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Zheng QL, Kong LN, Hu P, Liu DX. Identifying quality indicators for home care services: a modified Delphi and Analytic Hierarchy Process study. BMC Nurs 2024; 23:494. [PMID: 39026316 PMCID: PMC11264849 DOI: 10.1186/s12912-024-02169-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND As the recipients of home care services, patients have the most direct and profound experience of service quality. There is limited knowledge as to quality indicators for home care services from patients' perspective. This study aimed to identify quality indicators for home care services based on the Service Quality model and determine the weights of these indicators. METHODS A two-round Delphi survey and Analytic Hierarchy Process consultation were conducted to gather opinions from national experts on quality indicators for home care services developed on the basis of the Service Quality model. Consensus was defined as at least 80% agreement on the importance (important and very important) of indicators among experts. The Analytic Hierarchy Process was used to calculate the weight coefficients of the identified indicators. RESULTS The response rate was 95.0% and 97.4% in the first and second round, respectively. After two rounds, five first-level (tangibility, reliability, responsiveness, assurance and empathy) and 23 second-level indicators were identified. The Kendall's W values were 0.54 and 0.40 for the first-level and second-level indicators (p < 0.001). The weight coefficients for the first-level and second-level indicators were 0.110-0.298 and 0.019-0.088, respectively. CONCLUSION Quality indicators for home care services were identified based on the Service Quality model. These indicators can be used to evaluate the service quality of home care from patients' perspective and facilitate to determine work priorities and improve the quality of home care.
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Affiliation(s)
- Qiu-Lan Zheng
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing, China.
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Ping Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dun-Xiu Liu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Gu S, Jia C, Shen F, Wang X, Wang X, Gu H. The effects of community-based home health care on the physical and mental health of older adults with chronic diseases. Qual Life Res 2024; 33:691-703. [PMID: 38032396 DOI: 10.1007/s11136-023-03555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE This study aimed to explore the effects of community-based home health care (HHC) on the physical and mental health of older adults with chronic diseases in China. METHODS The study data were retrieved from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Ordinary least squares regression model was used to assess the effects of community-based HHC on the health. Entropy balancing was used to test the robustness of the regression results. RESULTS A total of 5571 older adults with chronic diseases were included. The results showed that older adults who had received community-based HHC reported significantly better self-rated health (coefficient = 0.051, 95%CI [0.004, 0.098]), less physical discomfort (coefficient = - 0.021, 95%CI [- 0.042, - 0.001]), lower depression scores (coefficient = - 0.263, 95%CI [- 0.490, - 0.037]), and lower anxiety scores (coefficient = - 0.233, 95%CI [- 0.379, - 0.088]) compared with those who had not received community-based HHC. Overall, community-based HHC conferred greater positive effects on the health of rural older adults, older adults with multiple chronic diseases, and older adults with low incomes. CONCLUSION Community-based HHC was beneficial for improving self-rated health and reducing physical discomfort, depression, and anxiety in older adults with chronic diseases, thus improving their quality of life. It is important to promote its development nationwide in China.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
| | - Cangcang Jia
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fangfang Shen
- General Practice Department, Daguang Road Community Healthcare Center, Nanjing, Jiangsu, China
| | - Xiaoyong Wang
- Health Insurance Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoling Wang
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
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3
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Min SH, Song J, Evans L, Bowles KH, McDonald MV, Chae S, Topaz M. Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis. Clin Nurs Res 2023; 32:1021-1030. [PMID: 37345951 PMCID: PMC11080676 DOI: 10.1177/10547738231183026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
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Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Sena Chae
- University of Iowa College of Nursing, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- Data Science Institute, Columbia University, New York, NY, USA
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Song J, Ojo M, Bowles KH, McDonald MV, Cato K, Rossetti SC, Adams V, Chae S, Hobensack M, Kennedy E, Tark A, Kang MJ, Woo K, Barrón Y, Sridharan S, Topaz M. Detecting Language Associated With Home Healthcare Patient's Risk for Hospitalization and Emergency Department Visit. Nurs Res 2022; 71:285-294. [PMID: 35171126 PMCID: PMC9246992 DOI: 10.1097/nnr.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND About one in five patients receiving home healthcare (HHC) services are hospitalized or visit an emergency department (ED) during a home care episode. Early identification of at-risk patients can prevent these negative outcomes. However, risk indicators, including language in clinical notes that indicate a concern about a patient, are often hidden in narrative documentation throughout their HHC episode. OBJECTIVE The aim of the study was to develop an automated natural language processing (NLP) algorithm to identify concerning language indicative of HHC patients' risk of hospitalizations or ED visits. METHODS This study used the Omaha System-a standardized nursing terminology that describes problems/signs/symptoms that can occur in the community setting. First, five HHC experts iteratively reviewed the Omaha System and identified concerning concepts indicative of HHC patients' risk of hospitalizations or ED visits. Next, we developed and tested an NLP algorithm to identify these concerning concepts in HHC clinical notes automatically. The resulting NLP algorithm was applied on a large subset of narrative notes (2.3 million notes) documented for 66,317 unique patients ( n = 87,966 HHC episodes) admitted to one large HHC agency in the Northeast United States between 2015 and 2017. RESULTS A total of 160 Omaha System signs/symptoms were identified as concerning concepts for hospitalizations or ED visits in HHC. These signs/symptoms belong to 31 of the 42 available Omaha System problems. Overall, the NLP algorithm showed good performance in identifying concerning concepts in clinical notes. More than 18% of clinical notes were detected as having at least one concerning concept, and more than 90% of HHC episodes included at least one Omaha System problem. The most frequently documented concerning concepts were pain, followed by issues related to neuromusculoskeletal function, circulation, mental health, and communicable/infectious conditions. CONCLUSION Our findings suggest that concerning problems or symptoms that could increase the risk of hospitalization or ED visit were frequently documented in narrative clinical notes. NLP can automatically extract information from narrative clinical notes to improve our understanding of care needs in HHC. Next steps are to evaluate which concerning concepts identified in clinical notes predict hospitalization or ED visit.
