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Sobotka SA, Foster C, Lynch E, Hird-McCorry L, Goodman DM. Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation. J Pediatr 2019; 212:166-171. [PMID: 31153586 PMCID: PMC7290238 DOI: 10.1016/j.jpeds.2019.04.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/10/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the reasons for discharge delays for children with long-term mechanical ventilation. STUDY DESIGN Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ2 tests were used to compare nursing hours and demographics. RESULTS Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient. CONCLUSIONS Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago
| | - Carolyn Foster
- Division of Academic General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine;,Mary Ann and J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago
| | - Lindsey Hird-McCorry
- Pulmonary Habilitation Program/Transitional Care Unit, Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Denise M. Goodman
- Division of Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Jones CD, Falvey J, Hess E, Levy CR, Nuccio E, Barón AE, Masoudi FA, Stevens-Lapsley J. Predicting Hospital Readmissions from Home Healthcare in Medicare Beneficiaries. J Am Geriatr Soc 2019; 67:2505-2510. [PMID: 31463941 DOI: 10.1111/jgs.16153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To use patient-level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee-for-service beneficiaries. DESIGN Retrospective analysis using multivariable logistic regression and gradient boosting machine (GBM) learning to develop and validate a predictive model. SETTING/PARTICIPANTS/MEAUREMENTS A 5% national sample of patients, aged 65 years or older, with Medicare fee-for-service who received skilled HHC services within 5 days of hospital discharge in 2012 (n = 43 407). Multiple data sets were merged, including Medicare Outcome and Assessment Information Set, Home Health Claims, Medicare Provider Analysis and Review, and Master Beneficiary Summary Files, to extract patient-level variables from the first HHC visit after discharge and measure 30-day readmission outcomes. RESULTS Among 43 407 patients with inpatient hospitalizations followed by HHC, 14.7% were readmitted within 30 days. Of the 53 candidate variables, seven remained in the final model as individually predictive of outcome: Elixhauser comorbidity index, index hospital length of stay, urinary catheter presence, patient status (ie, fragile health with high risk of complications or serious progressive condition), two or more hospitalizations in prior year, pressure injury risk or presence, and surgical wound presence. Of interest, surgical wounds, either from a total hip or total knee arthroplasty procedure or another surgical procedure, were associated with fewer readmissions. The optimism-corrected c-statistics for the full model and parsimonious model were 0.67 and 0.66, respectively, indicating fair discrimination. The Brier score for both models was 0.120, indicating good calibration. The GBM model identified similar predictive variables. CONCLUSION Variables available to HHC clinicians at the first postdischarge HHC visit can predict readmission risk and inform care plans in HHC. Future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome. J Am Geriatr Soc 67:2505-2510, 2019.
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Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Jason Falvey
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Edward Hess
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Cari R Levy
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eugene Nuccio
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna E Barón
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer Stevens-Lapsley
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Simpson M, Macias Tejada J, Driscoll A, Singh M, Klein M, Malone M. The Bundled Hospital Elder Life Program-HELP and HELP in Home Care-and Its Association With Clinical Outcomes Among Older Adults Discharged to Home Healthcare. J Am Geriatr Soc 2019; 67:1730-1736. [PMID: 31220334 DOI: 10.1111/jgs.15979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30-day all-cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP. DESIGN Matched case-control study. SETTING Two medical-surgical units within two midwestern rural hospitals and patient homes (home health). PARTICIPANTS Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non-Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching. MEASUREMENTS The primary study outcome was 30-day all-cause unplanned hospital readmission. Additional outcomes measured were 30-day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits. RESULTS Fewer cases (16.8%) than controls (28.4%) had a 30-day all-cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30-day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22-0.77; P < .01). The difference between case (10.8%) and control (15.5%) 30-day ED visit was not significant (P = .23). A lower LOS for the case group was shown (P < .01), while the number of skilled home care visits was not significantly different between groups (P = .28). CONCLUSION HELP protocol implementation during a patient's hospital stay and as a continued component of home care among older adults at risk for cognitive and/or functional decline appears to be associated with favorable outcomes. Our initial evaluation supports continued study of the Bundled HELP. Further research is needed to confirm the initial findings and to evaluate the impact of the adapted model on functional outcomes and delirium incidence in the home. J Am Geriatr Soc 67:1730-1736, 2019.
