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Ma C, Rajewski M, Bao S. Home Health Care to Asian Americans: a Systematic Review. J Racial Ethn Health Disparities 2024; 11:865-873. [PMID: 36940075 PMCID: PMC10026777 DOI: 10.1007/s40615-023-01568-8] [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] [Received: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Despite being the fastest growing minority group in the USA, Asian Americans are among the least studied ones, particularly in the home and community-based services settings. This study aimed to review and synthesize extant evidence on Asian American's access, utilization, and outcomes of home health care. METHODS This is a systematic review study. A comprehensive literature search was conducted in PubMed and CINAHL as well as hand search. Each study was screened, reviewed, and evaluated for quality by at least two reviewers independently. RESULTS Twelve articles were determined eligible and included for review. Asian Americans were less likely to be discharged to home health care following hospitalization. At admission to home health care, Asian Americans had a high rate of inappropriate medication issues (28%) and they also had poorer functional status compared to White Americans. Asian Americans were also reported with less improvement in functional status at the end of home health care; however, there were some inconsistencies in the evidence on Asian Americans' utilization of formal/skilled home health care. Quality evaluation indicated that findings from some studies were limited by small sample size, single site/home health agency, analytic approaches, and other methodologic limitations. CONCLUSIONS Asian Americans often experience inequities in home health care access, utilization, and outcomes. Multilevel factors may contribute to such inequities, including structural racism. Robust research using population-based data and advanced methodology is needed to better understand home health care to Asian Americans.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, New York, NY 10010 USA
| | - Martha Rajewski
- New York University Rory Meyers College of Nursing, New York, NY 10010 USA
| | - Silin Bao
- Community Regional Medical Center, Fresno, CA USA
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Wang X, Chen J, Feng M, Zhuang M, Wang J, Zhang L, Liu Y, Chen H. Demand and influencing factors of "Internet + Traditional Chinese Medicine" home nursing service for older adult patients with chronic diseases: a mixed research perspective. Front Public Health 2023; 11:1271082. [PMID: 37927869 PMCID: PMC10622788 DOI: 10.3389/fpubh.2023.1271082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background In the context of global aging, the characteristics of chronic diseases seriously affect the quality of life of older adults. It is urgent to carry out continuous nursing basis for older adult patients with chronic diseases. In view of the remarkable efficacy of Chinese medicine in the treatment of chronic diseases, this study may help to understand the demand for "Internet + Chinese medicine" home care service and its influencing factors of older adult chronic disease patients, and to provide a reference basis for improving the quality of life of the older adult chronic disease population. Methods This is a mixed study. The quantitative study adopted the convenience sampling method, and a total of 308 patients in a third-grade hospital in Shaanxi Province were investigated by general data questionnaire, traditional Chinese medicine service demand questionnaire, traditional Chinese medicine knowledge questionnaire, older adult Chinese medicine attitude questionnaire, and home care demand questionnaire from March to April 2022. In the qualitative study, semi-structured interviews were adopted, and patients were interviewed until the content was saturated. Colaizzi analysis method was used to analyze and summarize the topic of the interview data. Results 308 valid questionnaires were collected, and the patients scored (58.42 ± 17.16) on the demand for TCM nursing services, (59.86 ± 11.54) on the knowledge of TCM, (73.03 ± 9.11) on the attitude toward TCM, and (136.84 ± 46.39) on the demand for home care. The results of multiple linear regression showed that learning about the nursing service pathway, knowledge of general knowledge of Chinese medicine, and attitude toward Chinese medicine among the older adult and home care demand were the influencing factors of the demand for Chinese medicine nursing services for older adult patients with chronic diseases (p < 0.05). The results of the in-depth interviews were summarized into three themes: facilitating factor, hindering factor, and the "Internet + Chinese medicine" multiple needs of home care. Conclusion Older adult patients with chronic diseases have a high intention of home care demand and they are affected by multiple factors. Consequently, the actual demand situation of older adult patients with chronic diseases should be used as a guide to provide directed and diversified Chinese medicine home care services to meet the individualized needs of the older adult.
