This retrospective cohort study explored the symptom clusters associated with hospitalization and emergency department visits in home health care using cluster analysis. The findings seem interesting, yet the paper needs more clarity in terms of cluster group naming, terminologies, analysis, and study purpose. Risk factors were mentioned multiple times to refer to different variables in the tables and it is somewhat confusing.

Abstract:
Distinct clinical characteristics of each cluster should be briefly mentioned in the result section of the abstract because I think symptom itself is not a sole representation of each cluster.

Introduction:
The authors listed several previous studies that examined the risk factors for hospitalization and emergency department visits among patients in home health care. Despite the existing evidence, they stated this study was needed because grouping risk factors could be more effective than identifying individual risk factors . Still, I am not sure why this grouping is needed and how identifying combined broader symptoms (only based on the name of the clusters) are more effective than identifying specific conditions to prevent hospitalization and emergency department visits among this specific group of population. The authors could elaborate this up front.

Methods:
Are clusters that the authors identified based on only patients with hospitalization and ED visits or all study cohort in home health care? Clusters are named "clusters of risk factors" and the name itself sounds like the authors excluded those without hospitalization and ED visits from the cluster analysis, is it correct? If not, clusters should not be called "cluster of risk factors", instead I think they are simply "clusters" of those in home health care.

Results:
In the table 1 and 2, risk factors are mentioned multiple times and this should be clarified. At first, the author referred clusters of risk factors to symptoms (e.g., pain, cognitive/skin...etc) associated with hospitalization and emergency department visits. Then, in the tables, risk factors for hospitalization and EDs are listed as falls, medications, multiple hospitalization...etc, which I assume more commonly known risk factors. Then, again there are risk factors from clinical note which have multiple categories of symptoms including pain, skin, and cognition among others by cluster.