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Arbaje AI, Hsu YJ, Keita M, Greyson S, Wang J, Werner NE, Carl K, Hohl D, Jones K, Bowles KH, Chan KS, Marsteller JA, Gurses AP, Leff B. Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality. Qual Manag Health Care 2024; 33:140-148. [PMID: 37348080 PMCID: PMC10730761 DOI: 10.1097/qmh.0000000000000419] [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: 06/24/2023]
Abstract
BACKGROUND Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions. OBJECTIVE To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks. METHODS Development : A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing : Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied : Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists). RESULTS The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%). CONCLUSIONS The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.
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Affiliation(s)
- Alicia I. Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Maningbe Keita
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sylvan Greyson
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin—Madison, Madison, Wisconsin
| | | | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, Maryland
| | - Kate Jones
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Kathryn H. Bowles
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Kitty S. Chan
- MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and Medstar Georgetown University Hospital, Washington, DC
| | - Jill A. Marsteller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ayse P. Gurses
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland
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Arbaje AI, Hsu YJ, Zhou Z, Greyson S, Gurses AP, Keller S, Marsteller J, Bowles KH, McDonald MV, Vergez S, Harbison K, Hohl D, Carl K, Leff B. Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID-19. J Am Geriatr Soc 2024; 72:1079-1087. [PMID: 38441330 DOI: 10.1111/jgs.18839] [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: 06/13/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Skilled home healthcare (HH) provided in-person care to older adults during the COVID-19 pandemic, yet little is known about the pandemic's impact on HH care transition patterns. We investigated pandemic impact on (1) HH service volume; (2) population characteristics; and (3) care transition patterns for older adults receiving HH services after hospital or skilled nursing facility (SNF) discharge. METHODS Retrospective, cohort, comparative study of recently hospitalized older adults (≥ 65 years) receiving HH services after hospital or SNF discharge at two large HH agencies in Baltimore and New York City (NYC) 1-year pre- and 1-year post-pandemic onset. We used the Outcome and Assessment Information Set (OASIS) and service use records to examine HH utilization, patient characteristics, visit timeliness, medication issues, and 30-day emergency department (ED) visit and rehospitalization. RESULTS Across sites, admissions to HH declined by 23% in the pandemic's first year. Compared to the year prior, older adults receiving HH services during the first year of the pandemic were more likely to be younger, have worse mental, respiratory, and functional status in some areas, and be assessed by HH providers as having higher risk of rehospitalization. Thirty-day rehospitalization rates were lower during the first year of the pandemic. COVID-positive HH patients had lower odds of 30-day ED visit or rehospitalization. At the NYC site, extended duration between discharge and first HH visit was associated with reduced 30-day ED visit or rehospitalization. CONCLUSIONS HH patient characteristics and utilization were distinct in Baltimore versus NYC in the initial year of the COVID-19 pandemic. Study findings suggest some older adults who needed HH may not have received it, since the decrease in HH services occurred as SNF use decreased nationally. Findings demonstrate the importance of understanding HH agency responsiveness during public health emergencies to ensure older adults' access to care.
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Affiliation(s)
- Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zehui Zhou
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sylvan Greyson
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ayse P Gurses
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara Keller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Home Care Policy & Research, VNS Health, New York City, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, VNS Health, New York City, New York, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York City, New York, USA
| | - Katie Harbison
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, Maryland, USA
| | - Kimberly Carl
- Johns Hopkins Home Care Group, Baltimore, Maryland, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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Arbaje AI, Woodman S, Keita Fakeye MB, Leff B, Yu Q. Senior Services in US Hospitals and Readmission Risk or Mortality Among Medicare Beneficiaries Since the Affordable Care Act. J Appl Gerontol 2023. [PMID: 36864584 DOI: 10.1177/07334648231161925] [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: 03/04/2023] Open
Abstract
Background: The Senior Care Services Scale (SCSS) describes hospital provision of older adult services before the passage of the Affordable Care Act. Objectives: Since act passage, (1) update SCSS service groups; and (2) investigate hospital SCSS scores' relationship to readmission or mortality among Medicare beneficiaries. Methods: Retrospective cohort analysis of older adults ≥65 years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes: Hospital readmission, or death, within 30 and 90 days of discharge. Results: The updated SCSS had three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days (RR .94, 95% CI .91-.98), and 90 days (RR .94, 95% CI .91-.97). There was no significant association between Home-Care-and-Hospice and Post-Acute-Community-Care scores and study outcomes. Conclusion: Greater provision of hospital-level senior services may be associated with mortality reduction among Medicare beneficiaries.
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Affiliation(s)
- Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, 1466Johns Hopkins UniversitySchool of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 1466Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, MD, USA
| | - Susannah Woodman
- Center for Medicare and Medicaid Innovation, 1498Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | - Maningbe B Keita Fakeye
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 1466Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 1466Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, MD, USA.,Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Qilu Yu
- Office of Clinical and Regulatory Affairs, 25943National Center for Complementary and Alternative Medicine, Bethesda, MD, USA
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Time for a Paradigm Shift to Help Older Adults Thrive After Hospitalization. Qual Manag Health Care 2022; 31:278-280. [PMID: 36170604 DOI: 10.1097/qmh.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Sheikh F, Gathecha E, Arbaje AI, Christmas C. Internal Medicine Residents' Views About Care Transitions: Results of an Educational Intervention. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:2382120520988590. [PMID: 33786377 PMCID: PMC7960894 DOI: 10.1177/2382120520988590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
PROBLEM Suboptimal care transitions can lead to re-hospitalizations. INTERVENTION We developed a 2-week "Transitions of Care Curriculum" to train first-year internal medicine residents to improve their knowledge and skills to deliver optimal transitional care. Our objective was to use reflective writing essays to evaluate the impact of the curriculum on the residents. METHODS The rotation included: Transition of Care Teaching modules, Transition Audit, Transitional Care Site Visits, and Transition of Care Conference. Residents performed the above elements of care transitions during the curriculum and wrote reflective essays about their experiences. These essays were analyzed to assess for the overall impact of the curriculum on the residents.Qualitative analysis of reflective essays was used to evaluate the impact of the curriculum. Of the 20 residents who completed the rotation, 18 reflective essays were available for qualitative analysis. RESULTS Five major themes identified in the reflective essays for improvement were: discharge planning, patient-centered care, continuity of care, goals of care discussions, and patient safety. The most discussed theme was continuity of care, with following subthemes: fragmentation of the healthcare system, disjointed care to the patients, patient specific factors contributing to lack of continuity of care, lack of primary care provider role as a coordinator of care, and challenges during discharge process. Residents also identified system-based gaps and suggested solutions to overcome these gaps. CONCLUSIONS This experiential learning and use of reflective writing enhanced the residents' self-identified awareness of gaps in care transitions and prompted them to generate ideas for systems improvement and personal actions to improve their practice during care transitions.
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Affiliation(s)
- Fatima Sheikh
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evelyn Gathecha
- Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Healthcare Human Factors, Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen Christmas
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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