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Health Care Policy and Law
March 11, 2019

The Need to Realign Health System Processes for Patients Discharged From the Hospital—Getting Patients Home

Author Affiliations
  • 1School of Public Health, Brown University, Providence, Rhode Island
  • 2Providence Veterans Administration Medical Center, Providence, Rhode Island
JAMA Intern Med. 2019;179(5):614-616. doi:10.1001/jamainternmed.2019.0232

In this issue of JAMA Internal Medicine, Werner and colleagues1 compare the experiences of Medicare beneficiaries discharged to home with home health services with those discharged to skilled nursing facilities (SNFs). The authors report that, when comparing similar patients, those discharged to home had slightly higher rates of rehospitalization but lower 90-day Medicare costs than did those transferred to a SNF. Almost twice as many Medicare beneficiaries were discharged to a SNF than to home with home health care. Although those discharged to a SNF were, on average, older, sicker, and more frail than those discharged to home with home health care, the overlap between the 2 populations is substantial, raising the question of why more patients do not go home after discharge. To answer this question, one can examine patient factors such as financial concerns, preferences, fear of the complexity of their care requirements, and the availability of social support. Alternatively, one can focus on system factors such as continuity of care, rushed discharge planning, and financial incentives.

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