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5
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Seo S, Jang SN. [Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community]. J Korean Acad Nurs 2022; 52:105-119. [PMID: 35274624 DOI: 10.4040/jkan.21193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors. METHODS The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors. RESULTS The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p =.003). The cost was also influenced by less than moderate subjective health status (β = 4.37, p = .021), being part of a social participating groups (β = 4.41, p = .028), or participation in SHPPs (β = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029). CONCLUSION This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.
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Affiliation(s)
- Soyoung Seo
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea.
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Gilson A, Gassman M, Dodds D, Lombardo R, Ford Ii JH, Potteiger M. Refining a Digital Therapeutic Platform for Home Care Agencies in Dementia Care to Elicit Stakeholder Feedback: Focus Group Study With Stakeholders. JMIR Aging 2022; 5:e32516. [PMID: 35234657 PMCID: PMC8928048 DOI: 10.2196/32516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background Persons living with dementia require increasing levels of care, and the care model has evolved. The Centers for Medicare and Medicaid Services is transitioning long-term care services from institutional care to home- or community-based services, including reimbursement for nonclinical services. Although home care companies are positioned to handle this transition, they need innovative solutions to address the special challenges posed by caring for persons living with dementia. To live at home longer, these persons require support from formal caregivers (FCGs; ie, paid professionals), who often lack knowledge of their personal histories and have high turnover, or informal caregivers (eg, family or friends), who may have difficulty coping with behavioral and psychological symptoms of dementia. The Generation Connect platform was developed to support these individuals and their formal and informal caregivers. In preliminary studies, the platform improved mood and influenced caregiver satisfaction. To enhance platform effectiveness, Generation Connect received a grant from the National Institutes of Health Small Business Innovation Research to improve clinical outcomes, reduce health care costs, and lower out-of-pocket costs for persons living with dementia who receive care through home care agencies. Objective This study aims to evaluate information elicited from a series of stakeholder focus groups to understand existing processes, needs, barriers, and goals for the use of the Generation Connect platform by home care agencies and formal and informal caregivers. Methods A series of focus groups were conducted with home care agency corporate leadership, home care agency franchise owners, home care agency FCGs, and informal caregivers of persons living with dementia. The qualitative approach allowed for unrestricted idea generation that best informed the platform development to enable home care providers to differentiate their dementia care services, involve informal caregivers, improve FCG well-being, and extend the ability of persons living with dementia to age in place. Using the Technology-Enabled Caregiving in the Home framework, an inductive and iterative content analysis was conducted to identify thematic categories from the transcripts. Results Overall, 39 participants participated across the 6 stakeholder focus groups. The following five overarching themes were identified: technology related; care services; data, documentation, and outcomes; cost, finance, and resources; and resources for caregivers. Within each theme, the most frequent subthemes were identified. Exemplar stakeholder group statements provided support for each of the identified themes. Conclusions The focus group results will inform the further development of the Generation Connect platform to reduce the burden of caregiving for persons living with dementia, evaluate changes in cognition, preserve functional independence, and promote caregiver engagement between these individuals. The next step is to evaluate the effectiveness of the revised platform in the National Institutes of Health Small Business Innovation Research phase 2 clinical trial to assess the efficacy of its evidence-based interventions and market viability.
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Affiliation(s)
- Aaron Gilson
- Social & Administrative Pharmacy Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Michele Gassman
- Social & Administrative Pharmacy Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | | | | | - James H Ford Ii
- Social & Administrative Pharmacy Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
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Tay YL, Abu Bakar NS, Tumiran R, Ab Rahman NH, Mohd Ma'amor NAA, Yau WK, Abdullah Z. Effects of home visits on quality of life among older adults: a systematic review protocol. Syst Rev 2021; 10:307. [PMID: 34872589 PMCID: PMC8650292 DOI: 10.1186/s13643-021-01862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults. METHODS We will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive-promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions. DISCUSSION This review may provide evidence for the effectiveness of home visits in improving older adults' quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021234531 .
