Infection Trends in Home Health Care, 2013-2018

Infections are a frequent cause of hospital (re)admissions for older adults receiving home health care (HHC), and the Joint Commission has identified infection prevention and control in HHC as a national patient safety goal. HHC patients who are immunocompromised or recovering from surgical procedures are particularly susceptible to infections. Many sepsis survivors are discharged from the hospital to HHC and have high rates of readmission for recurrent infections and related complications.

Reported prevalence of infections in HHC has varied from 5% to 80%, depending on the patient population.Using data from the Outcome and Assessment Information Set (OASIS), the standardized assessment tool mandated for all Medicare-certified HHC agencies, Shang et al found that 17% of unplanned hospitalizations in HHC were due to 4 types of infection: (1) respiratory infection, (2) urinary tract infection (UTI), (3) wound site (skin or soft-tissue) infection, and (4) intravenous (IV) catheter-related. OASIS assessments are completed by clinicians at least twice during a HHC episode, including upon admission and for any change in health status that leads to inpatient transfer, discharge from HHC, death, or 60-day recertification if none of these events have occurred. However, this study likely underestimated the prevalence of infections leading to hospitalization because the data were limited to infections reported in OASIS.

In this study, we used 2013-2018 OASIS assessment data linked to Medicare inpatient data to estimate trends in the prevalence of infection in hospital transfers among HHC patients and subsequent 30-day mortality.