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Idris S, Aghanwa S, O'Halloran J, Durey A, Slack-Smith L. Homebound oral care for older adults: A qualitative study of professional carers' perspectives in Perth, Western Australia. Gerodontology 2024; 41:94-100. [PMID: 37454389 DOI: 10.1111/ger.12704] [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] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To examine professional support workers and case managers' (professional carers) perspectives of what promoted or compromised oral health care in homebound adults aged over 65 years in Perth, Western Australia and identify professional carers' need for support in this context. BACKGROUND Accessing dental services can be difficult to navigate and unaffordable for homebound older adults. Paid carers often play a substantial role in facilitating access to services yet there is limited qualitative evidence of the perspectives of these stakeholders. METHODS Given limited evidence in this area, this simple qualitative study was informed by constructivist grounded theory. Participants comprised 15 professional carers of homebound older adults. Transcripts were analysed to identify participant perceptions of key barriers and enablers to providing oral health care. RESULTS Barriers to clients accessing dental care included participants' uncertainty around navigating the dental system, low priority of oral health care, affordability and confusion around who was responsible to provide oral care. Enablers included participants supporting clients' autonomy around oral care, better integration of oral care into primary health care and education and opportunity for training for professional carers. CONCLUSION Ensuring oral health is part of primary health plans, clarifying roles and responsibilities around delivering oral health care to homebound older adults and training carers were key findings. Inter-sectoral collaboration between the dental and aged care sectors can benefit dental practitioners and professional carers in shared learning and has likely flow-on effects for homebound older adults.
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Affiliation(s)
- Safaa Idris
- UWA Dental School, University of Western Australia, Perth, WA, Australia
| | - Somto Aghanwa
- UWA Dental School, University of Western Australia, Perth, WA, Australia
| | | | - Angela Durey
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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O'Reilly-Jacob M, Perloff J, Srinivasan M, Alvarez M, Hoyt A. State Variation in the Utilization of Nurse Practitioner-Provided Home-Based Primary Care: A Medicare Claims Analysis. J Gerontol Nurs 2023; 49:11-17. [PMID: 37126015 DOI: 10.3928/00989134-20230414-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Nurse practitioners (NPs) provide an increasing proportion of home-based primary care, despite restrictive scope of practice laws in approximately one half of states. We examined the relationship between scope of practice laws and state volume of NP-provided home-based primary care by performing an analysis of 2018 to 2019 Medicare claims. For each state we calculated the proportion of total home-based primary care visits by NPs and the proportion of all NPs providing home-based primary care. We used the 2018 American Association of Nurse Practitioners classification of state practice environment. We performed chi-square tests to assess the significance between volume and practice environment. We found that 42% of home-based primary care is delivered by NPs nationally, but substantial variation exists across states. We did not find a discernible or statistically significant pattern of uptake of NP-provided home-based primary care across full, reduced, or restricted states. [Journal of Gerontological Nursing, 49(5), 11-17.].
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Integrated Care Components in Transitional Care Models from Hospital to Home for Frail Older Adults: A Systematic Review. Int J Integr Care 2022; 22:28. [PMID: 35855092 PMCID: PMC9248982 DOI: 10.5334/ijic.6447] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit. Methods This study is part of the European TRANS-SENIOR project. PubMed, CINAHL and Embase were searched for studies in English, German and Dutch that describe a TCM for frail older patients including both pre- and post-discharge components. Results Seventeen studies, covering 15 TCMs were included. All TCMs describe a person-centred, tailored, pro-active and continuous transitional care service. Components like a small sized care team, intensive follow-up, shared decision making and informal caregiver involvement are likely to be associated with reduced hospital readmission and ED visits. Twenty-seven transitional care outcomes were reported: 19 service outcomes, six patient outcomes and two provider outcomes. Conclusion Heterogeneity in content and outcomes complicates between-study comparison, yet several components were identified that improved care outcomes. Patient and provider outcomes should be included in future research.