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Affiliation(s)
- Michelle Simpson
- Aurora Research Institute, Ed Howe Center for Health Care Transformation, Aurora Health Care, Milwaukee, Wisconsin
| | | | - Amy Driscoll
- Aurora at Home, Aurora Health Care, Milwaukee, Wisconsin
| | - Maharaj Singh
- Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin
| | - Matthew Klein
- Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin
| | - Michael Malone
- Senior Services, Aurora Health Care, Milwaukee, Wisconsin.,Department of Senior Services, Aurora Health Care, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Abstract
OBJECTIVES The aim of this study is to explore the barriers and enablers of deprescribing from the perspectives of home care nurses, as well as to conduct a scalability assessment of an educational plan to address the learning needs of home care nurses about deprescribing. METHODS This study employed an exploratory qualitative descriptive research design, using scalability assessment from two focus groups with a total of 11 home care nurses in Ontario, Canada. Thematic analysis was used to derive themes about home care nurse's perspectives about barriers and enablers of deprescribing, as well as learning needs in relation to deprescribing approaches. RESULTS Home care nurse's identified challenges for managing polypharmacy in older adults in home care settings, including a lack of open communication and inconsistent medication reconciliation practices. Additionally, inadequate partnership and ineffective collaboration between interprofessional healthcare providers were identified as major barriers to safe deprescribing. Furthermore, home care nurses highlighted the importance of raising awareness about deprescribing in the community, and they emphasised the need for a consistent and standardised approach in educating healthcare providers, informal caregivers and older adults about the best practices of safe deprescribing. CONCLUSION Targeted deprescribing approaches are important in home care for optimising medication management and reducing polypharmacy in older adults. Nurses in home care play a vital role in medication management and, therefore, educational programmes must be developed to support their awareness and understanding of deprescribing. Study findings highlighted the need for the future improvement of existing programmes about safer medication management through the development of a supportive and collaborative relationship among the home care team, frail older adults and their informal caregivers.
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Affiliation(s)
- Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Farah Tahsin
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Justin P Turner
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
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55
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Dick AW, Murray MT, Chastain AM, Madigan EA, Sorbero M, Stone PW, Shang J. Measuring Quality in Home Healthcare. J Am Geriatr Soc 2019; 67:1859-1865. [PMID: 31063621 DOI: 10.1111/jgs.15963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Improving quality performance in home health is an increasingly high priority. The objective of this study was to examine trends in industry performance over time using three quality measures: a composite quality metric (Q index), an infection prevention measure (vaccination verification), and an outcome measure (hospital avoidance). DESIGN/SETTING/PARTICIPANTS/MEASURES We linked Home Health Compare and Provider of Services data from 2012 to 2016, which included 39 211 observations during the 5-year study period and 7670 agencies in 2016. The Q index was developed to allow comparability over time, equally weighting the contributions of each element. After examining summary statistics, we developed three regression models stratified by ownership (for-profit/nonprofit agency) and included two constructs of nurse staffing, in addition to controlling for known confounders. RESULTS Most agencies (80.4%) were for-profit agencies. The Q index and vaccination verification improved substantially over time, but there was no change in hospital avoidance. Ownership status was associated with all three measures (P < .001). Registered nurse staffing (relative to licensed practical nurses and home health aides) was associated with higher Q index and vaccination verification (P < .001). CONCLUSION The Q index allows for assessment of trends over time in home healthcare. Ownership and nurse staffing are important factors in the quality of care. The overall home care market is driven by for-profit agencies, but their characteristics and outcomes differ from nonprofit agencies. J Am Geriatr Soc 67:1859-1865, 2019.
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Affiliation(s)
- Andrew W Dick
- RAND Health, The RAND Corporation, Boston, Massachusetts
| | - Meghan T Murray
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Ashley M Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | | | - Mark Sorbero
- RAND Health, The RAND Corporation, Boston, Massachusetts
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, New York
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56
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Abstract
OBJECTIVE Home healthcare is the fastest growing arena in the healthcare system but patient safety research in this context is limited. The aim was to explore how patient safety in Swedish specialised home healthcare is described and adressed from multidisciplinary teams' and clinical managers' perspectives. DESIGN An explorative qualitative study. SETTING Multidisciplinary teams and clinical managers were recruited from three specialised home healthcare organisations in Sweden. METHODS Nine focus group interviews with multidisciplinary teams and six individual interviews with clinical managers were conducted, in total 51 participants. The data were transcribed verbatim and analysed using qualitative content analysis. RESULTS Patient safety was inherent in the well-established care ideology which shaped a common mindset between members in the multidisciplinary teams and clinical managers. This patient safety culture was challenged by the emerging complexity in which priority had to be given to standardised guidelines, quality assessments and management of information in maladapted communication systems and demands for required competence and skills. The multiple guidelines and quality assessments that aimed to promote patient safety from a macro-perspective, constrained the freedom, on a meso-level and micro-level, to adapt to challenges based on the care ideology. CONCLUSION Patient safety in home healthcare is dependent on adaptability at the management level; the team members' ability to adapt to the varying conditions and on patients being capable of adjusting their homes and behaviours to reduce safety risks. A strong culture related to a patient's value as a person where patients' and families' active participation and preferences guide the decisions, could be both a facilitator and a barrier to patient safety, depending on which value is given highest priority.
