Community-Level Association Between Home Health and Nursing Home Performance on Quality and Hospital 30-Day Readmissions for Medicare Patients

We evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients using data from the Centers for Medicare & Medicaid Services from 2010 to 2012. Our final sample included 2,855 communities that covered 4,140 hospitals with 6,751,713 patients, 13,060 nursing homes with 1,250,648 residents, and 7,613 home health agencies providing services to 35,660 zip codes. Based on a mixed-effect model, we found that increasing nursing home performance by 1 star for all of its four measures and home health performance by 10 points for all of its six measures is associated with decreases of 0.25% point (95% confidence interval [CI], 0.17-0.34) and 0.60% point (95% CI, 0.33-0.83), respectively, in community-level risk-standardized readmission rates.