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Gillespie SM, Li J, Karuza J, Levy C, Dang S, Olsan T, Kinosian B, Intrator O. Factors Associated With Hospitalization by Veterans in Home-Based Primary Care. J Am Med Dir Assoc 2021; 22:1043-1051.e1. [PMID: 33524340 DOI: 10.1016/j.jamda.2020.12.033] [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: 08/12/2020] [Revised: 12/12/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC). DESIGN Retrospective claims-based study. SETTING AND PARTICIPANTS HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497). METHODS Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories. RESULTS More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics. CONCLUSIONS AND IMPLICATIONS Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations.
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Affiliation(s)
- Suzanne M Gillespie
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| | - Jiejin Li
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Geriatrics & Extended Care Data Analysis Center, Office of Geriatrics & Extended Care, Office of Geriatrics and Extended Care, U.S. Department of Veterans Affairs, Washington, DC, USA; Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Jurgis Karuza
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Psychology, SUNY at Buffalo State, Buffalo, NY, USA
| | - Cari Levy
- Veterans Health Administration, ECHCS, Denver-Seattle Center of Innovation for Veterans Centric & Value Driven Care, Aurora, CO, USA; University of Colorado, Anschutz Medical Campus, School of Medicine, Department of Medicine, Division of Health Care Policy and Research, Aurora, CO, USA
| | - Stuti Dang
- Miami Veterans Affairs Healthcare System, Miami, FL, USA; Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, FL, USA; Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tobie Olsan
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA
| | - Bruce Kinosian
- Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Cpl Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Orna Intrator
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Geriatrics & Extended Care Data Analysis Center, Office of Geriatrics & Extended Care, Office of Geriatrics and Extended Care, U.S. Department of Veterans Affairs, Washington, DC, USA; Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
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Malone ML, Fain MJ. Building the Infrastructure for Rapid Implementation of High‐Value Home‐Care Delivery Models. J Am Geriatr Soc 2020; 68:1400-1401. [DOI: 10.1111/jgs.16473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mindy J. Fain
- Division of Geriatrics, General Internal Medicine and Palliative MedicineUniversity of Arizona Center on Aging Tucson Arizona
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Major-Monfried H, DeCherrie LV, Wajnberg A, Zhang M, Kelley AS, Ornstein KA. Managing Pain in Chronically Ill Homebound Patients Through Home-Based Primary and Palliative Care. Am J Hosp Palliat Care 2018; 36:333-338. [PMID: 30587000 DOI: 10.1177/1049909118820846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Many older adults are homebound due to chronic illness and suffer from significant symptoms, including pain. Home-based primary and palliative care (HBPC), which provides interdisciplinary medical and psychosocial care for this population, has been shown to significantly reduce symptom burden. However, little is known about how pain is managed in the homebound. OBJECTIVE: This article describes pain management for chronically, ill homebound adults in a model, urban HBPC program. DESIGN/MEASUREMENTS: This was a prospective observational cohort study of newly enrolled HBPC patients, who completed a baseline Edmonton Symptom Assessment System (ESAS) survey during the initial HBPC visit (N = 86). Baseline pain burden was captured by ESAS and pain severity was categorized as none, mild, or moderate-severe. All pain-related assessments and treatments over a 6-month period were categorized by medication type and titration, referrals to outside providers, procedures, and equipment. RESULTS: At baseline, 55% of the study population had no pain, 18% had mild pain, and 27% had moderate-severe pain. For those with moderate-severe pain at baseline (n = 23), prescriptions for pharmacological treatments for pain, such as opiates and acetaminophen, increased during the study period from 48% to 57% and 52% to 91%, respectively. Nonpharmacological interventions, including referrals to outside providers such as physical therapy, procedures, and equipment for pain management, were also common and 67% of the study population received a service referral during the follow-up period. CONCLUSIONS: Pharmacological and nonpharmacological treatments are widely used in the setting of HBPC to treat the pain of homebound, older adults.