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Affiliation(s)
- Marléne Lindblad
- School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Royal Institute of Technology, Stockholm, Sweden
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Maria Flink
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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57
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Bowles KH, Ratcliffe SJ, Holmes JH, Keim S, Potashnik S, Flores E, Humbrecht D, Whitehouse CR, Naylor MD. Using a Decision Support Algorithm for Referrals to Post-Acute Care. J Am Med Dir Assoc 2018; 20:408-413. [PMID: 30414821 DOI: 10.1016/j.jamda.2018.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although hospital clinicians strive to effectively refer patients who require post-acute care (PAC), their discharge planning processes often vary greatly, and typically are not evidence-based. DESIGN Quasi-experimental study employing pre-/postdesign. Aimed at improving patient-centered discharge processes, we examined the effects of the Discharge Referral Expert System for Care Transitions (DIRECT) algorithm that provides clinical decision support (CDS) regarding which patients to refer to PAC and to what level of care (home care or facility). SETTING AND PARTICIPANTS Conducted in 2 hospitals, DIRECT data elements were collected in the pre-period (control) but discharging clinicians were blinded to the advice and provided usual discharge care. During the postperiod (intervention), referral advice was provided within 24 hours of admission to clinicians, and updated twice daily. Propensity modeling was used to account for differences between the pre-/post patient cohorts. MEASURES Outcomes compared between the control and the intervention periods included PAC referral rates, patient characteristics, and same-, 7-, 14-, and 30-day readmissions or emergency department visits. RESULTS Although 24%-25% more patients were recommended for PAC referral by DIRECT algorithm advice, the proportion of patients receiving referrals for PAC did not significantly differ between the control (3302) and intervention (5006) periods. However, the characteristics of patients referred for PAC services differed significantly and inpatient readmission rates decreased significantly across all time intervals when clinicians had DIRECT CDS compared with without. There were no differences observed in return emergency department visits. Largest effects were observed when clinicians agreed with the algorithm to refer (yes/yes). CONCLUSIONS/IMPLICATIONS Our findings suggest the value of timely, automated, discharge CDS for clinicians to optimize PAC referral for those most likely to benefit. Although overall referral rates did not change with CDS, the algorithm may have identified those patients most in need, resulting in significantly lower inpatient readmission rates.
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Affiliation(s)
- Kathryn H Bowles
- University of Pennsylvania School of Nursing, New Courtland Center for Transitions and Health, Philadelphia, PA.
| | - Sarah J Ratcliffe
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John H Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sue Keim
- University of Pennsylvania School of Nursing, New Courtland Center for Transitions and Health, Philadelphia, PA
| | - Sheryl Potashnik
- University of Pennsylvania School of Nursing, New Courtland Center for Transitions and Health, Philadelphia, PA
| | - Emilia Flores
- University of Pennsylvania School of Nursing, New Courtland Center for Transitions and Health, Philadelphia, PA
| | | | - Christina R Whitehouse
- University of Pennsylvania School of Nursing, New Courtland Center for Transitions and Health, Philadelphia, PA
| | - Mary D Naylor
- University of Pennsylvania School of Nursing, New Courtland Center for Transitions and Health, Philadelphia, PA
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58
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Drennan VM. More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England. J Health Serv Res Policy 2018; 24:11-18. [PMID: 29754532 PMCID: PMC6304681 DOI: 10.1177/1355819618769082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Many countries seek to improve care for people with chronic conditions and
increase delivery of care outside of hospitals, including in the home.
Despite these policy objectives in the United Kingdom, the home visiting
nursing service workforce, known as district nursing, is declining. This
study aimed to investigate the factors influencing the development of
district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in
diverse socio-economic communities using semi-structured interviews with a
purposive sample of senior nurses in provider and commissioning
organizations. Thematic analysis was framed by theories of workforce
development. Findings: All participants reported that the context for the
district nursing service was one of major reorganizations in the face of
wider National Health Service changes and financial pressures. The analysis
identified five themes that can be seen to impact the ways in which the
district nursing workforce was developed. These were: the challenge of
recruitment and retention, a changing case-mix of patients and the
requirement for different clinical skills, the growth of specialist home
visiting nursing services and its impact on generalist nursing, the capacity
of the district nursing service to meet growing demand, and the influence of
the short-term service commissioning process on the need for long-term
workforce development. Conclusion There is an apparent paradox between health policies which promote more care
within and closer to home and the reported decline in district nursing
services. Using the lens of workforce development theory, an explanatory
framework was offered with factors such as the nature of the nursing labour
market, human resource practices, career advancement opportunities as well
as the contractual context and the economic environment.