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Affiliation(s)
- Yea Lu Tay
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia.
| | - Nurul Salwana Abu Bakar
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
| | - Ruzimah Tumiran
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
| | - Noor Hasidah Ab Rahman
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
| | | | - Weng Keong Yau
- General Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Zalilah Abdullah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
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8
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Chiu TY, Yu HW, Chen YM. Continuous Use of Home Care Services and Functional Performance: A Population-Based Approach. J Appl Gerontol 2021; 41:736-743. [PMID: 34291697 DOI: 10.1177/07334648211032419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Home care (HC) services are the foundational service in Taiwan, such as personal care, housekeeping, showers, meal preparation, and so on. We used population-representative data to evaluate the effects of HC services use on the long-term functional performance of older adults. METHOD This longitudinal study used latent growth curve modeling, measured as trajectories in activities of daily living (ADL) ability. We retrieved data for 1,851 care recipients from the Long-Term Care Service Management System database. RESULTS Continuous use of HC services had positive effects on functional performance over time of declining functional capacity (β = .075, p < .05). While greater age was associated with slower increases in ADL scores, being female and living alone were associated with faster increases in ADL scores. DISCUSSION Continuous use of the HC services provided has a significant impact on maintaining or improving functional performance among older adults in the early stage of declined functional capacity.
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Affiliation(s)
- Tzu-Ying Chiu
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei City, Taiwan
| | - Hsiao-Wei Yu
- Department of Gerontological Care and Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Family Medicine, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,Geriatric and Long-term Care Research Center. Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
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9
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Masoumi N, Hosseinzadeh M, VanSon C, Ghezeljeh TN. Home healthcare in Iran: A hybrid concept analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:196-203. [PMID: 34277369 PMCID: PMC8262539 DOI: 10.4103/ijnmr.ijnmr_198_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/21/2020] [Accepted: 02/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Healthcare is changing from a focus on acute care health issues to one of managing chronic conditions. This change has resulted in the development of home health-care systems as a way of managing chronic conditions outside the hospital. The aim of this study was to analyze the concept of home healthcare using a hybrid model. MATERIALS AND METHODS This hybrid concept analysis consisted of three phases: theoretical, fieldwork, and analytical. Science Direct, PubMed, ProQuest, and Scopus were searched with related terms in the theoretical phase. In the fieldwork phase, six professionals with experience in home healthcare were interviewed and after each interview, qualitative content analysis was conducted. During the final phase, descriptions and themes from the first two phases were combined. RESULTS In the theoretical phase, the definition of home healthcare included descriptions answering the Who, What, When, Where, and Why questions. In the fieldwork phase, the results were divided into three areas: 1-comprehensive care; 2-extent of services; and 3-outcomes. The final analysis phase of this study indicated that the home health-care concept is a comprehensive, professional, and holistic care system accompanied by medical services and professionals whose goals are to support an individual's health and provide care in their home. Healthcare provided in one's home was found to preserve a patient's dignity and reduce health-care costs. CONCLUSIONS The definition of the home healthcare concept establishes a foundation for developing a comprehensive home health-care system. This concept analysis for home healthcare could be a guide for future studies.
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Affiliation(s)
- Nasrin Masoumi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Hosseinzadeh
- Department of Community Health Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Catherine VanSon
- College of Nursing, Washington State University, Vancouver, Washington, United States
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Factors Associated with Timing of the Start-of-Care Nursing Visits in Home Health Care. J Am Med Dir Assoc 2021; 22:2358-2365.e3. [PMID: 33844990 DOI: 10.1016/j.jamda.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Home health care patients have critical needs requiring timely care following hospital discharge. Although Medicare requires timely start-of-care nursing visits, a significant portion of home health care patients wait longer than 2 days for the first visit. No previous studies investigated the pattern of start-of-care visits or factors associated with their timing. This study's purpose was to examine variation in timing of start-of-care visits and characterize patients with visits later than 2 days postdischarge. DESIGN Retrospective cohort study. SETTING/PARTICIPANTS Patients admitted to a large, Northeastern US, urban home health care organization during 2019. The study included 48,497 home care episodes for 45,390 individual patients. MEASUREMENT We calculated time to start of care from hospital discharge for 2 patient groups: those seen within 2 days vs those seen >2 days postdischarge. We examined patient factors, hospital discharge factors, and timing of start of care using multivariate logistic regression. RESULTS Of 48,497 episodes, 16,251 (33.5%) had a start-of-care nursing visit >2 days after discharge. Increased odds of this time frame were associated with being black or Hispanic and having solely Medicaid insurance. Odds were highest for patients discharged on Fridays, Saturdays, and Mondays. Factors associated with visits within 2 days included surgical wound presence, urinary catheter, pain, 5 or more medications, and intravenous or infusion therapies at home. CONCLUSIONS AND IMPLICATIONS Findings provide the first publication of clinical and demographic characteristics associated with home health care start-of-care timing and its variation. Further examination is needed, and adjustments to staff scheduling and improved information transfer are 2 suggested interventions to decrease variation.
