Factors in Predicting the Number of Home Care Physical Visits

There has been a significant increase in the utilization of home health care during the past decade. Medicare has attempted to control home care costs by 1) allowing Medicare beneficiaries to join Health Maintenance Organizations, and 2) requiring the use of the Outcome and Assessment Information Set (OASIS) for all patients admitted to home care services. These changes have challenged the home care physical therapist to be a better predictor of the total number of visits needed to complete the rehabilitation process. This was a retrospective study of 335 patients who received home health care physical therapy. The first part of this study determined the effects of admission activities of daily living (ADL) score, number of visits, level of comorbidity, payer class, and caregiver support on discharge ADL score. The second part of the study determined the effects of admission ADL score, level of comorbidity, payer class, and caregiver support on the total number of home care physical therapy visits. ADL scores were calculated using the Barthel Index. The level of comorbidity was calculated using the Charlson comorbidity index. Admission ADL score, number of visits, and level of comorbidity were the strongest predictors of discharge ADL score. Admission ADL score, while the strongest of the variables in the study, was a weak predictor of the number of visits. Although use of a prediction equation is not warranted by the data, the admission ADL score may provide the physical therapist with useful information when predicting the number of physical therapy visits needed. The Barthel Index is a useful tool to calculate the admission ADL score and can easily be calculated from the OASIS and physical therapy evaluation.Key words: Barthel index, Comorbidity, Home health, Number of visits, Payer class