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J Health Econ. 2018 May;59:26-45. doi: 10.1016/j.jhealeco.2018.03.003. Epub 2018 Mar 27.

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

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The Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA.
New York University School of Medicine, New York, NY 10016, USA.


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.


Continuity of care; Home health care; Hospital readmissions; Provider handoffs; Workforce assignment

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