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Fettes L, Bayly J, de Bruin LM, Patel M, Ashford S, Higginson IJ, Maddocks M. Relationships between prolonged physical and social isolation during the COVID-19 pandemic, reduced physical activity and disability in activities of daily living among people with advanced respiratory disease. Chron Respir Dis 2021; 18:14799731211035822. [PMID: 34382888 PMCID: PMC8370888 DOI: 10.1177/14799731211035822] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In people with advanced respiratory disease, we examined (i) the impact of COVID-19-related physical and social isolation on physical activity and (ii) relationships between time spent in isolation and disability in activities of daily living. Cross-sectional analysis was conducted in adults with advanced non-small cell lung cancer, chronic obstructive lung disease or interstitial lung disease. Measures included change in physical activity since physically and socially isolating (Likert scale) and disability (Barthel Index and Lawton-Brody IADL scale) or difficulty (World Health Organisation Disability Assessment Schedule-2.0) in daily activities. Multiple logistic regression was used to examine factors associated with disability in daily activities. 194/201 participants were isolating for a median [IQR] 5 [3-8]-month period, often leading to lower levels of physical activity at home (n = 94, 47%), and outside home (n = 129, 65%). 104 (52%) and 142 (71%) were not fully independent in basic and instrumental activities of daily living, respectively. 96% reported some degree of difficulty in undertaking daily activities. Prolonged physical and social isolation related to increased disability in basic (r = -0.28, p < 0.001) and instrumental (r = -0.24, p < 0.001) activities of daily living, and greater difficulty in daily activities (r = 0.22, p = 0.002). Each month spent in physical or social isolation was independently related to disability in basic activities of daily living (odds ratio [OR], 1.17 [95% CI: 1.03-1.33], p = 0.013). These findings suggest disability in daily activities is associated with prolonged physical or social isolation, which may present as difficulty in people who are fully independent. Post-isolation recovery and rehabilitation needs should be considered for all people deemed extremely clinically vulnerable.
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Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Leonora Michelle de Bruin
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Malini Patel
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK.,Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK.,Centre for Nursing Midwifery and Allied health Research and the National Hospital for Neurology and Neurosurgery, 8964University College London Hospitals, Holborn, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
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12
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Wang J, Yu F, Cai X, Caprio TV, Li Y. Functional outcome in home health: Do racial and ethnic minority patients with dementia fare worse? PLoS One 2020; 15:e0233650. [PMID: 32453771 PMCID: PMC7250428 DOI: 10.1371/journal.pone.0233650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Evaluate the independent and interactive effects of dementia and racial/ethnic minority status on functional outcomes during a home health (HH) admission among Medicare beneficiaries. Methods Secondary analysis of data from the Outcome and Assessment Information Set [OASIS] and billing records in a non-profit HH agency in New York. Participants were adults ≥ 65 years old who received HH in CY 2017 with OASIS records at HH admission and HH discharge. Dementia was identified by diagnosis (ICD-10 codes) and cognitive impairment (OASIS: M1700, M1710, M1740). We used OASIS records to assess race/ethnicity (M0140) and functional status (M1800-M1870 on activities of daily living [ADL]). Functional outcome was measured as change in the composite ADL score from HH admission to HH discharge, where a negative score means improvement and a positive score means decline. Results The sample included 4,783 patients, among whom 93.9% improved in ADLs at HH discharge. In multivariable linear regression that adjusted for HH service use and covariates (R2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p<0.001) were independently related to less ADL improvement at HH discharge, with significant interaction related to further decrease in ADL improvement. Relative to white patients without dementia, African American patients with dementia (β = 1.08, 95% CI: 0.81, 1.35, p<0.001), Hispanics with dementia (β = 0.92, 95% CI: 0.38, 1.47, p = 0.001) and Asian Americans with dementia (β = 1.47, 95% CI: 0.81, 2.13, p<0.001) showed the least ADL improvement at HH discharge. Conclusion Racial/ethnic minority status and dementia were associated with less ADL improvement in HH with independent and interactive effects. Policies should ensure that these patients have equitable access to appropriate, adequate community-based services to meet their needs in ADLs and disease management for improved outcomes.
