Unfulfilled home health referrals lead to higher mortality among Medicare Advantage members.

OBJECTIVES: Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system-related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not. STUDY DESIGN: Retrospective quasi-experimental study. METHODS: Following acute hospitalization, members with discharge orders to receive home health services between January 2021 and October 2022 were identified in a medical claims database consisting of MA beneficiaries. Members who received services within 30 days of discharge were balanced using inverse propensity score weighting on member- and admission-related covariates with a comparator group of members who did not receive services. Primary outcomes included mortality and readmissions in the ensuing 30, 90, and 180 days. Secondary outcomes included emergency department visits, primary care visits, and per-member per-month costs. RESULTS: The home health-treated group consisted of 2115 discharges, and the untreated group consisted of 761 discharges. The treated group experienced lower mortality at 30 days (2% vs 3%, respectively; OR, 0.58; 95% CI, 0.36-0.92), 90 days (8% vs 10%; OR, 0.77; 95% CI, 0.60-0.98), and 180 days (11% vs 14%; OR, 0.81; 95% CI, 0.65-0.99). The treated group also experienced higher readmissions at 30 days (13% vs 10%; OR, 1.26; 95% CI, 1.01-1.60), 90 days (24% vs 16%; OR, 1.69; 95% CI, 1.39-2.05), and 180 days (33% vs 24%; OR, 1.52; 95% CI, 1.29-1.79). CONCLUSION: MA members referred to home health after acute hospitalization who did not receive home health services had higher mortality.

An outbreak of Escherichia coli O157:H7 infections among visitors to a dairy farm.

BACKGROUND: Outbreaks of Escherichia coli O157:H7 infections have involved direct transmission from animals and their environment to humans. We describe an outbreak among visitors to a Pennsylvania dairy and petting farm that provides public access to animals. METHODS: We conducted both a case-control study among visitors to a farm to identify risk factors for infection and a household survey to determine the rates of diarrheal illness among these visitors. We performed an extensive environmental study to identify sources of E. coli O157:H7 on the farm. RESULTS: Fifty-one patients with confirmed or suspected E. coli O157:H7 infection were enrolled in the case-control study. The median age of the patients was four years, and the hemolytic-uremic syndrome developed in eight. Contact with calves and their environment was associated with an increased risk of infection, whereas hand washing was protective. The household survey indicated that visitors to the farm during the outbreak had higher than expected rates of diarrhea. Environmental studies showed that 28 of the 216 cattle on the farm (13 percent) were colonized with E. coli O157:H7 that had the same distinct pattern on pulsed-field gel electrophoresis that was found in isolates from the patients. This organism was also recovered from surfaces that were accessible to the public. CONCLUSIONS: In a large outbreak of E. coli O157:H7 infections among visitors to a dairy farm, predominantly children, high rates of carriage of E. coli O157:H7 among calves and young cattle most likely resulted in contamination of both the animals' hides and the environment.