Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Carol Hall Ellenbecker

Second Advisor

Lin Zhan

Third Advisor

Jie Chen


In April, 2009, the Commonwealth Fund released a study on re-hospitalization indicating that in 2004, 20% of Medicare beneficiaries admitted to the hospital were readmitted within 30 days, and the cost of these admissions was $17.4 billion. Many factors have been found to be associated with re-hospitalized, however, the relationship of social environment factors and re-hospitalization are not well understood. The purpose of this study was to explore the relationship of social environmental factors and re-hospitalization of elderly home healthcare patients. The specific aim is to identify the relationships between re-hospitalization among elderly home healthcare patients and living arrangement, informal primary caregiver, frequency of informal primary care- giving and type of assistance received other than Home Healthcare services.

Medicare mandated OASIS data of elderly Medicare patients from a large Certified Home Healthcare Agency in the northeastern region of the United States was analyzed. Of the 1,312 patients comprising the sample, 257 (19.6%) were re-hospitalized. Pearson correlation analyses, T-test, chi-square, one way ANOVA, Logistic regression, Log-Rank test, Cox regression, linear regression and Cox Proportional-Hazards Regression Model were employed to test the hypotheses.

Key findings of this study include: More than half (63.8%) of the re-hospitalizations occurred within the first 20 days after being admitted to HHC; Functional ability and cognitive functioning predicted re-hospitalization among home health care elderly patients; Social environmental support was positively associated with Self Care Agency and re-hospitalization; Informal caregivers (friends/neighbors and/or paid primary caregiver) are associated with early re-hospitalization.

Findings of this research would allow home care agencies to identify those patients in need of social environmental support and providing support that may prevent unnecessary re-hospitalization. The findings would also inform regulators in the development of reimbursement strategies that avoid costly hospital readmission, and assure patient quality of care.


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