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Affiliation(s)
- Vari M Drennan
- Professor of Health Care & Policy Research, Centre for Health & Social Care Research, Faculty of Health, Social Care & Education, Kingston University and St George's University of London, UK
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59
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Abstract
The baby boom after World War II, coupled with the rapid advances in medical technology and public health, has led to the current rapid aging in the world's population. Countries in Asia are experiencing a faster rate of aging than most other countries around the world. Taiwan is expected to advance from an aged society to a super-aged society in the next 7~10 years. Consequently, the demand for long-term care is increasing. The focus of healthcare has changed from acute to chronic, from disease-oriented to function-oriented and from cure to care. Families, once the cornerstone of care, have become overwhelmed by the effects of the declining birthrate and aging. Encountering the public demand for a balance between healthcare and quality of life has led to the increasing role of home-based care in the medical system. The elderly-care profession is diverse and growing. The trend of transdisciplinary team which integrating care professions, nursing professions, family medicine, geriatric medicine, rehabilitation medicine, telemedicine, and medical aids with the resource of social welfare enables home health care services to better provide well-rounded medical care. Before end of life, hospice home care services increase the likelihood of dying at home in accordance with the patient's preference, easing the symptoms of terminal illness and reducing the sorrow experienced by family members. The single insurer model used by the National Health Insurance system will inevitably replace some hospital and institutional services with home health care services that more effectively and flexibly use medical resources and attenuate the increase in medical costs.
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Affiliation(s)
- Pi-Shan Hsu
- MD, Chief, Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan, ROC
| | - Jui-An Chen
- MD, Resident, Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan, ROC
| | - Yu-Tso Chen
- MD, Resident, Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan, ROC
| | - Han-Ming Wu
- MD, Resident, Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan, ROC
| | - Szu-Ying Lee
- MSN, RN, Doctoral Candidate, School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan, ROC
| | - Chung-Liang Lai
- PhD, MD, Assistant Administrator, and Attending Physician, Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, and Adjunct Assistant Professor, Department of Occupational Therapy, Asia University, Taiwan, ROC.
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60
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Yu SJ. [Role of Visiting Nursing Care in Japanese Home Healthcare]. Hu Li Za Zhi 2018; 65:11-16. [PMID: 29405015 DOI: 10.6224/jn.201802_65(1).03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.
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Affiliation(s)
- Sang-Ju Yu
- MPH, MD, Chairman, Taiwan Society of Home Health Care, and Chief, Home Clinic, Dulan, Taiwan, ROC.
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61
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Huang EW, Chiou SF, Pan ML, Wu HH, Jiang JR, Lu YD. [The Development of an Intelligent Long-Term Care Services System That Integrates Innovative Information and Communication Technologies]. Hu Li Za Zhi 2017; 64:10-18. [PMID: 28762220 DOI: 10.6224/jn.000049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rapid progress in information and communication technologies and the increasing popularity of healthcare-related applications has increased interest in the topic of intelligent medical care. This topic emphasizes the use of information and communication technologies to collect and analyze a variety of data in order to provide physicians and other healthcare professionals with clinical decision support. At present, so-called smart hospitals are the focal point of most intelligent-systems development activity, with little attention currently being focused on long-term care needs. The present article discusses the application of intelligent systems in the field of long-term care, especially in community and home-based models of care. System-implementation components such as the data entry interface components of mobile devices, the data transmission and synchronization components between the mobile device and file server, the data presentation, and the statistics analysis components are also introduced. These components have been used to develop long-term care service-related applications, including home health nursing, home-care services, meals on wheels, and assistive devices rental. We believe that the findings will be useful for the promotion of innovative long-term care services as well as the improvement of healthcare quality and efficiency.
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Affiliation(s)
- Ean-Wen Huang
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taiwan, ROC.
| | - Shwu-Fen Chiou
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan, ROC
| | - Mei-Lien Pan
- Institute of Information Science, Academia Sinica, and Adjunct Assistant Professor, National Taipei University of Nursing and Health Sciences, Taiwan, ROC
| | - Hua-Huan Wu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taiwan, ROC
| | - Jia-Rong Jiang
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taiwan, ROC
| | - Yi-De Lu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taiwan, ROC
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Abstract
BACKGROUND While telehealth has been shown to improve heart failure patients' health outcomes, patients' acceptance of telehealth at the point of referral is reported to be low. Little is known about the factors related to patients' initial acceptance or refusal of telehealth services. The aim of this review was to synthesize evidence on the factors affecting heart failure patients' decision making to accept telehealth services in a home setting. METHODS An integrative literature review was conducted. Six electronic databases and three grey literature sites were searched. Two reviewers independently reviewed articles for inclusion. Articles were included if they reported original data related to the acceptance of telehealth services among heart failure patients at home. RESULTS Five studies met the inclusion criteria and were included in the review. Key findings indicated that patients generally hold positive views about telehealth. Factors that may affect the adoption of telehealth include concerns over equipment or technology, concerns over service change, ease-of-use, knowledge of the benefits of telehealth, access to care, cost, and privacy. CONCLUSIONS Despite evidence of effectiveness for telehealth, there is a high rate of telehealth refusal among patients. Understanding factors associated with heart failure patients' decisions regarding telehealth can help healthcare organizations structure education programs and other interventions to improve acceptance rates.
