Factors Associated with Timing of the Start-of-Care Nursing Visits in Home Health Care.
Jiyoun Song, Maryam Zolnoori, Margaret V McDonald and 7 others
PMID 33844990WHAT IT FOUND
At one home health agency, one-third of hospital-to-home patients waited more than two days for the first nurse visit.
Delays were more common for Black or Hispanic patients, Medicaid or managed care coverage, and prior hospitalization risk.
Key findings
01One-third of episodes (16,251) had the first nursing start-of-care visit more than 2 days after hospital discharge.
02After adjustment, surgical wounds were associated with lower odds of late start-of-care (OR 0.44), while non-Hispanic Black and Hispanic patients had higher odds than non-Hispanic White patients (OR 1.76 and 1.61).
03Several hospitalization risk factors, including prior falls and recent multiple hospitalizations or emergency department visits, were associated with higher odds of start-of-care more than 2 days (ORs 1.21, 1.14, and 1.17).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used only 2019 data from one large urban home health agency, so the timing pattern may not apply to other agencies or rural areas. It included only patients coming from hospital, not patients referred from community or other post-acute settings. The analysis shows associations, not causes. It does not prove that late visits led to worse outcomes, or that wounds and pain caused earlier visits. The paper does not report why visits were late, such as staffing, referral timing, authorization delays, patient availability, or geography. The timing measure used hospital discharge date and OASIS completion date, which may differ from CMS reporting based on referral or return-home dates.
Declared interests
The supplied text lists NIH extramural research support; no author conflicts of interest were reported.
The easy way to misread this
Do not read these odds ratios as proof that starting care within 2 days improves outcomes. The study is observational and comes from one agency, so it describes scheduling patterns, not the effect of timeliness.