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Affiliation(s)
- Xinghuan Wang
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Jinyan Chen
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Meiqin Feng
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Miaoqing Zhuang
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Jiayi Wang
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Luyu Zhang
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Yue Liu
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Hongfang Chen
- Personnel Department, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an, China
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Squires A, Engel P, Ma C, Miner S, Feldman PH, McDonald MV, Jones S. Continuity of Care Versus Language Concordance as an Intervention to Reduce Hospital Readmissions From Home Health Care. Med Care 2023; 61:605-610. [PMID: 37561604 PMCID: PMC10421624 DOI: 10.1097/mlr.0000000000001884] [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: 08/12/2023]
Abstract
BACKGROUND Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. OBJECTIVE The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. DESIGN A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. PARTICIPANTS The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. MEASURES The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. RESULTS When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). CONCLUSION In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.
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Affiliation(s)
| | | | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University
| | - Sarah Miner
- Wegman’s School of Nursing, New York University
| | | | | | - Simon Jones
- Director of Analytics, Center for Delivery Systems Science Department of Population Health, Grossman School of Medicine, New York University
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FASHAW‐WALTERS SHEKINAHA, RAHMAN MOMOTAZUR, GEE GILBERT, MOR VINCENT, RIVERA‐HERNANDEZ MARICRUZ, FORD CERON, THOMAS KALIS. Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access. Milbank Q 2023; 101:527-559. [PMID: 36961089 PMCID: PMC10262386 DOI: 10.1111/1468-0009.12616] [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] [Received: 05/31/2022] [Revised: 11/14/2022] [Accepted: 01/03/2023] [Indexed: 03/25/2023] Open
Abstract
Policy Points Public reporting is associated with both mitigating and exacerbating inequities in high-quality home health agency use for marginalized groups. Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does. Targeted federal, state, and local interventions should focus on raising awareness about the five-star quality ratings among marginalized populations for whom inequities have been exacerbated. CONTEXT Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high-quality, long-term care for older adults. The objective of this study is to evaluate the impact of the home health five-star ratings on changes in high-quality home health agency use by race, ethnicity, income status, and place-based factors. METHODS We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high-quality home health agencies between July 2014 and June 2017. To estimate the impact of the home health five-star rating introduction on the use of high-quality home health agencies, we use a longitudinal observational pretest-posttest design. FINDINGS After the introduction of the home health five-star ratings in 2016, we found that adjusted rates of high-quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. Additionally, we found that the disparity in high-quality home health agency use between low-income and higher-income home health patients was exacerbated after the introduction of the five-star quality ratings. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high-quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high-quality home health agency use. Other neighborhoods experience a nonsignificant change in high-quality home health agency use. CONCLUSIONS Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low-income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Targeted interventions should focus on raising awareness around the five-star ratings.
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Affiliation(s)
| | - MOMOTAZUR RAHMAN
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
| | - GILBERT GEE
- Fielding School of Public HealthUniversity of California at Los Angeles
| | - VINCENT MOR
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
- US Department of Veterans Affairs Medical CenterCenter of Innovation in Long‐Term Services and Supports
| | - MARICRUZ RIVERA‐HERNANDEZ
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
| | - CERON FORD
- School of Public HealthUniversity of Minnesota
| | - KALI S. THOMAS
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
- US Department of Veterans Affairs Medical CenterCenter of Innovation in Long‐Term Services and Supports
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Newman C, Whitehead P, Thomson M. What are the common areas of risk and their characteristics found in intermediate care from an occupational therapy perspective? A scoping review. Br J Occup Ther 2022. [DOI: 10.1177/03080226221079233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Engaging with risk is a certain and unavoidable part of occupational therapy. Intermediate care services are mostly accessed by older people with complex needs, yet little is known in the literature about the extent, type and nature of risk involved in these services. Method A scoping review was systematically conducted to map the common areas of risk (risk domains) from an occupational therapy perspective. Thematic analysis was conducted in order to identify the risk characteristics related to the literature reviewed. Results 25 journal articles were identified and arranged into 10 risk domains: Falls, discharge, practice errors, activities of daily living, pressure care, frailty management, patient handling, loneliness, nutritional care and language barriers. Three risk characteristics were identified: (1) Risk awareness and identifying risk, (2) decision-making under risk and (3) improving safety. Conclusion Occupational therapists play a diverse role in migrating risk for older people which is not fully explored beyond addressing deficits in functional ability and hazardous environments. The process of how risk is controlled and reconciled with occupation and how positive risk-taking is facilitated are implicit and not directly addressed within the literature reviewed. The findings reveal gaps in knowledge and provide a foundation for further research.