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Affiliation(s)
- Kyungmi Woo
- 1 Columbia University School of Nursing , New York, New York
| | - Dawn Dowding
- 1 Columbia University School of Nursing , New York, New York.,2 Center for Home Care Policy and Research , Visiting Nurse Service of New York, New York, New York
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Ataman G, Erbaydar T. Unmet home healthcare needs and quality of life in cancer patients: a hospital-based Turkish sample. Health Soc Care Community 2017; 25:1347-1354. [PMID: 28215048 DOI: 10.1111/hsc.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 06/06/2023]
Abstract
Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37-item, study-specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease-related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital-integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital-based healthcare services.
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Affiliation(s)
- Gülsen Ataman
- Faculty of Medicine, Ankara University, Ankara, Turkey
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Dorsey ER, Achey MA, Beck CA, Beran DB, Biglan KM, Boyd CM, Schmidt PN, Simone R, Willis AW, Galifianakis NB, Katz M, Tanner CM, Dodenhoff K, Ziman N, Aldred J, Carter J, Jimenez-Shahed J, Hunter C, Spindler M, Mari Z, Morgan JC, McLane D, Hickey P, Gauger L, Richard IH, Bull MT, Mejia NI, Bwala G, Nance M, Shih L, Anderson L, Singer C, Zadikoff C, Okon N, Feigin A, Ayan J, Vaughan C, Pahwa R, Cooper J, Webb S, Dhall R, Hassan A, Weis D, DeMello S, Riggare SS, Wicks P, Smith J, Keenan HT, Korn R, Schwarz H, Sharma S, Stevenson EA, Zhu W. National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers. Telemed J E Health 2016; 22:590-8. [PMID: 26886406 DOI: 10.1089/tmj.2015.0191] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. MATERIALS AND METHODS Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. RESULTS During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. CONCLUSIONS Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.
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Affiliation(s)
- E Ray Dorsey
- 1 Department of Neurology, Rochester, New York.,2 CHET, University of Rochester Medical Center , Rochester, New York
| | | | - Christopher A Beck
- 4 Department of Biostatistics, University of Rochester , Rochester, New York
| | | | | | - Cynthia M Boyd
- 6 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | | | - Allison W Willis
- 8 Department of Neurology, Philadelphia, Pennsylvania.,9 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Nicholas B Galifianakis
- 10 Department of Neurology, University of California San Francisco , San Francisco, California
| | - Maya Katz
- 10 Department of Neurology, University of California San Francisco , San Francisco, California
| | - Caroline M Tanner
- 10 Department of Neurology, University of California San Francisco , San Francisco, California
| | - Kristen Dodenhoff
- 10 Department of Neurology, University of California San Francisco , San Francisco, California
| | - Nathan Ziman
- 10 Department of Neurology, University of California San Francisco , San Francisco, California
| | - Jason Aldred
- 11 Northwest Neurological, PLLC , Spokane, Washington
| | - Julie Carter
- 12 Parkinson Center and Movement Disorders Program, Oregon Health and Science University , Portland, Oregon
| | | | - Christine Hunter
- 13 Department of Neurology, Baylor College of Medicine , Houston, Texas
| | | | - Zoltan Mari
- 14 Department of Neurology and Neurosurgery, Johns Hopkins University , Baltimore, Maryland
| | - John C Morgan
- 15 Department of Neurology, Georgia Regents University , Augusta, Georgia
| | - Dedi McLane
- 15 Department of Neurology, Georgia Regents University , Augusta, Georgia
| | - Patrick Hickey
- 16 Department of Neurology, Duke Medical Center , Durham, North Carolina
| | - Lisa Gauger
- 16 Department of Neurology, Duke Medical Center , Durham, North Carolina
| | | | | | - Nicte I Mejia
- 17 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Grace Bwala
- 17 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Martha Nance
- 18 Struthers Parkinson's Center , Golden Valley, Minnesota
| | - Ludy Shih
- 19 Department of Neurology, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Lauren Anderson
- 19 Department of Neurology, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Carlos Singer
- 20 Department of Neurology, University of Miami , Miami, Florida
| | - Cindy Zadikoff
- 21 Department of Neurology, Northwestern University , Evanston, Illinois
| | - Natalia Okon
- 21 Department of Neurology, Northwestern University , Evanston, Illinois
| | - Andrew Feigin
- 22 The Feinstein Institute for Medical Research, North Shore-LIJ Health System , Manhasset, New York
| | - Jean Ayan
- 22 The Feinstein Institute for Medical Research, North Shore-LIJ Health System , Manhasset, New York
| | - Christina Vaughan
- 23 Department of Neurology, Medical University of South Carolina , Charleston, South Carolina
| | - Rajesh Pahwa
- 24 Department of Neurology, University of Kansas Medical Center , Kansas City, Kansas
| | - Jessica Cooper
- 24 Department of Neurology, University of Kansas Medical Center , Kansas City, Kansas
| | - Sydney Webb
- 24 Department of Neurology, University of Kansas Medical Center , Kansas City, Kansas
| | - Rohit Dhall
- 25 Parkinson's Institute , Sunnyvale, California
| | - Anhar Hassan
- 26 Department of Neurology, Mayo Clinic , Rochester, Minnesota
| | - Delana Weis
- 26 Department of Neurology, Mayo Clinic , Rochester, Minnesota
| | - Steven DeMello
- 27 Center for Information Technology Research in the Interest of Society, University of California , Berkeley, California
| | - Sara S Riggare
- 28 Health Informatics Centre, Karolinska Institute , Stockholm, Sweden
| | - Paul Wicks
- 29 PatientsLikeMe, Cambridge, Massachusetts
| | | | - H Tait Keenan
- 2 CHET, University of Rochester Medical Center , Rochester, New York
| | - Ryan Korn
- 2 CHET, University of Rochester Medical Center , Rochester, New York
| | | | - Saloni Sharma
- 2 CHET, University of Rochester Medical Center , Rochester, New York
| | - E Anna Stevenson
- 2 CHET, University of Rochester Medical Center , Rochester, New York
| | - William Zhu
- 2 CHET, University of Rochester Medical Center , Rochester, New York
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Ylönen M, Viljamaa J, Isoaho H, Junttila K, Leino-Kilpi H, Suhonen R. Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol. J Adv Nurs 2015; 71:2413-25. [PMID: 25976713 DOI: 10.1111/jan.12683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
Abstract
AIM To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. BACKGROUND The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. DESIGN Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. METHODS During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. DISCUSSION Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300.
