The Coming Home Intervention to Enhance Safe Hospital-to-Home Health Transitions: Pilot Evaluation.

Abstract

Background: Care transitions from hospital to skilled home health care (HH) often pose safety risks, especially for older adults. The Coming Home Intervention (CHI) was developed to enhance these transitions based on the Hospital-to-Home Health Transition Quality (H3TQ) index, a previously validated survey instrument assessing quality issues during hospital-to-HH transitions.

Objectives: This study aimed to pilot CHI and evaluate its impact at 2 large HH agencies in Baltimore, MD, and New York, NY.

Methods: The 2 participating HH agencies implement CHI by providing HH clinicians and patients tools for expectation setting, clarification of healthcare-related roles of family and HH personnel, clinical care guides to support information management, and the H3TQ for identification of quality/safety issues. Using a quasi-experimental, before-and-after difference-in-difference design, changes before and after CHI implementation were compared between intervention and comparison groups. Quality of hospital-to-HH transitions was rated by older adults/caregivers and HH clinicians using the H3TQ before and after CHI implementation. In total, 394 responses were from older adults/caregivers and 604 responses were from HH clinicians. Outcomes including identification of medication issues and 30-day emergency department use or rehospitalization were evaluated using the Outcome and Assessment Information Set with a difference-in-difference approach (n = 3,471 in the Baltimore site; n = 758 in the New York City site). Results were analyzed and reported separately for each HH agency.

Results: CHI implementation in Baltimore was associated with a statistically non-significant, decreasing trend in 30-day emergency department use or rehospitalization (odds ratio = 0.68, 95% confidence interval = 0.45-1.03). After implementation, older adults/caregivers rated quality issues measured by H3TQ less favorably. In New York City, older adults/caregivers reported fewer quality issues (incidence rate ratio = 0.50, 95% confidence interval = 0.27-0.89) after implementation. Assessment of other measures did not show significant changes.

Conclusion: The pilot implementation of CHI demonstrated potential to improve hospital-to-HH transition quality. Study findings can guide future CHI implementation in larger studies in a broader population of older adults receiving HH services after hospital discharge.