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Timely Response To Referrals Improves Patient Outcomes

Timely Response to Referrals Improves Patient Outcomes

One in three patients discharged from the hospital may be at a higher risk of adverse outcomes due to delayed home health. This endangers patients who are sick, elderly, and homebound. Learn more about how to protect yourself and your family.

The Journal of the American Medical Directors Association published a straightforward study weighing the effects of timely response to referrals in home health.1 Like many home health studies, researchers used hospitalization and urgent care rates as indicators of overall quality of care. While rehospitalization rates are important management metrics for hospitals and home health agencies, with the potential to affect quality ratings and reimbursement, researchers have found hospitalization rates in home health and similar metrics to be a convenient, objective shorthand for assessing overall patient outcomes.                                  

Timely Home Health Associated with Significant Improvements

A referral is a written order from your primary care physician to see a specialist or to get specific medical services. Referrals are required by most health insurance companies, Medicare, or Medicaid to ensure that patients are seeing the correct providers for the correct problems. If the primary care physician agrees the patient would benefit from home health, he/she will make a referral to a certified home health agency and authorize a treatment, commonly called a “plan of care.”

Maxim Topaz, PhD, RN (Columbia University) and research colleagues analyzed the records of nearly 50,000 home health patients. They found that receiving the first home health nursing visit later than two days after the referral was associated with a 12% higher likelihood for urgent care or hospitalization. These results add to those of a recent study specific to diabetes. Older adults with diabetes are at elevated risk of complications following hospitalization, according to one study. Home health care services mitigate the risk of adverse events and facilitate a safe transition home.2 In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. The study examined the association between timing of home health initiation and 30-day rehospitalization outcomes among over 787,000 Medicare beneficiaries following a diabetic- related hospital admission during 2015. Of these patients, about 27% were discharged to home health care. The study found that the patients who received delayed services had higher odds of being re-hospitalized, compared to the patients who received a timely home health referral within two days of discharge. The patients who received late services were four times more likely to be re-hospitalized.

Roughly One Out of Three Referrals Receive Slow Home Health

According to the findings of the Topaz et al. study, 34% of home health starts of care did not occur on time. The previous, study specific to serious diabetes-related primary diagnoses, found that nearly three out of ten patients received their first nursing visits more than seven days after the home health referral, if at all.  


  1. Topaz M, Barrón Y, Song J, Onorato N, Sockolow P, Zolnoori M, Cato K, Sridharan S, Bowles KH, McDonald MV. Risk of rehospitalization or emergency department visit is significantly higher for pa-tients who receive their first home health care nursing visit later than 2 days after hospital dis-charge. Journal of the American Medical Directors Association. 2022 Oct 1;23(10):1642-7.
  2. Smith JM, Lin H, Thomas-Hawkins C, Tsui J, Jarrín OF. Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity. International Journal of Environmental Research and Public Health. 2021 Jan;18(11):5623.