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Affiliation(s)
- Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, NY, United States of America
- * E-mail:
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, MN, United States of America
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States of America
| | - Thomas V. Caprio
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- University of Rochester Medical Home Care, Rochester, NY, United States of America
- Finger Lakes Geriatric Education Center, Rochester, NY, United States of America
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States of America
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Haex R, Thoma‐Lürken T, Beurskens AJHM, Zwakhalen SMG. How do clients and (In)formal caregivers experience quality of home care? A qualitative approach. J Adv Nurs 2020; 76:264-274. [PMID: 31612489 PMCID: PMC6972588 DOI: 10.1111/jan.14234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
Abstract
AIM To explore and understand the views of clients and formal and informal caregivers about the experienced quality of home care for older people. DESIGN A descriptive qualitative study was conducted using individual interviews. METHODS Six home care clients, four formal and six informal caregivers were recruited from two Dutch home care organizations. Individual, semi-structured interviews took place between April - November 2018. The INDividually EXperienced QUAlity of Long-term care framework was used to guide data collection and content analyses. RESULTS The analyses revealed several important attributes contributing to experienced quality of home care such as a preferred small number of caregivers, perceived sufficient time for care provision and a caring atmosphere facilitating open communication and humour. Participants indicated that care routines fitting with the care receiver's former way of living were important. A more 'close' personal care relationship related to trust, openness and empathy was preferred over a more 'detached' professional care relationship. CONCLUSION This study identified a wide range of attributes related to experienced quality of care from the perspectives of clients and formal and informal caregivers in home care. IMPACT Care providers are being challenged to structurally assess individual experienced quality of home care. This study underlines the importance of incorporating care preferences and experiences throughout the care process from a relationship-centred care approach. Relevant care measures and outcomes should be determined to gain insight and further improve individual care provision.
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Affiliation(s)
- Roy Haex
- Department of Health Services ResearchLiving Lab on Ageing and Long‐Term CareCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Theresa Thoma‐Lürken
- Department of Health Services ResearchLiving Lab on Ageing and Long‐Term CareCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Anna J. H. M. Beurskens
- Department of Family MedicineCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Faculty of HealthZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Sandra M. G. Zwakhalen
- Department of Health Services ResearchLiving Lab on Ageing and Long‐Term CareCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Faculty of HealthZuyd University of Applied SciencesHeerlenThe Netherlands
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Abstract
Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during an HHC stay. This was a secondary data analysis of a 5% random sample (n = 105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in seven or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing HHC length of stay, being female, and prior inpatient stay. Clinicians, policy makers, and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement.
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Ozdemir T, Ozdilekcan C, Goksel F. The contribution of hospital-based home health services in pulmonary diseases: Current Practice in Turkey. Medicine (Baltimore) 2019; 98:e18032. [PMID: 31770218 PMCID: PMC6890344 DOI: 10.1097/md.0000000000018032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The medical management of chronic respiratory diseases becomes more difficult with the increase in the rate of the elderly population. Monitoring and treating chronic respiratory diseases at home are more comfortable for both the patient and their relatives. Therefore, countries need to develop policies regarding home health services (HHS) according to the state of their social, cultural, and financial infrastructure. OBJECTIVE The objective of this study is to show the role and contribution of hospital-based HHS regarding respiratory disorders, and to evaluate the model and its efficiency. STUDY DESIGN The design of this study was cross-sectional. Data were obtained from the Ministry of Health of Turkey with official permission. Data were collected for HHS concerning respiratory diseases between 2011 and 2017. Age and sex distribution, the number of recorded patients, the number of visits for pulmonary diseases, the distribution of institutional visits, and the quantitative alterations within the years were investigated. STUDY POPULATION The study population was based on patients with respiratory disorders who were given HHS as directed by the Ministry of Health of Turkey. RESULTS Between 2011 and 2017, the majority of patients with pulmonary diseases, mostly those with chronic obstructive pulmonary disease, asthma, and lung cancer, visited government hospitals (78%). The number of house visits concerning pulmonary disorders increased nearly ten times, but hospitalization due to respiratory diseases decreased (13.5% in 2011 to 12.9% in 2017). CONCLUSION Hospital-based HHS in pulmonary diseases can be considered as an appropriate model for implementation for countries like Turkey, those that have inadequate hospice-type health service infrastructure.
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Affiliation(s)
| | | | - Fatih Goksel
- Department of Radiation Oncology, University of Health Sciences Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Turkey
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Nikbakht Nasrabadi A, Shahsavari H, Almasian M, Heydari H, Hazini A. Designing a Process Model of Home Care Service Delivery in Iran: A Mixed Methods Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2019; 7:288-299. [PMID: 31641678 PMCID: PMC6779923 DOI: 10.30476/ijcbnm.2019.73934.0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Considering the position of home health care in the current world, the objective of this study was to design an applied model of providing home care services in Iran.
Methods: The mixed methods approach was employed in three stages in Iran from Feb 2015 to Sep 2016. During the first phase, the qualitative method of content analysis was used. Data were collected by conducting 26 individual interviews and holding one focus group session involving 7 people. Data analysis was based on Graneheim and Lundman’s approach to content analysis.