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Affiliation(s)
- Hannah Major-Monfried
- 1 Department of Pediatrics, Columbia University Medical Center, New York City, NY, USA
| | - Linda V DeCherrie
- 2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ania Wajnberg
- 3 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Meng Zhang
- 3 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Amy S Kelley
- 2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Katherine A Ornstein
- 2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,3 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Reckrey JM, DeCherrie LV, Dugue M, Rosen A, Soriano TA, Ornstein K. Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program. ACTA ACUST UNITED AC 2018; 16:122-8. [PMID: 26414814 DOI: 10.1891/1521-0987.16.3.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The growing population of homebound adults increasingly receives home-based primary care (HBPC) services. These patients are predominantly frail older adults who are homebound because of multiple medical comorbidities, yet they often also have psychiatric diagnoses requiring mental health care. Unfortunately, in-home psychiatric services are rarely available to homebound patients. To address unmet psychiatric need among the homebound patients enrolled in our large academic HBPC program, we piloted a psychiatric in-home consultation service. During our 16-month pilot, 10% of all enrolled HBPC patients were referred for and received psychiatric consultation. Depression and anxiety were among the most common reasons for referral. To better meet patients' medical and psychiatric needs, HBPC programs need to consider strategies to incorporate psychiatric services into their routine care plans.
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Using Nurse Practitioner Co-Management to Reduce Hospitalizations and Readmissions Within a Home-Based Primary Care Program. J Healthc Qual 2018; 39:249-258. [PMID: 27631706 DOI: 10.1097/jhq.0000000000000059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse practitioner (NP) co-management involves an NP and physician sharing responsibility for the care of a patient. This study evaluates the impact of NP co-management for clinically complex patients in a home-based primary care program on hospitalizations, 30-day hospital readmissions, and provider satisfaction. We compared preenrollment and postenrollment hospitalization and 30-day readmission rates of home-bound patients active in the Nurse Practitioner Co-Management Program within the Mount Sinai Visiting Doctors Program (MSVD) (n = 87) between January 1, 2012, and July 1, 2013. Data were collected from electronic medical records. An anonymous online survey was administered to all physicians active in the MSVD in July 2013 (n = 13).After enrollment in co-management, patients have lower annual hospitalization rates (1.26 vs. 2.27, p = .005) and fewer patients have 30-day readmissions (5.8% vs. 17.2%, p = .004). Eight of 13 physicians feel "much" or "somewhat" less burned out by their work after implementation of co-management. The high level of provider satisfaction and reductions in annual hospitalization and readmission rates among high-risk home-bound patients associated with NP co-management may yield not only benefits for patients, caregivers, and providers but also cost savings for institutions.
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9
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Kim CO, Jang SN. Home-Based Primary Care for Homebound Older Adults: Literature Review. Ann Geriatr Med Res 2018; 22:62-72. [PMID: 32743249 PMCID: PMC7387609 DOI: 10.4235/agmr.2018.22.2.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/18/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022] Open
Abstract
Home-based primary care (HBPC) refers to the type of home care services which provide interdisciplinary primary care services with a comprehensive and continuous manner. Currently, it is getting much attention due to possess potential of converting primary care services from outpatient clinic to home, especially for those who are medically isolated including homebound older adults. This study examined a number of HBPCs introduced in the literature since 1990s, and summarizes the key factors with the analytic framework of 5Ps: purpose, patients, people, process, patterns. The results of this study emphasize that contents of primary care for older population should be different from those of the general population. This paper may be interpreted as the practice guideline of the following policy questions: “How can we design the HBPC if it is introduced in the nearest future?” In the future, it is necessary to have a heated debate concerning what is the most desirable primary care system for older adults.
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Affiliation(s)
- Chang-O Kim
- Institute of Social Welfare, Sungkonghoe University, Seoul, Korea.,Clinical Research Center, Yangji Hospital, Seoul, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Schamess A, Foraker R, Kretovics M, Barnes K, Beatty S, Bose-Brill S, Tayal N. Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care. Disabil Health J 2017; 10:326-333. [DOI: 10.1016/j.dhjo.2016.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 02/04/2023]
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Smith-Carrier T, Sinha SK, Nowaczynski M, Akhtar S, Seddon G, Pham TNT. It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:723-733. [PMID: 27287281 DOI: 10.1111/hsc.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.