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Affiliation(s)
- Minna Ylönen
- Department of Nursing Science, University of Turku, Finland
| | - Jaakko Viljamaa
- Department of Vascular Surgery, Turku University Hospital, Finland
| | | | - Kristiina Junttila
- Group Administration, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Finland
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Yang MT, Huang SY. Appearance-based multimodal human tracking and identification for healthcare in the digital home. Sensors (Basel) 2014; 14:14253-77. [PMID: 25098207 PMCID: PMC4179041 DOI: 10.3390/s140814253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 11/17/2022]
Abstract
There is an urgent need for intelligent home surveillance systems to provide home security, monitor health conditions, and detect emergencies of family members. One of the fundamental problems to realize the power of these intelligent services is how to detect, track, and identify people at home. Compared to RFID tags that need to be worn all the time, vision-based sensors provide a natural and nonintrusive solution. Observing that body appearance and body build, as well as face, provide valuable cues for human identification, we model and record multi-view faces, full-body colors and shapes of family members in an appearance database by using two Kinects located at a home's entrance. Then the Kinects and another set of color cameras installed in other parts of the house are used to detect, track, and identify people by matching the captured color images with the registered templates in the appearance database. People are detected and tracked by multisensor fusion (Kinects and color cameras) using a Kalman filter that can handle duplicate or partial measurements. People are identified by multimodal fusion (face, body appearance, and silhouette) using a track-based majority voting. Moreover, the appearance-based human detection, tracking, and identification modules can cooperate seamlessly and benefit from each other. Experimental results show the effectiveness of the human tracking across multiple sensors and human identification considering the information of multi-view faces, full-body clothes, and silhouettes. The proposed home surveillance system can be applied to domestic applications in digital home security and intelligent healthcare.
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Affiliation(s)
- Mau-Tsuen Yang
- Department of Computer Science & Information Engineering, National Dong-Hwa University, No. 1, Sec. 2, Da-Hsueh Rd., Shoufeng, Hualien 974, Taiwan.
| | - Shen-Yen Huang
- Department of Computer Science & Information Engineering, National Dong-Hwa University, No. 1, Sec. 2, Da-Hsueh Rd., Shoufeng, Hualien 974, Taiwan.
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Pickett YR, Greenberg RL, Bazelais KN, Bruce ML. Depression treatment disparities among older minority home healthcare patients. Am J Geriatr Psychiatry 2014; 22:519-22. [PMID: 23711738 PMCID: PMC3760983 DOI: 10.1016/j.jagp.2013.01.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Determine the racial/ethnic effect on depression treatment among home healthcare patients. DESIGN Cross-sectional analyses of administrative data. SETTING A large home healthcare agency in Bronx, NY. PARTICIPANTS Patients 65 years and older admitted to homecare in 2010 (N = 3,744). MEASUREMENTS Patient Health Questionnaire (PHQ)-2 depression screen. Other data, such as diagnosis, medications, and demographics, were collected from the patient electronic medical record. RESULTS 6.52% of the sample had a depression diagnosis, 11.11% screened positive for depression (+PHQ-2), and 13.39% were prescribed antidepressants. The odds of receiving an antidepressant among those who screened positive for depression were 0.42 (95% confidence interval [CI]: 0.22-0.79) for African Americans and 0.49 (95% CI: 0.26-0.93) for Hispanics compared with Caucasians. CONCLUSIONS These findings suggest that disparities continue to exist in depression treatment for older minority home healthcare patients compared with older Caucasians.