In the second phase of the study, a literature review was carried out and at the end of this stage, a preliminary model was designed. The model was standardized in the third phase using the Delphi method with 23 participants in two rounds.
Results: In the first and second stages of the study, various categories emerged including patient referral, agreement, determination of the needed level of care, care plans designing, provision of comprehensive services, documentation, service monitoring, inter-professional cooperation, issuance of death certificates at home, ethical considerations, and the evaluation of services. Then, in the Delphi phase, 20 (95.2%) of the experts confirmed the structure and content of the model and its applicability.
Conclusion: The designed model can be helpful in organizing the provision of integrated and comprehensive health services to clients at home, which can be effective in improving the clients’ health and enhancing their self-care and autonomy.
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Affiliation(s)
- Alireza Nikbakht Nasrabadi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Almasian
- Department of English Language, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Heshmatolah Heydari
- Social Determinants of Health Research Center, Lorestan University of Medical Science, Khorramabad, Iran.,Department of Community Health Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Abdolrahim Hazini
- Department of Home-Based Palliative Care, ALA Cancer Prevention and Control of Charity Center (MACSA), Charity Foundation, Tehran, Iran
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Nasir JA, Dang C. Quantitative thresholds based decision support approach for the home health care scheduling and routing problem. Health Care Manag Sci 2019; 23:215-238. [PMID: 30714070 DOI: 10.1007/s10729-019-09469-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/17/2019] [Indexed: 02/05/2023]
Abstract
In the domain of Home Health Care (HHC), precise decisions regarding patient's selection, staffing level, and scheduling of health care staff have a significant impact on the efficiency and effectiveness of the HHC system. However, decentralized planning, the absence of well defined decision rules, delayed decisions and lack of interactive tools typically lead towards low satisfaction level among all the stakeholders of the HHC system. In order to address these issues, we propose an integrated three phase decision support methodology for the HHC system. More specifically, the proposed methodology exploits the structure of the HHC problem and logistic regression based approaches to identify the decision rules for patient acceptance, staff hiring, and staff utilization. In the first phase, a mathematical model is constructed for the HHC scheduling and routing problem using Mixed-Integer Linear Programming (MILP). The mathematical model is solved with the MILP solver CPLEX and a Variable Neighbourhood Search (VNS) based method is used to find the heuristic solution for the HHC problem. The model considers the planning concerns related to compatibility, time restrictions, distance, and cost. In the second phase, Bender's method and Receiver Operating Characteristic (ROC) curves are implemented to identify the thresholds based on the CPLEX and VNS solution. While the third phase creates a fresh solution for the HHC problem with a new data set and validates the thresholds predicted in the second phase. The effectiveness of these thresholds is evaluated by utilizing performance measures of the widely-used confusion matrix. The evaluation of the thresholds shows that the ROC curves based thresholds of the first two parameters achieved 67% to 71% accuracy against the two considered solution methods. While the Bender's method based thresholds for the same parameters attained more than 70% accuracy in cases where probability value is small (p ≤ 0.5). The promising results indicate that the proposed methodology is applicable to define the decision rules for the HHC problem and beneficial to all the concerned stakeholders in making relevant decisions.
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Affiliation(s)
- Jamal Abdul Nasir
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Hong Kong.
| | - Chuangyin Dang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Hong Kong
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Al-Surimi K, Al-Harbi I, El-Metwally A, Badri M. Quality of life among home healthcare patients in Saudi Arabia: household-based survey. Health Qual Life Outcomes 2019; 17:21. [PMID: 30683116 PMCID: PMC6347790 DOI: 10.1186/s12955-019-1095-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background The need for home healthcare programs is an increasingly becoming important common component of healthcare worldwide, as an alternative to hospitalization, owing to the growing elderly population, chronic and acute diseases that need continuous monitoring and care. The overall aim of this study was to describe and assess the quality of life (QOL) and associated determinants among patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia. Methods This cross-sectional study was conducted among patients enrolled at the HHC program. The World Health Organization QOL questionnaire (WHOQOL-BREF) was used to collect data about the different domains of patients’ QOL. Logistic regression models were fitted to determine factors associated with QOL low score. Results The study included 253 patients. Mean age was 67.05 (± 20.0). The overall QOL for HHC patients was significantly affected by both socio-demographic and morbid characteristics. In the final Multivariate logistic regression models, marital status, and having psychological problems, stroke and number illness were independently associated with the overall QOL of HHC patients (p = .022, p = .002, p = .031, .057 respectively). The physical health domain score was significantly associated with education level, having psychological problems and stroke (p = .028, p = .002, p = .007 retrospectively) whereas the psychological domain score was significantly associated with age (p = < 0.001) and three types of chronic diseases: pulmonary (p = .002), psychological problems (p = < 0.001). The social domain score was significantly associated only with the marital status (p = .026). The environmental domain was significantly associated with the education level and having stroke (p = .017 vs .027). Conclusions The overall QOL and its domains are significantly associated with several different factors. Many of these factors can be monitored and enhanced by improving quality of HHC services, thus improving the QOL of patients.
