{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T20:01:50Z","timestamp":1782158510027,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":206,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HD069443"],"award-info":[{"award-number":["R01HD069443"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P2CHD065702"],"award-info":[{"award-number":["P2CHD065702"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01AG058789"],"award-info":[{"award-number":["K01AG058789"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01AG073538"],"award-info":[{"award-number":["K01AG073538"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AG024832"],"award-info":[{"award-number":["P30AG024832"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54GM104941"],"award-info":[{"award-number":["U54GM104941"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K01AG058789"],"award-info":[{"award-number":["K01AG058789"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K01AG073538"],"award-info":[{"award-number":["K01AG073538"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG024832"],"award-info":[{"award-number":["P30AG024832"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["A&D Transl Res & Clin Interv"],"published-print":{"date-parts":[[2022,1]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n The objective of this study was to identify home health utilization factors associated with successful discharge to community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a retrospective study of 100% national Medicare home health data files (2016 to 2017). Multilevel logistic regression was used to study the relationship of home health utilization with a modified definition of successful discharge to community (M\u2010SDC) after home health (no readmission or discharge within 30 days). Significant interactions were identified using backward selection. The associations between domains were examined in a model stratified by ADRD, with and without controlling for mobility, self\u2010care, and caregiver assistance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The cohort consisted of 535,691 patients, 18.0% with ADRD. The overall M\u2010SDC rate was 92.1%. The likelihood of M\u2010SDC was increased when physical therapy services were provided, episodes of care were longer than 15 days, and the total number of therapy visits was greater than 10. The likelihood of M\u2010SDC decreased when speech therapy, nursing, and home health aide services were provided and when patients were discharged early. When controlling for mobility, self\u2010care, and caregiver support, length of home health episode was the only characteristic that showed a significant interaction with ADRD.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n The results of this study indicate that the provision of physical therapy services and moderate lengths of care and volume of visits are associated with increased likelihood of M\u2010SDC. A decreased likelihood of M\u2010SDC when speech therapy, nursing, and home health aide services are delivered may be a proxy indicator of patient acuity and disease severity and needs to be further investigated. An important next step in understanding home health access and outcomes for people with ADRD is to examine the impact of the Patient\u2010Driven Groupings Model on home health utilization characteristics, especially length of episodes.<\/jats:p>\n <\/jats:sec>\n \n Highlights<\/jats:title>\n \n \n \n Most people remain in the community after discharge from home health.<\/jats:p>\n <\/jats:list-item>\n \n Likelihood of modified successful discharge to community (M\u2010SDC) increased with physical therapy, longer episodes, and more than 10 visits.<\/jats:p>\n <\/jats:list-item>\n \n Likelihood of M\u2010SDC decreased with speech therapy, skilled nursing, home health aide visits, and early discharge.<\/jats:p>\n <\/jats:list-item>\n \n Longer home health episodes increased likelihood of M\u2010SDC for people with Alzheimer's disease and related dementias.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/trc2.12341","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T16:49:58Z","timestamp":1658854198000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Home health utilization association with discharge to community for people with dementia"],"prefix":"10.1002","volume":"8","author":[{"given":"Sara","family":"Knox","sequence":"first","affiliation":[{"name":"Division of Physical Therapy Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Downer","sequence":"additional","affiliation":[{"name":"Department of Nutrition Metabolism & Rehabilitation Sciences University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Haas","sequence":"additional","affiliation":[{"name":"Department of Preventative Medicine and Community Health University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Ottenbacher","sequence":"additional","affiliation":[{"name":"Department of Nutrition Metabolism & Rehabilitation Sciences University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Medicare Policy Advisory Commision (MedPAC). March2019report to the Congress: Medicare payment policy. Chapter9: Home health care services. In. Washington DC2019:227\u2010248."},{"key":"e_1_2_10_3_1","unstructured":"Medicare Policy Advisory Commision (MedPAC). March2020report to the Congress: Medicare payment policy. Chapter9: Home health care services. In. Washington DC2020:251\u2010269."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1310\/tsr1705-394"},{"key":"e_1_2_10_5_1","unstructured":"Medicare Policy Advisory Commision (MedPAC).March 2021 report to the Congress: Medicare payment policy. Chapter 8: Home health care services. In. Washington DC2021:231\u2010248."},{"key":"e_1_2_10_6_1","unstructured":"Centers for Medicare & Medicaid Services.Medicare and Medicaid Programs; CY 2021 Home Health Prospective Payment System Rate Update Home Health Quality Reporting Program Requirements and Home Infusion Therapy Services and Supplier Enrollment Requirements; and Home Health Value\u2010Based Purchasing Model Data Submission Requirements. In. 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In. Washington DC:2018."},{"key":"e_1_2_10_13_1","unstructured":"Abt Associates Inc. Specifications for HH QRP quality measures and standardized patient assessment data elements (SPADEs). In. Cambridge MA: Department of Health & Human Services Center for Medicare & Medicaid Services;2019."},{"key":"e_1_2_10_14_1","unstructured":"Acumen LLC. Home health claims\u2010based rehospitalization measures technical report.2017.https:\/\/www.cms.gov\/Medicare\/Quality\u2010Initiatives\u2010Patient\u2010Assessment\u2010Instruments\/HomeHealthQualityInits\/Home\u2010Health\u2010Quality\u2010Measures.html. Accessed 12\u20104\u201018."},{"key":"e_1_2_10_15_1","volume-title":"Quality CfCSa","author":"Centers for Medicare and Medicaid Services","year":"2016"},{"key":"e_1_2_10_16_1","unstructured":"HollyR.CMS releases latest version of comprehensive home health data set. Home Health Care News.https:\/\/homehealthcarenews.com\/2018\/08\/cms\u2010releases\u2010latest\u2010version\u2010of\u2010comprehensive\u2010home\u2010health\u2010data\u2010set\/. Published2018. Accessed2021."},{"key":"e_1_2_10_17_1","unstructured":"Centers for Medicare & Medicaid Services.Public Use Files.https:\/\/www.cms.gov\/Research\u2010Statistics\u2010Data\u2010and\u2010Systems\/Statistics\u2010Trends\u2010and\u2010Reports\/Medicare\u2010Geographic\u2010Variation\/GV_PUF. Published2021. Accessed2021."},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(02)00452-3"},{"key":"e_1_2_10_19_1","unstructured":"Centers for Medicare & Medicaid Services.Chronic Conditions Data Warehouse Chronic Conditions Algorithms.https:\/\/www2.ccwdata.org\/web\/guest\/condition\u2010categories. Updated 02\/2021. Accessed 9\/16\/2021 2021."},{"key":"e_1_2_10_20_1","unstructured":"Centers for Medicare & Medicaid Services.Rehospitalization During the First 30 Days of Home Health. In: National Quality Forum;2016."},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2019.12.021"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.19.1690"},{"key":"e_1_2_10_23_1","unstructured":"SAS\/ACCESS [computer software] 9.4 [computer program].Cary NC:SAS Institute Inc.;2013."},{"key":"e_1_2_10_24_1","unstructured":"Center for Medicare Advocacy.Center Comments on 2019 Proposed Home Health Rule.https:\/\/medicareadvocacy.org\/center\u2010comments\u2010on\u20102019\u2010proposed\u2010home\u2010health\u2010rule\/. Published2019. 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