Objective: To identify variables that may profile elders hospitalized with heart failure who are at risk for poor post-discharge outcomes. A framework adapted from the Health Behavioral Model of Utilization described by Andersen and Newman (1973) of need factors was used to guide the research. Design: Data were collected in two phases. Phase I was a secondary analysis and retrospective medical record review of the control groups from the Comprehensive Discharge Planning Studies for Hospitalized Elders who had a diagnosis of heart failure. Phase II was a prospective quasi-experimental design for elders discharged with a diagnosis of heart failure. Sample: A total of 103 patients had complete data sets on service use. The mean age of the sample was 78, 55% were female and 30% were black. The 48 Phase I elders were admitted to one of two urban hospitals from 1992 to 1995. Phase II patients were admitted to one of two community hospitals from 1998 to 1999. Main Outcome Measures: All-cause readmissions, heart failure-related admissions, unscheduled acute physician office or clinic visits, emergency department visits, and total service use. Methods: Data were collected on index hospital admission and at 2, 6, and 12 weeks after discharge. Separate multiple regression equations were calculated for each of the types of services used over the entire 12 week period. Findings: A low serum sodium (p=.037) and a fair or poor self-reported health status (p=.022) predicted all-cause readmission. A low serum sodium (p=.040)predicted heart failure-related readmissions. The number of heart failure symptoms (p=.025) and index admission to an urban hospital (p <.0001) predicted acute unscheduled physician visits. Admission to a community hospital (p=.012) predicted emergency department visits and the number of coexisting medical conditions (p=.067) indicated an increased risk for an emergency department visit. Total service use over the 12 week period was predicted by a fair or poor self-reported health status (p=.050) and a greater number of coexisting conditions (p=.033). Conclusions: The findings indicate that it may be possible to profile hospitalized elders with heart failure who are at risk for poor post-discharge outcomes. An increased understanding of the characteristics of patients who are at risk for being high resource consumers can assist providers in the development of interventions aimed at improving patient outcomes while reducing unnecessary and costly uses of health care services. Implications: Heart failure, a syndrome characterized by progressive cardiac dysfunction, affects more than one million older Americans. In 1996, heart failure admissions cost Medicare 3.6 billion dollars, a sum that does not account for the dollars spent on emergency dpartment visits, unplanned doctors' office or clinic visits, and home health care. As the population ages, it is expected that the incidence of heart failure will increase. If post-discharge service needs are known, then it may be possible to formulate public policy to provide and plan for those needs.
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