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Affiliation(s)
- Khaled Al-Surimi
- Department of Health Systems and Management, College of Public Health and Health Informatics, King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. .,Primary Care and Public Health Department, School of Public health, Imperial College London, Riyadh, UK.
| | - Iman Al-Harbi
- Department of Health Systems and Management, College of Public Health and Health Informatics, King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ashraf El-Metwally
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Motasim Badri
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
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19
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Pepito JA, C. Locsin R, Constantino RE. Caring for Older Persons in a Technologically Advanced Nursing Future. Health (London) 2019. [DOI: 10.4236/health.2019.115039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Shahsavari H, Nasrabadi AN, Almasian M, Heydari H, Hazini A. Exploration of the administrative aspects of the delivery of home health care services: a qualitative study. ASIA PACIFIC FAMILY MEDICINE 2018; 17:1. [PMID: 29410602 PMCID: PMC5781270 DOI: 10.1186/s12930-018-0038-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 01/16/2018] [Indexed: 05/03/2023]
Abstract
BACKGROUND Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. OBJECTIVES The purpose of this study was to explore the administrative aspects of the delivery of home health care services. METHODS This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. RESULTS 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. CONCLUSION Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.
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Affiliation(s)
- Hooman Shahsavari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Almasian
- School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Heshmatolah Heydari
- Social Determinants of Health Research Center, Lorestan University of Medical Science, Khorramabad, Iran
- Department of Community Health Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Abdolrahim Hazini
- Department of Home-based Palliative Care, ALA cancer prevention and control of charity center (MACSA), Tehran, Iran
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O'Connor M, Hanlon A, Mauer E, Meghani S, Masterson-Creber R, Marcantonio S, Coburn K, Van Cleave J, Davitt J, Riegel B, Bowles KH, Keim S, Greenberg SA, Sefcik JS, Topaz M, Kong D, Naylor M. Identifying distinct risk profiles to predict adverse events among community-dwelling older adults. Geriatr Nurs 2017; 38:510-519. [PMID: 28479081 PMCID: PMC5991797 DOI: 10.1016/j.gerinurse.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 12/17/2022]
Abstract
Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p < 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults.
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Affiliation(s)
- Melissa O'Connor
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA; Villanova University, College of Nursing, USA.
| | - Alexandra Hanlon
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
| | - Elizabeth Mauer
- Department of Healthcare Policy & Research, Weill Cornell Medicine, USA
| | - Salimah Meghani
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
| | | | | | | | - Janet Van Cleave
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA; New York University, College of Nursing, USA
| | - Joan Davitt
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA; University of Maryland, School of Social Work, USA
| | - Barbara Riegel
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
| | - Kathryn H Bowles
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA; Center for Home Care Research and Policy, Visiting Nurse Service of New York, USA
| | - Susan Keim
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
| | - Sherry A Greenberg
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA; New York University, College of Nursing, USA
| | - Justine S Sefcik
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
| | | | - Dexia Kong
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
| | - Mary Naylor
- NewCourtland Center for Transitions in Health, University of Pennsylvania School of Nursing, USA
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O'Connor M, Moriarty H, Madden-Baer R, Bowles KH. Identifying Critical Factors in Determining Discharge Readiness from Skilled Home Health: An Interprofessional Perspective. Res Gerontol Nurs 2017; 9:269-277. [PMID: 27855240 DOI: 10.3928/19404921-20160930-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022]
Abstract
A lack of readiness for discharge from skilled home health can result in adverse events among older adults. The purpose of the current study was to explore interprofessional home health clinician perceptions of the factors they consider important to determine readiness for discharge among skilled home health recipients. A qualitative descriptive study was conducted using four focus groups among 32 interprofessional clinicians from one large skilled home health agency and two telephone interviews with home visiting physicians. A semi-structured interview guide was followed. Qualitative content analysis was used for manifest coding and then thematic analysis. Five themes emerged: (a) patient safety, (b) long-term plan is in place, (c) reached maximum self-care potential, (d) presence of a willing and able caregiver, and (e) patient attributes. The goal of this line of inquiry is to develop an evidence-based home health discharge decision support tool to provide a standardized approach in determining readiness for discharge from skilled home health services. [Res Gerontol Nurs. 2016; 9(6):269-277.].
