Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors.
Kathryn H Bowles, Christopher M Murtaugh, Lizeyka Jordan and 6 others
PMID 31837933WHAT IT FOUND
Home health sepsis survivors faced early readmission risk, and records rarely documented sepsis; fluid/electrolyte disorder, prior stays, dyspnea, severe dependence, home intravenous therapy, and septic shock marked higher risk, so these patients may need closer monitoring.
Key findings
01Of 165,228 Medicare sepsis survivors discharged to home health, 22.5% were readmitted within 30 days, and 6.64% within seven days.
02Early readmission risk rose from 6.64% to 7.15% with fluid/electrolyte disorder and to 10.61% with three or more previous stays; dyspnea, 8 to 9 ADL/IADL dependencies, stay of 8 days or more, home infusion, and septic shock were also associated with higher risk.
03Home health diagnoses listed sepsis codes only 4% of the time, and an additional 3% noted septicemia or bacteremia.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational record analysis, not a randomised trial, so it cannot show that treating these risk factors prevents readmission. It included only Medicare beneficiaries who survived sepsis, were discharged to home health, had complete OASIS-C data, and had no other facility stay, so it may not apply to younger patients, those sent to other settings, or those with incomplete records. Sepsis was identified using administrative diagnosis codes, and home health records often did not document sepsis, so risk may be underrecognised or misclassified. The model shows associations among many variables; it does not prove that any one factor caused readmission. Home health assessment data may not be complete early enough after referral to guide the first days of care.
Declared interests
The paper reports NIH extramural research support. No author conflicts of interest are stated in the supplied text.
The easy way to misread this
Do not conclude that these risk factors caused readmission or that home health nursing visits prevent readmission; this is an observational analysis of records, not a trial of treatment.