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Saragosa M, Nizzer S, McKay S, Kuluski K. The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping. BMC Health Serv Res 2023; 23:934. [PMID: 37653515 PMCID: PMC10469468 DOI: 10.1186/s12913-023-09899-2] [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: 01/06/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Care transitions have a significant impact on patient health outcomes and care experience. However, there is limited research on how clients receiving care in the home care sector experience the hospital-to-home transition. An essential strategy for improving client care and experience is through client engagement efforts. The study's aim was to provide insight into the care transition experiences and perspectives of home care clients and caregivers of those receiving home care who experienced a hospital admission and returned to home care services by thematically and illustratively mapping their collective journey. METHODS This study applied a qualitative descriptive exploratory design using a patient journey mapping approach. Home care clients and their caregivers with a recent experience of a hospital discharge back to the community were recruited. A conventional inductive approach to analysis enabled the identification of categories and a collective patient journey map. Follow-up interviews supported the validation of the map. RESULTS Seven participants (five clients and two caregivers) participated in 11 interviews. Participants contributed to the production of a collective journey map and the following four categories and themes: (1) Touchpoints as interactions with the health system; Life is changing; (2) Pain points as barriers in the health system: Sensing nobody is listening and Trying to find a good fit; (3) Facilitators to positive care transitions: Developing relationships and gaining some continuity and Trying to advocate, and (4) Emotional impact: Having only so much emotional capacity. CONCLUSIONS The patient journey map enabled a collective illustration of the care transition depicted in touchpoints, pain points, enablers, and feelings experienced by home care recipients and their caregivers. Patient journey mapping offers an opportunity to acknowledge home care clients and their caregivers as critical to quality care delivery across the continuum.
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Affiliation(s)
- Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada.
- VHA Home HealthCare, Toronto, ON, Canada.
| | | | - Sandra McKay
- VHA Home HealthCare, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, East York, Toronto, ON, Canada
| | - Kerry Kuluski
- Trillium Health Partners, Mississauga, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Wang J, Ying M, Li Y. Home Health Agencies With More Socially Vulnerable Patients Have Poorer Experience of Care Ratings. J Appl Gerontol 2021; 41:661-670. [PMID: 34937402 DOI: 10.1177/07334648211053859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings. METHODS Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs. RESULTS CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p < .001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p<0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p<0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p < .001). DISCUSSION CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, NY, USA
| | - Meiling Ying
- Department of Public Health Sciences, University of Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, NY, USA
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Wang J, Cato K, Conwell Y, Yu F, Heffner K, Caprio TV, Nathan K, Monroe TB, Muench U, Li Y. Pain treatment and functional improvement in home health care: Relationship with dementia. J Am Geriatr Soc 2021; 69:3545-3556. [PMID: 34418061 DOI: 10.1111/jgs.17420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Pain management is important to post-acute functional recovery, yet older persons with Alzheimer's disease and related dementias (ADRD) are often undertreated for pain. The main objectives were (1) to examine the relationship between ADRD and analgesic use among Medicare home health care (HHC) recipients with daily interfering pain, and (2) to examine the impact of analgesic use on functional outcome in patients with and without ADRD. METHODS We analyzed longitudinal data from the Outcome and Assessment Information Set, Medicare HHC claims, and HHC electronic medical records during a 60-day HHC episode. The sample included 6048 Medicare beneficiaries ≥65 years receiving care from an HHC agency in New York in 2019 who reported daily interfering pain. Analgesic use was assessed during HHC medication reconciliation and included any analgesic, non-opioid analgesic, and opioid. ADRD was identified from ICD-10 codes (HHC claims) and cognitive impairment symptoms (Outcome and Assessment Information Set [OASIS]). Functional outcome was measured as change in the composite Activity of Daily Living (ADL) limitation score in the HHC episode. RESULTS ADRD was related to a lower likelihood of using any analgesic (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49, 0.90, p = 0.008) and opioids (OR = 0.54, 95% CI: 0.47, 0.62, p < 0.001), but not related to non-opioid analgesic use (OR = 0.94, 95% CI: 0.74, 1.18, p = 0.58). Stratified analyses showed that any analgesic use (β = -0.43, 95% CI: -0.73, -0.13, p = 0.004) and non-opioid analgesic use (β = -0.31, 95% CI: -0.56, -0.06, p = 0.016) were associated with greater ADL improvement in patients with ADRD, but not in patients without ADRD. Opioid use was not significantly related to ADL improvement regardless of ADRD status. CONCLUSIONS HHC patients with ADRD may be undertreated for pain, yet pain treatment is essential for functional improvement in HHC. HHC clinicians and policymakers should ensure adequate pain management for older persons with ADRD for improved functional outcomes.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Kenrick Cato
