Journal article
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care
Journal of advanced nursing, Vol.79(2), pp.593-604
11/22/2022
DOI: 10.1111/jan.15498
PMCID: PMC10163408
PMID: 36414419
Abstract
AimsTo identify clusters of risk factors in home health care and determine if the clusters are associated with hospitalizations or emergency department visits. DesignA retrospective cohort study. MethodsThis study included 61,454 patients pertaining to 79,079 episodes receiving home health care between 2015 and 2017 from one of the largest home health care organizations in the United States. Potential risk factors were extracted from structured data and unstructured clinical notes analysed by natural language processing. A K-means cluster analysis was conducted. Kaplan-Meier analysis was conducted to identify the association between clusters and hospitalizations or emergency department visits during home health care. ResultsA total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Risk factors formed three clusters. Cluster 1 is characterized by a combination of risk factors related to "impaired physical comfort with pain," defined as situations where patients may experience increased pain. Cluster 2 is characterized by "high comorbidity burden" defined as multiple comorbidities or other risks for hospitalization (e.g., prior falls). Cluster 3 is characterized by "impaired cognitive/psychological and skin integrity" including dementia or skin ulcer. Compared to Cluster 1, the risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 (all p < .001). ConclusionRisk factors were clustered into three types describing distinct characteristics for hospitalizations or emergency department visits. Different combinations of risk factors affected the likelihood of these negative outcomes. ImpactCluster-based risk prediction models could be integrated into early warning systems to identify patients at risk for hospitalizations or emergency department visits leading to more timely, patient-centred care, ultimately preventing these events. Patient or Public ContributionThere was no involvement of patients in developing the research question, determining the outcome measures, or implementing the study.
Details
- Title: Subtitle
- The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care
- Creators
- Jiyoun Song - Columbia UniversitySena Chae - University of IowaKathryn H. Bowles - University of PennsylvaniaMargaret McDonald - CVS Health (United States)Yolanda Barron - CVS Health (United States)Kenrick Cato - Columbia UniversitySarah Collins Rossetti - Columbia UniversityMollie Hobensack - Columbia UniversitySridevi Sridharan - CVS Health (United States)Lauren Evans - CVS Health (United States)Anahita Davoudi - CVS Health (United States)Maxim Topaz - Columbia University
- Resource Type
- Journal article
- Publication Details
- Journal of advanced nursing, Vol.79(2), pp.593-604
- DOI
- 10.1111/jan.15498
- PMID
- 36414419
- PMCID
- PMC10163408
- NLM abbreviation
- J Adv Nurs
- ISSN
- 0309-2402
- eISSN
- 1365-2648
- Publisher
- Wiley
- Number of pages
- 12
- Grant note
- Jonas Scholarship R01 HS027742 / Agency for Healthcare Research and Quality; United States Department of Health & Human Services; Agency for Healthcare Research & Quality T32NR007969 / National Institute of Nursing Research; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Nursing Research (NINR)
- Language
- English
- Date published
- 11/22/2022
- Academic Unit
- Nursing
- Record Identifier
- 9984368206102771
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