Abstract 14886: Utilization Patterns and Outcomes of Home Health Care After Coronary Artery Bypass Grafting

Introduction: Home health care (HHC) use after discharge may improve short-term outcomes and reduce expenditures for patients undergoing coronary artery bypass grafting (CABG), but there is limited data describing utilization patterns of HHC and its association with longer-term outcomes. Thus, we investigated the utilization patterns of HHC and its impact on 1-year outcomes among Medicare beneficiaries who underwent CABG. Methods: Medicare beneficiaries undergoing CABG between July 2016 and December 2018 were identified using 100% Medicare files. Beneficiaries were excluded if they were <65 years old, died during the inpatient stay, or used inpatient post-acute care before or after the index procedure. Use of HHC (yes versus no) was defined as the presence of a home health claim within 0-1 days of discharge. Clinical outcomes included 1-year mortality and all-cause readmission. We created a matched sample using a multivariable probit regression model (1:1) and balanced HHC users to non-users by demographic, clinical, and hospital factors to compare clinical outcomes. Results: Among the 91,166 beneficiaries in our sample, 54,169 (59.4%) used HHC after discharge, and were more likely to be older, female, White, have dual-eligibility status, comorbid, have had a non-elective, a concomitant valve procedure, and longer hospital length of stay. With respect to hospital characteristics, HHC users were more likely to be admitted to hospitals that were major teaching, larger bed size, not-for-profit, and not system-affiliated. Use of HHC varied from 0% to 100% across 976 hospitals, with a median of 66.2% (IQR=44.2%). After matching and adjustment for covariates, there was no significant difference in 1-year mortality among HHC users and non-users (2.2% vs. 2.5%, -0.3%, p=0.029), although 1-year readmission rates were 7.9 percentage points higher (29.4% vs. 21.5%, p<0.001) for HHC users vs. non-users. Conclusions: Over half of Medicare beneficiaries undergoing CABG used HHC after discharge, with significant differences across patients and hospitals and mixed impact on clinical outcomes. While unmeasured severity may account for some of our findings, more research is needed to understand utilization patterns and impact of HHC after CABG.