- Columbia University School of Nursing, New York, New York, USA.,Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, New York, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kathi Heffner
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, New York, New York, USA.,Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.,UR Medicine Home Care, University of Rochester Medical Center, New York, New York, USA.,Finger Lakes Geriatric Education Center, University of Rochester Medical Center, New York, New York, USA
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.,Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York, USA
| | - Todd B Monroe
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Ulrike Muench
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, New York, New York, USA
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McDonald AP, Rizzotti R, Rivera JM, D'Arcy RCN, Park G, Song X. Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives. Aging Med (Milton) 2021; 4:4-11. [PMID: 33738374 PMCID: PMC7954833 DOI: 10.1002/agm2.12144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID-19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health. METHODS Two focus groups enrolled home-living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in-home care for frail older adults were administered at audio-recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software. RESULTS The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology-based supports and suggested that telehealth / health-monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty. CONCLUSIONS The integrated perspectives provided an updated understanding of what older adults and practitioners value in home-living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
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Affiliation(s)
- Andrew P. McDonald
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Joanna M. Rivera
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Ryan C. N. D'Arcy
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Applied SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Grace Park
- Community Actions and Resources Empowering Seniors (CARES)Fraser HealthSurreyBritish ColumbiaCanada
- Home and Community Care MedicineFraser HealthSurreyBritish ColumbiaCanada
| | - Xiaowei Song
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of ScienceSimon Fraser UniversityBurnabyBritish ColumbiaCanada
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Collins TL, Yong KW, Marchetti MT, Miller KL, Booths B, Falvey JR. The Value of Home Health Physical Therapy. Home Healthc Now 2019; 37:145-151. [PMID: 31058732 DOI: 10.1097/nhh.0000000000000760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of the Triple Aim is to improve population health, reduce healthcare costs, and improve the patient experience. These goals-to reduce cost while improving health outcomes and patient experiences have shifted utilization of services from other postacute care settings to the home. The purpose of this perspective article is to discuss how home healthcare services, and home physical therapy (PT) specifically, provide value to patients, caregivers, and payers to meet the goals of the Triple Aim. This article will substantiate the value of home PT and provide healthcare professionals with evidence-based information on the value of home PT.
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Affiliation(s)
- Tracey L Collins
- Tracey L. Collins, PT, PhD, MBA, is a Geriatric Certified Specialist, and Assistant Professor, Department of Physical Therapy, University of Scranton, Scranton, Pennsylvania. Karen W. Yong, PT, MPT, is a Physical Therapist, ANX Home Healthcare, Daly City, and Home Rehab Services, Pacifica, California. Mary T. Marchetti, PT, PhD, is a Geriatric Certified Specialist, and Assistant Professor, Duquesne University, Pittsburgh, Pennsylvania. Kenneth L. Miller, PT, DPT, CEEAA, is an Assistant Professor, UNT Health Science Center, Fort Worth, Texas. Brian Booths, DPT, ATC, is a Market Manager, Select Medical, Mechanicsburg, Pennsylvania. Jason R. Falvey, PT, DPT, CEEAA, is a Postdoctoral Fellow, Yale University, New Haven, Connecticut
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Stuck RE, Rogers WA. Supporting trust in home healthcare providers: insights into the care recipients' perspective. Home Health Care Serv Q 2019; 38:61-79. [PMID: 31006351 DOI: 10.1080/01621424.2019.1604462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Successful care in home health for older adults is heavily dependent on the relationships between care recipients and care providers. A key component of that relationship is trust. To investigate trust in this context, we explored what older care recipients perceive as supporting trust in home care providers. Participants discussed three main categories that support trust in a care provider: professional skills (e.g., safety), personal traits (e.g., honesty), and communication (e.g., content). Insights from the care recipients' perspective are utilized to provide training recommendations for developing trust. For example, care providers should complete tasks in the care recipients' preferred manner.
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Affiliation(s)
- Rachel E Stuck
- a School of Psychology , Georgia Institute of Technology , Atlanta , USA
| | - Wendy A Rogers
- b Department of Kinesiology and Community Health , University of Illinois Urbana-Champagne , Champaign , USA
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