Relationships between home health care delivery practices and patient outcomes: key evidence for high-value care - Project Summary/Abstract Millions of homebound patients receive nursing and rehabilitation visits from home health agencies (HHAs) annually, with goals of improving patient function and facilitating successful discharge to the community while avoiding adverse events like falls and inpatient admissions. However, there is minimal evidence to guide HHAs on which care delivery practices will improve patient outcomes, especially for patients with different clinical needs. Three aspects of home health care delivery that are both measurable and modifiable by HHAs include visit mix (e.g., the proportion of physical therapy visits versus nursing visits), service intensity (i.e., the number of visits per week), and visit distribution (i.e., frontloading visits early in the episode versus spreading visits over a longer period). However, there is no comprehensive understanding of the relationships between these practices and patient outcomes. To fill these gaps, we will take a learning health systems approach and partner with a large non-profit company serving over 150,000 patients annually in 23 states to conduct a secondary analysis of 2020 – 2025 data to achieve these aims: 1. Examine relationships between home health care delivery practices (i.e., visit mix, service intensity, and visit frontloading) and patient outcomes (i.e., successful discharge to the community, change in function from admission to discharge, transfer to inpatient facility, injurious falls); 2. Determine if relationships between each home health care delivery practice and patient outcomes differ for patients with different clinical needs. Clinical needs will be based on whether patients primarily require home health for neurologic or musculoskeletal rehabilitation, medication management, behavioral health care, complex nursing interventions, or wound care. Due to the rise in value-based healthcare initiatives that prioritize care quality alongside efforts to lower costs, HHAs are increasingly being held financially accountable for patient outcomes. However, without adequate patient-centered guidance on how to improve outcomes, HHAs are left with cost reduction as the primary strategy to improve the overall value of home health care. We will leverage our unique health system partnership and the lived experience of our advisory committee to examine outcomes across payers and types of home health stays (i.e., admitted to home health post-hospital versus directly from the community) to provide a novel and comprehensive understanding of how care delivery practices impact outcomes. Results from this proposal will help drive patient-centered health system innovation leading to high-quality rehabilitation and nursing practices that generate optimal patient outcomes with the potential to inform care delivery practices for all patients receiving home health nationwide.