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Affiliation(s)
- Yolonda R Pickett
- Department of Psychiatry, Weill Cornell Medical College, New York, NY; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY.
| | | | - Kisha N Bazelais
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
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Markkanen P, Quinn M, Galligan C, Sama S, Brouillette N, Okyere D. Characterizing the nature of home care work and occupational hazards: a developmental intervention study. Am J Ind Med 2014; 57:445-57. [PMID: 24347541 DOI: 10.1002/ajim.22287] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Home care (HC) aide is the fastest growing occupation, yet job hazards are under-studied. This study documents the context of HC aide work, characterizes occupational safety and health (OSH) hazards, and identifies preventive interventions using qualitative methods. METHODS We conducted 12 focus groups among aides and 26 in-depth interviews comprising 15 HC agency, union, and insurance company representatives as well as 11 HC recipients in Massachusetts. All focus groups and interviews were audio-recorded, transcribed, and coded with NVIVO software. RESULTS Major OSH concerns were musculoskeletal disorders from client care tasks and verbal abuse. Performing tasks beyond specified job duties may be an OSH risk factor. HC aides' safety and clients' safety are closely linked. Client handling devices, client evaluation, care plan development, and training are key interventions for both aides' and clients' safety. CONCLUSIONS Promoting OSH in HC is essential for maintaining a viable workforce.
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Affiliation(s)
- Pia Markkanen
- Department of Work Environment; University of Massachusetts Lowell; Lowell Massachusetts
| | - Margaret Quinn
- Department of Work Environment; University of Massachusetts Lowell; Lowell Massachusetts
| | | | - Susan Sama
- Department of Work Environment; University of Massachusetts Lowell; Lowell Massachusetts
| | - Natalie Brouillette
- Department of Work Environment; University of Massachusetts Lowell; Lowell Massachusetts
| | - Daniel Okyere
- Department of Work Environment; University of Massachusetts Lowell; Lowell Massachusetts
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Lee T. Community-based home healthcare project for korean older adults. Osong Public Health Res Perspect 2013; 4:233-9. [PMID: 24298438 PMCID: PMC3845225 DOI: 10.1016/j.phrp.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 08/30/2013] [Accepted: 09/02/2013] [Indexed: 11/27/2022] Open
Abstract
Objectives The aim of this study was to identify the effects of community-based home healthcare projects that influence service performances with regard to Korean national long-term care insurance services in older adults. Methods The project's applicants were 18 operational agencies in national long-term care institutions in Korea, and participants were care recipients (n = 2263) registered in long-term care institutions. We applied our healthcare system to the recruited participants for a 3-month period from October 2012 to December 2012. We measured the community-based home healthcare services such as long-term care, health and medical service, and welfare and leisure service prior to and after applying the community-based home healthcare system. Results After the implementation of community-based home healthcare project, all community-based home healthcare services showed an increase than prior to the project implementation. The nutrition management service was the most increased and its increase rate was 628.6%. A comparison between the long-term care insurance beneficiaries and nonbeneficiaries showed that health and medical services’ increase rate of nonbeneficiaries was significantly higher than beneficiaries (p < 0.001). Conclusion Our community-based home healthcare project might improve the service implementation for older adults and there was a difference in the increase rate of health and medical services between Korean national long-term care insurance beneficiaries and nonbeneficiaries.
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Affiliation(s)
- Taebum Lee
- Advanced Medical Device Research Center, Korea Electrotechnology Research Institute, Ansan, Korea
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Ryvicker M, McDonald MV, Trachtenberg M, Peng TR, Sridharan S, Feldman PH. Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients? J Healthc Qual 2013; 35:32-40. [PMID: 24004037 DOI: 10.1111/jhq.12023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting.
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Affiliation(s)
- Miriam Ryvicker
- Center for Home Care Policy and Research, Visiting Nurse Service of New York (VNSNY), New York City, USA
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Abstract
Major depression is disproportionately common among elderly adults receiving home healthcare and is characterized by greater medical illness, functional impairment, and pain. Depression is persistent in this population and is associated with numerous poor outcomes such as increased risk of hospitalization, injury-producing falls, and higher health care costs. Despite the need for mental health care in these patients, significant barriers unique to the home healthcare setting contribute to under-detection and under-treatment of depression. Intervention models target the home healthcare nurse as liaison between patients and physicians, and instruct in the identification and management of depression for their patients. Successful implementation requires interventions that 'fit' how home healthcare is organized and practiced, and long distance implementation strategies are required to increase the reach of these interventions.