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Affiliation(s)
- Tracy Smith-Carrier
- School of Social Work, King's University College at Western University, London, Ontario, Canada
| | - Samir K Sinha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Johns Hopkins University School of Medicine, Balitmore, Maryland, USA
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Nowaczynski
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- House Calls: Interdisciplinary Healthcare for Homebound Seniors, SPRINT Senior Care, Toronto, Ontario, Canada
| | - Sabrina Akhtar
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Home-Based Care Program, Toronto Western Family Health Team, Toronto, Ontario, Canada
| | - Gayle Seddon
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | - Thuy-Nga Tia Pham
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto, Ontario, Canada
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Jones MG, Ornstein KA, Skovran DM, Soriano TA, DeCherrie LV. Characterizing the high-risk homebound patients in need of nurse practitioner co-management. Geriatr Nurs 2016; 38:213-218. [PMID: 27876403 DOI: 10.1016/j.gerinurse.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/28/2016] [Accepted: 10/27/2016] [Indexed: 11/19/2022]
Abstract
By providing more frequent provider visits, prompt responses to acute issues, and care coordination, nurse practitioner (NP) co-management has been beneficial for the care of chronically ill older adults. This paper describes the homebound patients with high symptom burden and healthcare utilization who were referred to an NP co-management intervention and outlines key features of the intervention. We compared demographic, clinical, and healthcare utilization data of patients referred for NP co-management within a large home-based primary care (HBPC) program (n = 87) to patients in the HBPC program not referred for co-management (n = 1027). A physician survey found recurrent hospitalizations to be the top reason for co-management referral and a focus group with nurses and social workers noted that co-management patients are typically those with active medical issues more so than psychosocial needs. Co-management patients are younger than non-co-management patients (72.31 vs. 80.30 years old, P < 0.001), with a higher mean Charlson comorbidity score (3.53 vs. 2.47, P = 0.0001). They have higher baseline annual hospitalization rates (2.27 vs. 0.61, P = 0.0005) and total annual home visit rates (13.1 vs. 6.60, P = 0.0001). NP co-management can be utilized in HBPC to provide intensive medical management to high-risk homebound patients.
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Affiliation(s)
- Masha G Jones
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - David M Skovran
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Theresa A Soriano
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Linda V DeCherrie
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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Wajnberg A, Soones TN, Smith KL, Russell D, Ross JS, Federman A. Identifying Sociodemographic Characteristics Associated With Burden Among Caregivers of the Urban Homebound: The Importance of Racial and Relationship Differences. Gerontol Geriatr Med 2016; 2:2333721416667878. [PMID: 28913372 PMCID: PMC5590692 DOI: 10.1177/2333721416667878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022] Open
Abstract
Limited research has explored whether the burden associated with caring for homebound patients varies across racial groups or by relationship status. We examined these variations for this vulnerable population. Patients self-identified informal caregivers and caregiver burden/depression were assessed using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies–Depression scale (CES-D). Forty-nine informal caregivers completed the interview. Mean age was 58 (SD = 14), 78% were female, 37% Black, 35% Hispanic, and 46% had completed high school. Over 60% of caregivers had moderate or severe caregiver burden and 30% had significant depression. White caregivers had greater burden than Black and Hispanic caregivers (p = .02). Mean caregiver burden was higher among spouse/partner caregivers, versus those who identified as children or other family or friends (p = .004). Additional research is needed to better understand the experience of racial and ethnic minorities and spouses in providing informal care to homebound adults.
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Affiliation(s)
| | | | | | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Services of New York, NY, USA
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Thomas JE, Jacobs RJ, Caballero J, Ownby RL, Lessmann EM, Mallare K, Adler M. Factors to assess depression in homebound older adults. Ment Health Clin 2016; 6:236-241. [PMID: 29955476 PMCID: PMC6007589 DOI: 10.9740/mhc.2016.09.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The number of homebound older adults is expected to increase as the elderly population grows. Many homebound older persons may be at high risk for depression, which has been associated with adverse health outcomes. The objective of this study was to identify selected factors that may predict depression in the homebound older population. Methods: Data from 340 homebound adults, aged 65 and older who were enrolled in Broward Meals on Wheels and who participated in a telephone survey were analyzed. Participants were asked to report demographic information, health status, medication-taking behaviors, mental health, and life satisfaction. Multiple regression analysis was used to identify predictors of depressed mood in this sample of older adults. Results: The majority of the sample (aged 65–95 years; mean, 77 years) were female (76.5%), white (77.1%), and living alone (52.6%). Multivariate modeling indicated that difficulty remembering the number of prescribed medications to be taken, feeling groggy after taking certain medications, poor self-reported health status, taking anxiety medications, and less satisfaction with life explained 34% (adjusted R2) of the variance in predicting depressed mood (F = 33.1, df = 5, P < .001). Discussion: Multiple factors related to medication use were identified that may contribute to higher levels of depressed mood in homebound older adults. These factors found in our study may be used to create a screening model to be used by pharmacists to identify homebound older adults who would benefit from further assessment for depression.