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Affiliation(s)
- Craig Newman
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Phillip Whitehead
- Population Health Sciences Institute Faculty of Medical Sciences, Newcastle University, UK
| | - Mary Thomson
- Newcastle Business School, Northumbria University, UK
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Squires A, Ma C, Miner S, Feldman P, Jacobs EA, Jones SA. Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: A retrospective analysis. Int J Nurs Stud 2021; 125:104093. [PMID: 34710627 DOI: 10.1016/j.ijnurstu.2021.104093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. OBJECTIVE To determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge. DESIGN Retrospective cross-sectional study of hospital readmissions from an urban home health care agency's administrative records and the national electronic home health care record for the United States, captured between 2010 and 2015. SETTING New York City, New York, USA. PARTICIPANTS The dataset comprised 90,221 post-hospitalization patients and 6.5 million home health care visits. METHODS First, a Chi-square test was used to determine if there were significant differences in crude readmission rates based on language group. Inverse probability of treatment weighting was used to adjust for significant differences in known hospital readmission risk factors between to examine all-cause hospital readmission during a home health care stay. The final matched sample included 87,561 patients with a language preference of English, Spanish, Russian, Chinese, or Korean. English-speaking patients were considered the comparison group to the non-English speaking patients. A Marginal Structural Model was applied to estimate the impact of non-English language preference against English language preference on rehospitalization. The results of the marginal structural model were expressed as an odds ratio of likelihood of readmission to the hospital from home health care. RESULTS Home health patients with a non-English language preference had a higher hospital readmission risk than English-speaking patients. Crude readmission rate for the limited English proficiency patients was 20.4% (95% CI, 19.9-21.0%) overall compared to 18.5% (95% CI, 18.7-19.2%) for English speakers (p < 0.001). Being a non-English-speaking patient was associated with an odds ratio of 1.011 (95% CI, 1.004-1.018) in increased hospital readmission rates from home health care (p = 0.001). There were also statistically significant differences in readmission rate by language group (p < 0.001), with Korean speakers having the lowest rate and Spanish speakers having the highest, when compared to English speakers. CONCLUSIONS People with a non-English language preference have a higher readmission rate from home health care. Hospital and home healthcare agencies may need specialized care coordination services to reduce readmission risk for these patients. Tweetable abstract: A new US-based study finds that home care patients with language barriers are at higher risk for hospital readmission.
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Affiliation(s)
- Allison Squires
- Director, Florence S. Downs PhD Program, Rory Meyers College of Nursing, Research Associate Professor, Department of General Internal Medicine, Grossman School of Medicine, New York University, 433 First Avenue, 6th floor, New York, NY 10010, United States.
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, United States.
| | - Sarah Miner
- Wegman's School of Nursing, St. John Fischer College, Rochester, NY, United States.
| | - Penny Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10017, United States.
| | - Elizabeth A Jacobs
- Maine Medical Center Research Institute, MaineHealth, Scarborough, ME 04047, United States.
| | - Simon A Jones
- Department of Population Health, Division of General Internal Medicine, Grossman School of Medicine, New York University, New York, NY 10010, United States.
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Gerchow L, Burka LR, Miner S, Squires A. Language barriers between nurses and patients: A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:534-553. [PMID: 32994104 PMCID: PMC8011998 DOI: 10.1016/j.pec.2020.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/05/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Global migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers. METHODS A systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists. RESULTS 48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions. CONCLUSION Generally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload. PRACTICE IMPLICATIONS This review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.
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Affiliation(s)
- Lauren Gerchow
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA.
| | - Larissa R Burka
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA
| | - Sarah Miner
- St. John Fisher College Wegmans School of Nursing, 3690 East Ave, Rochester, NY, USA
| | - Allison Squires
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA
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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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