admission to home care and avoiding an unnecessary hospitalization.