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Impact of Home-Based Healthcare Services on Hospital Readmission among Older Adults in Nigeria

Abstract

Hospital readmission among older adults is an important public health and healthcare-system concern because repeated hospital admissions may increase healthcare costs, place additional pressure on health facilities, and negatively affect the wellbeing and quality of life of older adults and their caregivers. Older adults may be particularly vulnerable to readmission because of chronic diseases, multiple health conditions, functional limitations, medication-related problems, inadequate post-discharge support, and difficulties accessing follow-up healthcare services. Home-based healthcare services provide an opportunity to extend healthcare beyond the hospital by delivering clinical assessment, medication support, health education, rehabilitation, monitoring, follow-up, and other appropriate healthcare services within patients' homes. Such services may facilitate early identification of health deterioration, improve treatment adherence, strengthen caregiver support, and promote continuity of care following hospital discharge. Against this background, this study investigates the impact of home-based healthcare services on hospital readmission among older adults in Nigeria. The study will be anchored on the Continuity of Care Model, Andersen's Behavioral Model of Health Services Use, and the Donabedian Model of Healthcare Quality. The Continuity of Care Model emphasizes coordination, consistency, communication, and sustained healthcare relationships across different stages of care. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need factors, with home-based healthcare serving as an enabling mechanism that may improve access to follow-up care. The Donabedian Model explains healthcare quality through structure, process, and outcome, with home-based healthcare representing an important service-delivery process and hospital readmission serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how home-based healthcare services may influence hospital readmission among older adults in Nigeria. The study will adopt a quantitative quasi-experimental or prospective cohort research design. The study population will comprise older adults discharged from selected public and private hospitals in Nigeria and healthcare providers involved in home-based healthcare programmes. A multistage sampling technique will be used to select states, local government areas, hospitals, home-based healthcare providers, and eligible older adults. Home-based healthcare services will be assessed using indicators such as frequency of home visits, clinical assessment, medication review, medication adherence support, vital-sign monitoring, chronic disease management, wound care where applicable, rehabilitation services, nutrition and health education, caregiver education, follow-up counselling, appointment reminders, early identification of complications, referral coordination, emergency escalation procedures, and continuity of care. Hospital readmission will be assessed using indicators such as occurrence of readmission within specified follow-up periods, number of readmissions, time to first readmission, potentially preventable readmissions, causes of readmission, emergency versus planned readmissions, and length of stay during subsequent admission. Data will be collected using structured questionnaires, hospital discharge records, patient medical records, home-visit records, follow-up registers, medication records, referral documents, and caregiver interviews. Descriptive statistics will be used to summarize participants' demographic and clinical characteristics, exposure to home-based healthcare, and readmission patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, survival analysis where appropriate, and logistic or multiple regression analysis, will be used to determine the impact of home-based healthcare services on hospital readmission. Where a quasi-experimental design is adopted, readmission outcomes among older adults receiving structured home-based healthcare may be compared with outcomes among similar patients receiving conventional post-discharge follow-up. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that home-based healthcare services have a significant negative impact on hospital readmission among older adults in Nigeria, indicating that access to appropriate home-based care may reduce the likelihood of repeated hospital admission. Older adults receiving regular and coordinated home-based healthcare are expected to demonstrate fewer preventable readmissions, longer periods before readmission, improved medication adherence, and better management of chronic health conditions than those receiving limited post-discharge support. Home visits may enable healthcare providers to identify early signs of deterioration, address medication-related problems, reinforce discharge instructions, support caregivers, and facilitate timely referral before health conditions become severe. However, inadequate healthcare personnel, limited funding, transportation difficulties, poor coordination between hospitals and community services, insufficient caregiver support, weak referral systems, and limited availability of home-based healthcare programmes may reduce effectiveness. The study therefore expects accessible, coordinated, adequately staffed, and patient-centred home-based healthcare services to contribute significantly to reducing avoidable hospital readmissions among older adults in Nigeria. The study is expected to contribute to the literature on home-based healthcare, hospital readmission, older adult health, post-discharge care, continuity of care, chronic disease management, community-based healthcare, geriatric healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, healthcare providers, home-based care organizations, geriatric healthcare programmes, development partners, caregivers, and policymakers regarding strategies for improving post-discharge care for older adults. The study will also provide evidence-based recommendations for expanding home-based healthcare programmes, strengthening hospital-to-community transition systems, improving medication reconciliation and follow-up, training healthcare workers in geriatric home care, supporting family caregivers, strengthening referral and communication systems, improving home-visit documentation, and integrating home-based healthcare into primary and community healthcare services to reduce preventable hospital readmissions among older adults in Nigeria.

Keywords: Home-based healthcare services, hospital readmission, older adults, post-discharge care, continuity of care, geriatric healthcare, community-based healthcare, chronic disease management, healthcare utilization, Nigeria, public health.