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The effect of workforce assignment on performance: Evidence from home health care

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  • David, Guy
  • Kim, Kunhee Lucy

Abstract

Effective workforce assignment has the potential for improving performance. Using novel home health data combining provider work logs, personnel data, and detailed patient records, we estimate the effect of provider handoffs—a marker of care discontinuity—on hospital readmissions, an important performance measure for healthcare systems. We use workflow interruption caused by attrition and providers’ work inactivity as an instrument for nurse handoffs. We find handoffs to substantially increase hospital readmissions. Our estimates imply that a single handoff increases the likelihood of 30-day hospital readmission by 16 percent and one in four hospitalizations during home health care would be avoided if handoffs were eliminated. Moreover, handoffs are more detrimental for high-severity patients and expedite hospital readmission. The frequency and sequencing of handoffs also affect the likelihood of rehospitalization.

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  • David, Guy & Kim, Kunhee Lucy, 2018. "The effect of workforce assignment on performance: Evidence from home health care," Journal of Health Economics, Elsevier, vol. 59(C), pages 26-45.
    • Handle: RePEc:eee:jhecon:v:59:y:2018:i:c:p:26-45
    DOI: 10.1016/j.jhealeco.2018.03.003
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    References listed on IDEAS

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    Cited by:

    1. Norma B. Coe & Jing Guo & R. Tamara Konetzka & Courtney Harold Van Houtven, 2019. "What is the marginal benefit of payment‐induced family care? Impact on Medicaid spending and health of care recipients," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 678-692, May.
    2. Saad Zbiri & Patrick Rozenberg & Carine Milcent, 2024. "Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans," Post-Print hal-04626835, HAL.
    3. Lorena Martini & Luigi Apuzzo & Daniele Pandolfi & Irene Gabutti & Domenico Mantoan, 2022. "La programmazione del personale sanitario in ambito territoriale: una revisione sistematica della letteratura e analisi del contesto italiano in base al PNRR e DM77/2022," MECOSAN, FrancoAngeli Editore, vol. 2022(124), pages 7-43.
    4. Bernard Bensaid & Solen Croiset & Robert J. Gary-Bobo, 2022. "Economies of Density, Team Synergies and Unobserved Heterogeneity: A Study of Home Care Services," CESifo Working Paper Series 9864, CESifo.
    5. Atul Gupta & Guy David & Lucy Kim, 2023. "The effect of performance pay incentives on market frictions: evidence from medicare," International Journal of Health Economics and Management, Springer, vol. 23(1), pages 27-57, March.
    6. Hummy Song & Elena Andreyeva & Guy David, 2022. "Time Is the Wisest Counselor of All: The Value of Provider–Patient Engagement Length in Home Healthcare," Management Science, INFORMS, vol. 68(1), pages 420-441, January.

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