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Weissman J, Meyers BS, Ghosh S, Bruce ML. Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly. Gen Hosp Psychiatry 2011; 33:587-93. [PMID: 21920609 PMCID: PMC3208729 DOI: 10.1016/j.genhosppsych.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/18/2011] [Accepted: 07/26/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study examined in home health care (HHC) the demographic, functional and clinical factors by antidepressant (AD) type including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and "Other" ADs such as bupropion and mirtazapine. METHOD Cross-sectional sample (N=909) was analyzed from the 2007 National Home Health and Hospice Care Survey that included patients 65 years and older [mean=78.79 years, confidence interval (CI)=77.88-79.69 years] taking one AD. RESULTS Selective serotonin reuptake inhibitors were the most commonly used (63.89%) AD, followed by "Other" ADs (14.29%), TCAs (11.31%) and SNRIs. In a multinomial regression referencing SSRIs, blacks had increased odds of tricyclic use compared to whites [odds ratio (OR)=5.96, CI=1.85-19.19]. Hispanics had decreased odds of "Other" AD (OR=0.13, CI=0.02-0.73) and SNRI use (OR=0.06, CI=0.008-0.45) compared to non-Hispanics. The HHC elderly taking psychotropic medications besides ADs were less likely to use SNRIs (OR=0.31, CI=0.11-0.88) and tricyclics (OR=0.27, CI=0.08-0.87). Advancing age was marginally associated with tricyclic use (OR=1.04, CI=0.99-1.09). CONCLUSION Race/ethnicity and age differences by AD type - including blacks' increased TCA use, Hispanics' decreased SNRI and "Other" AD use, and older elderly's increased tricyclic use - suggest systematic differences in prescribing practice variations including differences by geography, patient preferences or access to care in the HHC elderly.
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Affiliation(s)
- Judith Weissman
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10601, USA.
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Brown EL, Raue PJ, Klimstra S, Mlodzianowski AE, Greenberg RL, Bruce ML. An intervention to improve nurse-physician communication in depression care. Am J Geriatr Psychiatry 2010; 18:483-90. [PMID: 21217559 DOI: 10.1097/JGP.0b013e3181bf9efa] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Depression in older adult home care recipients is frequently undetected and inadequately treated. Failed communication between home healthcare personnel and the patient's physician has been identified as a barrier for depression care. The purpose of this pilot intervention study was to improve nurse competency for communicating depression-related information to the physician. DESIGN A single group pre-post experimental design. SETTING Two Medicare-certified home healthcare agencies serving an urban and suburban area in New York. PARTICIPANTS Twenty-eight home care nurses, all female Registered Nurses. INTERVENTION Two-hour skills training workshop. MEASUREMENTS To evaluate the intervention, pre-post changes in effective nurse communication using Objective Structured Clinical Examinations and nurse survey reports. RESULTS The intervention significantly improved the ability of the home care nurse to perform a case presentation in a complete and standard organized format pre versus postintervention. The intervention also increased nurse-reported certainty to communicate depression-related information to the physician. CONCLUSIONS Our findings provide support for the ability of a brief, depression-focused communication skills training intervention to improve home care nurse competency for effectively communicating depression-related information to the physician.
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Gellis ZD. Depression Screening in Medically Ill Homecare Elderly. Best Pract Ment Health 2010; 6:1-16. [PMID: 21743801 PMCID: PMC3131671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE: This article provides data on a depression screening model (HOME) in acute home health care designed to detect clinical depression among medically ill homebound older patients. The model was developed to address the lack of mental health services in home health care settings and to specifically improve geriatric depression screening as part of routine care. Authors report on the concordance of homecare and research interview ratings of depression in older homecare patients. DESIGN AND METHODS: Using a prospective cohort design, data were collected from 289 elderly patients, aged 65 and older, from a large home health care agency to examine depression, cognitive functioning, medical comorbidity, functional status, and social isolation. Research interviews used the depression module of the structured clinical interview for DSM (SCID). RESULTS: The overall prevalence of major depression was 5.7 percent according to both homecare and research raters. The prevalence of subthreshold depressive disorder was 16.4 percent as reported by research raters. Observed agreement was 73 percent and kappa agreement was 0.42, indicating a fair to moderate agreement. We identified patient characteristics that may influence the accuracy of homecare worker estimates of depressive symptoms. IMPLICATIONS: Findings suggest that depression continues to be underdetected in medically ill homebound elderly patients. Ongoing training in depression screening methods, patient follow-up interviews, and appropriate referral would improve care of depressed elderly homecare patients.
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Affiliation(s)
- Zvi D Gellis
- Associate Professor, Hartford Geriatric Social Work Faculty Scholar, Center for Mental Health and Aging, School of Social Policy & Practice, University of Pennsylvania
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Adnane M, Jiang Z, Choi S, Jang H. Detecting specific health-related events using an integrated sensor system for vital sign monitoring. Sensors (Basel) 2009; 9:6897-912. [PMID: 22399978 DOI: 10.3390/s90906897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/24/2009] [Indexed: 11/16/2022]
Abstract
In this paper, a new method for the detection of apnea/hypopnea periods in physiological data is presented. The method is based on the intelligent combination of an integrated sensor system for long-time cardiorespiratory signal monitoring and dedicated signal-processing packages. Integrated sensors are a PVDF film and conductive fabric sheets. The signal processing package includes dedicated respiratory cycle (RC) and QRS complex detection algorithms and a new method using the respiratory cycle variability (RCV) for detecting apnea/hypopnea periods in physiological data. Results show that our method is suitable for online analysis of long time series data.
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