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Mkanta WN, Chumbler NR, Yang K, Saigal R, Abdollahi M, Mejia de Grubb MC, Ezekekwu EU. An Examination of the Likelihood of Home Discharge After General Hospitalizations Among Medicaid Recipients. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2017. [PMCID: PMC5798719 DOI: 10.1177/0046958017711783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ability to predict discharge destination would be a useful way of optimizing posthospital care. We conducted a cross-sectional, multiple state study of inpatient services to assess the likelihood of home discharges in 2009 among Medicaid enrollees who were discharged following general hospitalizations. Analyses were conducted using hospitalization data from the states of California, Georgia, Michigan, and Mississippi. A total of 33 160 patients were included in the study among which 13 948 (42%) were discharged to their own homes and 19 212 (58%) were discharged to continue with institutional-based treatment. A multiple logistic regression model showed that gender, age, race, and having ambulatory care-sensitive conditions upon admission were significant predictors of home-based discharges. Females were at higher odds of home discharges in the sample (odds ratio [OR] = 1.631; 95% confidence interval [CI], 1.520-1.751), while patients with ambulatory care-sensitive conditions were less likely to get home discharges (OR = 0.739; 95% CI, 0.684-0.798). As the nation engages in the continued effort to improve the effectiveness of the health care system, cost savings are possible if providers and systems of care are able to identify admission factors with greater prospects for in-home services after discharge.
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Affiliation(s)
| | | | - Kai Yang
- Wayne State University, Detroit, MI, USA
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Cha MY, Hong HS. [Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women]. J Korean Acad Nurs 2016; 45:221-30. [PMID: 25947184 DOI: 10.4040/jkan.2015.45.2.221] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects. METHODS A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL. RESULTS Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001). CONCLUSION Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.
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Affiliation(s)
- Mi Youn Cha
- Department of Nursing, Uiduk University, Pohang, Korea
| | - Hae Sook Hong
- College of Nursing, Kyungpook National University, Daegu, Korea.
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Kang Y, McHugh MD, Chittams J, Bowles KH. Risk Factors for All-Cause Rehospitalization Among Medicare Recipients with Heart Failure Receiving Telehomecare. Telemed J E Health 2016; 23:305-312. [PMID: 27689956 DOI: 10.1089/tmj.2016.0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify potential risk factors associated with rehospitalization among Medicare recipients with heart failure (HF) receiving telehomecare. MATERIALS AND METHODS This study is a nonexperimental, cross-sectional secondary data analysis of the Centers for Medicare and Medicaid (CMS) mandated assessment called the Outcome and Assessment Information Set (OASIS)-C, provided by a large home care company. A total of 526 patients who received telehomecare from January 1, 2011 to August 31, 2013 were included in the analyses, which used multiple logistic regression. RESULTS The overall rate of rehospitalization was 36% while patients were receiving telehomecare. Moderately frail health status (p = 0.01), the presence of severe pain (p = 0.01), the presence of dermatologic problems (p = 0.03), and independence in dressing one's lower body (compared to slightly dependent [p = 0.01] or mostly dependent patient groups [p = 0.02]) were identified as risk factors for rehospitalization. CONCLUSIONS The risk factors identified from this study may be used to drive more effective telehomecare placements, and referrals for additional services among telehomecare patients with HF.
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Affiliation(s)
- Youjeong Kang
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Matthew D McHugh
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,2 Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Jesse Chittams
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Kathryn H Bowles
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,3 vanAmeringen Professor in Nursing Excellence, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,4 Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York
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Cornally N, Coffey A, Daly E, McGlade C, Weathers E, O’Herlihy E, O’Caoimh R, McLoughlin K, Svendrovski A, Molloy W. Measuring staff perception of end-of-life experience of older adults in long-term care. Appl Nurs Res 2016; 30:245-51. [DOI: 10.1016/j.apnr.2015.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 11/30/2022]
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Hyun HS, Lee I. [Nutritional status and risk factors for malnutrition in low-income urban elders]. J Korean Acad Nurs 2015; 44:708-16. [PMID: 25608548 DOI: 10.4040/jkan.2014.44.6.708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the nutritional status of low-income urban elders by diversified ways, and to analyze the risk factors for malnutrition. METHODS The participants in this study were 183 low-income elders registered at a visiting healthcare facility in a public health center. Data were collected using anthropometric measurements, and a questionnaire survey. For data analysis, descriptive statistics, χ²-test, t-test, Fisher's exact test, multiple logistic regression analysis were performed using SPSS 20.0. RESULTS Regarding the nutritional status of low-income elders as measured by the Mini Nutritional Assessment (MNA), 10.4% of the elders were classified as malnourished; 57.4% as at high risk for malnutrition; and 32.2% as having normal nutrition levels. The main factors affecting malnutrition for low-income elders were loss of appetite (OR=3.34, 95% CI: 1.16~9.56) and difficulties in meal preparation (OR=2.35, 95% CI: 1.13~4.88). CONCLUSION In order to effectively improve nutrition in low-income urban elders, it is necessary to develop individual intervention strategies to manage factors that increase the risk of malnutrition and to use systematic approach strategies in local communities in terms of a nutrition support system.
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Affiliation(s)
- Hye Sun Hyun
- Department of Nursing, Sangmyung University, Cheonan, Korea
| | - Insook Lee
- College of Nursing, Seoul National University, Seoul, Korea.
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