Major Issue:
1. The conceptual framework is unclear. While the Omaha System is mentioned however does not appear to inform or guide interpretation of results. Beyond cluster 1 (Pain) the naming of clusters is not consistent with The Omaha System and cluster 3 (Cognitive/psychological impairment and poor integumentary status) is described superficially using multiple terms when there is likely a deeper meaning to this cluster. It is unclear is this is because only 31/42 Omaha System Problems were used to guide the analysis or if this is a limitation of the Omaha System in general. An alternate nursing diagnosis taxonomy (NANDA) may help to name clusters using actionable nursing diagnoses, e.g., 1) acute pain, 2) ineffective health management, 3) impaired verbal communication.

Minor Issues:
1. Page 4, line 8: definition of HHC does not include social work mentioned later on page x
2. Page 4, line 20: HHC episode length under Medicare is outdated
3. Page 8: Ethical considerations, retrospective nature is not a reason that informed consent is not required. State if waiver of informed consent was obtained and rationale that satisfied IRB.
4. Table 2: It is unclear why some entries are bolded with underlining. P-values are described as all significant <0.05 at ANOVA test but there is no description of how P-values are displayed.
5. Figures 1 and 2 are superficially discussed in text and do not add to the paper - suggest removing.