Medicare beneficiaries are increasingly using home health as the first postacute care setting after hospital discharge following total joint arthroplasty (TJA). Yet, prior research has shown that changes in payment models for TJA may negatively influence functional outcomes for Medicare beneficiaries. The purpose of this study was to evaluate the impact of poor functional outcomes during a home health episode of care on hospitalization risk for older recipients of TJA.
For this study, 5822 Medicare beneficiaries who underwent elective TJA and subsequently participated in home health care following hospital discharge were identified using Medicare hospitalizations records and home health claims. Recovery of activities-of-daily-living (ADL) function was evaluated using patient assessment data completed at home health admission and discharge from the Medicare Outcomes and Assessment Information Set (OASIS). Hospitalization outcomes were captured from Medicare hospital claims. Cox-Proportional hazards regression was used to evaluate the hazard ratio for hospitalization after home health discharge.
The 5822 Medicare beneficiaries who received a TJA and subsequently were discharged to home health were evaluated (n = 3989 [68.6%] following total knee replacement, n = 1883 [31.4%]) following total hip replacement). Nearly 9% (n = 534) of patients did not improve their ability to perform ADLs during the home health episode; this lack of improvement was associated with a more than 2-fold increase in hospital readmission rate following home health discharge (2.3% vs 4.9%). In adjusted models, there was a significant 77% increase (HR = 1.77; 95% CI = 1.14-2.74) in hospitalization risk during the 90-day postsurgical period.
Poor recovery of ADL function in home health settings following TJA is strongly associated with elevated risk of future hospitalizations.
Medicare beneficiaries who fail to make substantive improvements in basic ADL function during home health care episodes following TJA may need intensive monitoring from interdisciplinary team members across the continuum of care, especially during transitions from home care to outpatient care.
An increasing number of patients receive home health care after joint replacement surgery, but outcomes after home health are unclear. These findings suggest that improvements in basic tasks such as walking or bathing are associated with a lower likelihood of hospitalization.

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