Table 2.
Factors Associated with Post-Acute Care Discharge Transitions
| Relative Risk Ratios1 (S.E.) | p-value2 | ||
|---|---|---|---|
| HHC vs. Home3 | SNF vs. Home4 | (SNF vs. HHC) | |
| Reference group | Home | HHC | |
| Individual-level variables | |||
| Age (ref: 65–75) | |||
| <65 | 0.750*** (0.038) | 0.634*** (0.028) | 0.003 |
| 75–84 | 1.116*** (0.040) | 1.415*** (0.045) | 0.000 |
| 85–94 | 1.283*** (0.046) | 1.897*** (0.063) | 0.000 |
| >=95 | 1.581*** (0.076) | 2.645*** (0.118) | 0.000 |
| Gender (ref: Male) | |||
| Female | 1.126*** (0.026) | 1.145*** (0.023) | 0.448 |
| Race (ref: Non-Hispanic White) | |||
| Non-Hispanic Black | 0.908* (0.048) | 0.845*** (0.038) | 0.192 |
| Hispanic | 0.779*** (0.068) | 0.603*** (0.055) | 0.001 |
| Asian/Pacific Islander | 0.921 (0.091) | 0.767*** (0.061) | 0.088 |
| Other | 1.047 (0.098) | 0.994 (0.087) | 0.599 |
| Dual eligibility (ref: Non-dual) | 1.042 (0.039) | 1.186*** (0.040) | 0.000 |
| MA enrollees (ref: FFS enrollees) | 1.487*** (0.086) | 1.644*** (0.083) | 0.098 |
| Index Admission LOS >= 3 days (ref: <3 days) | 1.843*** (0.043) | 10.178*** (0.303) | 0.000 |
| DRG type (ref: Medical) | |||
| Surgical | 0.976 (0.040) | 1.809*** (0.061) | 0.000 |
| DRG weights | 1.115*** (0.020) | 1.148*** (0.018) | 0.027 |
| Number of Chronic Conditions (ref: <=10) | |||
| 11–19 | 1.020 (0.046) | 1.053 (0.041) | 0.475 |
| >=20 | 1.060 (0.069) | 1.024 (0.059) | 0.588 |
| Presence of Chronic Conditions (Medicare fee-for-service only) | |||
| Alzheimer’s Disease and Related Dementias | 1.142*** (0.031) | 1.441*** (0.034) | 0.000 |
| Acute Myocardial Infarction | 1.050 (0.042) | 0.942 (0.034) | 0.006 |
| Atrial Fibrillation | 1.022 (0.028) | 0.917*** (0.023) | 0.000 |
| Chronic Kidney Disease | 1.033 (0.029) | 1.004 (0.023) | 0.288 |
| Chronic Obstructive Pulmonary Disease | 1.031 (0.029) | 0.935*** (0.023) | 0.000 |
| Heart Failure | 1.067** (0.031) | 0.986 (0.024) | 0.004 |
| Diabetes | 1.073*** (0.029) | 1.005 (0.024) | 0.010 |
| Ischemic Heart Disease | 0.921** (0.030) | 0.896*** (0.024) | 0.367 |
| Osteoporosis | 1.025 (0.028) | 1.071*** (0.026) | 0.098 |
| Rheumatoid Arthritis/Osteoarthritis | 1.021 (0.036) | 1.067** (0.032) | 0.198 |
| Asthma | 0.983 (0.030) | 0.902*** (0.024) | 0.004 |
| Hypertension | 1.011 (0.056) | 1.076 (0.052) | 0.280 |
| Sensory - Deafness and Hearing Impairment | 0.970 (0.028) | 0.965 (0.023) | 0.827 |
| Mobility Impairments | 1.246*** (0.047) | 1.282*** (0.045) | 0.438 |
| Multiple Sclerosis and Transverse Myelitis | 1.163 (0.113) | 1.096 (0.095) | 0.527 |
| Obesity | 0.974 (0.029) | 1.019 (0.025) | 0.102 |
| Sensory - Blindness and Visual Impairment | 1.142** (0.070) | 1.074 (0.061) | 0.249 |
| Cancer | 0.993 (0.029) | 0.937** (0.024) | 0.043 |
| Anxiety/Depression | 1.060** (0.032) | 1.069** (0.029) | 0.781 |
| Mental Illness | 0.915*** (0.032) | 1.069** (0.032) | 0.000 |
| Hip/Pelvic Fracture in 2018 | 1.314*** (0.095) | 4.154*** (0.229) | 0.000 |
| Stroke / Transient Ischemic Attack in 2018 | 1.161*** (0.041) | 1.504*** (0.044) | 0.000 |
| Pressure Ulcers and Chronic Ulcers in 2018 | 1.500*** (0.047) | 1.767*** (0.049) | 0.000 |
| Drug Use Disorder | 0.964 (0.042) | 0.917** (0.035) | 0.252 |
| AL-level variables | |||
| AL beds | 1.000 (0.000) | 1.001*** (0.000) | 0.000 |
| Proportion of duals in AL | 1.008 (0.070) | 2.669*** (0.165) | 0.000 |
| Average age in AL | 1.029*** (0.003) | 1.050*** (0.002) | 0.000 |
| Hospital-level variables | |||
| Hospital Ownership (ref: for-profit) | |||
| Nonprofit/Public | 1.044 (0.050) | 0.876*** (0.040) | 0.000 |
| Other | 1.140** (0.076) | 0.890** (0.053) | 0.000 |
| Teaching Status (ref: Major) | |||
| Limited | 1.119** (0.064) | 1.043 (0.049) | 0.194 |
| Graduate | 0.999 (0.089) | 1.026 (0.072) | 0.709 |
| No Affiliation | 1.038 (0.055) | 0.977 (0.044) | 0.211 |
| Hospital Beds | 1.000 (0.000) | 1.000 (0.000) | 0.393 |
| Location (ref: Urban) | |||
| Rural | 0.982 (0.072) | 0.858** (0.054) | 0.035 |
| County-level variables | |||
| Hospital beds per 1000 people 65+ | 0.996*** (0.001) | 0.995*** (0.001) | 0.753 |
| Nursing home beds per 1000 people 65+ | 0.997 (0.002) | 1.007*** (0.002) | 0.000 |
| Home health agencies per 1000 people 65+ | 0.911 (0.078) | 0.940 (0.068) | 0.674 |
| State dummies | Not shown | Not shown | Not shown |
| Observations | 87,856 | 87,856 | 87,856 |
| Clustered SE | Yes | Yes | |
Note:
1.
Relative risk ratios estimated in multinomial logistic regression models between post-acute care referral (reference group = home without HHC) and outcomes;
2.
p-values generated in another set of multinomial logistic regression models between post-acute care referral (reference group = home with HHC) and outcomes;
3.
HHC=Home health care;
4.
SNF= skilled nursing facilities; standard errors are clustered at the level of the discharging hospital (in parentheses);
***
p<0.01,
**
p<0.05,
*
p<0.1;
HHC = home health care; SNF = skilled nursing facility