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Affiliation(s)
- Jennifer E. Thomas
- Assistant Professor, School of Pharmacy, Husson University, Bangor, Maine
| | - Robin J. Jacobs
- Associate Professor, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Joshua Caballero
- (Corresponding author) Associate Professor, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida,
| | - Raymond L. Ownby
- Professor, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Kayla Mallare
- Pharmacy Student, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mark Adler
- Executive Director, Broward Meals on Wheels, Plantation, Florida
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Shafir A, Garrigues SK, Schenker Y, Leff B, Neil J, Ritchie C. Homebound Patient and Caregiver Perceptions of Quality of Care in Home-Based Primary Care: A Qualitative Study. J Am Geriatr Soc 2016; 64:1622-7. [PMID: 27384919 DOI: 10.1111/jgs.14244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess patient and caregiver perceptions of what constitutes quality care in home-based primary care (HBPC). DESIGN Cross-sectional qualitative design; semistructured interview study. SETTING Academic home-based primary care program. PARTICIPANTS Homebound patients (n = 13) and 10 caregivers (n = 10) receiving HBPC. MEASUREMENTS Semistructured interviews explored experiences with a HBPC program and perceptions of quality care. Interviews were audio-recorded and transcribed. Qualitative content analysis was performed to identify major themes. RESULTS Five major themes emerged related to participant perceptions of quality care: access, affordability, competency, care coordination, goal attainment. Participants felt that reliable, consistent access provided "peace of mind" and reduced hospital and emergency department use. Insurance coverage of program costs and coordinated care provided by an interdisciplinary team were positively regarded. Interpersonal skills and technical abilities of providers influenced patient perception of provider competency. Assessing and helping patients attain care goals contributed to a perception of quality care. CONCLUSION Patients and caregivers associate high-quality HBPC with around-the-clock access to affordable interdisciplinary providers with strong interpersonal skills and technical competency. These results expand on prior research and are concordant with HBPC goals of around-the-clock access to multidisciplinary teams with the goals of reduced emergency department and hospital use. HBPC programs should be structured to optimize access, affordability, coordinated care, and goal ascertainment and alignment. Quality indicators should be created and validated with these patient and caregiver views of care quality in mind.
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Affiliation(s)
- Adi Shafir
- UPMC Internal Medicine Residency Program, Pittsburgh, Pennsylvania
| | - Sarah K Garrigues
- Division of Geriatrics, University of California at San Francisco, San Francisco, California
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jessica Neil
- University of California at San Francisco Internal Medicine Residency Program, San Francisco
| | - Christine Ritchie
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Jewish Home of San Francisco Center for Research on Aging, San Francisco, California
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Yang N, Ornstein KA, Reckrey JM. Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound. J Pain Symptom Manage 2016; 52:73-80. [PMID: 27033155 PMCID: PMC5369236 DOI: 10.1016/j.jpainsymman.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/10/2016] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Homebound adults experience significant symptom burden. OBJECTIVES To examine demographic and clinical characteristics associated with high symptom burden in the homebound, and to examine associations between symptom burden and time to hospitalization, nursing home placement, and death. METHODS Three hundred eighteen patients newly enrolled in the Mount Sinai Visiting Doctors Program, an urban home-based primary care program, were studied. Patient sociodemographic characteristics, symptom burden (measured via the Edmonton Symptom Assessment Scale), and incidents of hospitalization, nursing home placement, and death were collected via medical chart review. Multivariate Cox proportional hazards models were used to analyze the effect of high symptom burden on time to first hospitalization, nursing home placement, and death. RESULTS Of the study sample, 45% had severe symptom burden (i.e., Edmonton Symptom Assessment Scale score >6 on at least one symptom). Patients with severe symptom burden were younger (82.0 vs. 85.5 years, P < 0.01), had more comorbid conditions (3.2 vs. 2.5 Charlson score, P < 0.01), higher prevalence of depression (43.4% vs. 12.0%, P < 0.01), lower prevalence of dementia (34.3% vs. 60.6%, P < 0.01), and used fewer hours of home health services (73.6 vs. 94.4 hours/wk, P < 0.01). Severe symptom burden was associated with a shorter time to first hospitalization (hazard ratio = 1.51, 95% CI 1.06-2.15) in adjusted models but had no association with time to nursing home placement or death. CONCLUSION The homebound with severe symptom burden represents a unique cohort of patients who are at increased risk of hospitalization. Tailored symptom management via home-based primary and palliative care programs may prevent unnecessary health care utilization in this population.
