Journal of General Internal Medicine

, Volume 32, Issue 12, pp 1301–1308 | Cite as

Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients

  • Matthew C. Lohman
  • Brandi P. Cotton
  • Alexandra B. Zagaria
  • Yuhua Bao
  • Rebecca L. Greenberg
  • Karen L. Fortuna
  • Martha L. Bruce
Original Research



Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population.


To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients.


Cross-sectional analysis using data from 132 home health agencies in the US.


Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780).

Main Measures

Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use.

Key Results

In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10–33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital.


Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.


home care pharmacoepidemiology Medicare 


Compliance with Ethical Standards




This work was supported by grants from the National Institute of Mental Health at the National Institutes of Health (R01 MH096441, T32 MH073553).

Prior Presentations


Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Matthew C. Lohman
    • 1
    • 2
  • Brandi P. Cotton
    • 1
    • 2
  • Alexandra B. Zagaria
    • 3
  • Yuhua Bao
    • 4
    • 5
  • Rebecca L. Greenberg
    • 6
  • Karen L. Fortuna
    • 1
    • 2
  • Martha L. Bruce
    • 1
    • 2
  1. 1.Department of PsychiatryGeisel School of Medicine at DartmouthLebanonUSA
  2. 2.Dartmouth Centers for Health and AgingLebanonUSA
  3. 3.The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of Medicine at DartmouthLebanonUSA
  4. 4.Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeNew YorkUSA
  5. 5.Department of PsychiatryWeill Cornell Medical CollegeNew YorkUSA
  6. 6.Institute of Geriatric PsychiatryWeill Cornell Medical CollegeWhite PlainsUSA

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