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Affiliation(s)
- Nancy Yang
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ornstein KA, Leff B, Covinsky KE, Ritchie CS, Federman AD, Roberts L, Kelley AS, Siu AL, Szanton SL. Epidemiology of the Homebound Population in the United States. JAMA Intern Med 2015; 175:1180-6. [PMID: 26010119 PMCID: PMC4749137 DOI: 10.1001/jamainternmed.2015.1849] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Increasing numbers of older, community-dwelling adults have functional impairments that prevent them from leaving their homes. It is uncertain how many people who live in the United States are homebound. OBJECTIVES To develop measures of the frequency of leaving and ability to leave the home and to use these measures to estimate the size of the homebound population in the US population. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional data from the National Health and Aging Trends Study collected in 2011 in the contiguous United States. Participants were a nationally representative sample of 7603 noninstitutionalized Medicare beneficiaries 65 years and older. MAIN OUTCOMES AND MEASURES We defined homebound persons as those who never (completely homebound) or rarely (mostly homebound) left the home in the last month. We defined semihomebound persons as those who only left the home with assistance or had difficulty or needed help leaving the home. We compared demographic, clinical, and health care utilization characteristics across different homebound status categories. RESULTS In 2011, the prevalence of homebound individuals was 5.6% (95% CI, 5.1%-6.2%), including an estimated 395,422 people who were completely homebound and 1,578,984 people who were mostly homebound. Among semihomebound individuals, the prevalence of those who never left home without personal assistance was 3.3% (95% CI, 2.8%-3.8%), and the prevalence of those who required help or had difficulty was 11.7% (95% CI, 10.9%-12.6%). Completely homebound individuals were more likely to be older (83.2 vs 74.3 years, P < .001), female (67.9% vs 53.4%, P < .006), and of nonwhite race (34.1% vs 17.6%, P < .001) and have less education and income than nonhomebound individuals. They also had more chronic conditions (4.9 vs 2.5) and were more likely to have been hospitalized in the last 12 months (52.1% vs 16.2%) (P < .001 for both). Only 11.9% of completely homebound individuals reported receiving primary care services at home. CONCLUSIONS AND RELEVANCE In total, 5.6% of the elderly, community-dwelling Medicare population (approximately 2 million people) were completely or mostly homebound in 2011. Our findings can inform improvements in clinical and social services for these individuals.
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Affiliation(s)
- Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York2Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York3Division of General Internal Medicine, Depa
| | - Bruce Leff
- Division of Geriatric Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland5Department of Community and Public Health, School of Nursing, The Johns Hopkins University, Baltimore, Maryland6Department of Health Policy and Manag
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Alex D Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laken Roberts
- Department of Community and Public Health, School of Nursing, The Johns Hopkins University, Baltimore, Maryland
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York8Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Albert L Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York8Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Sarah L Szanton
- Department of Community and Public Health, School of Nursing, The Johns Hopkins University, Baltimore, Maryland6Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Reckrey JM, Soriano TA, Hernandez CR, DeCherrie LV, Chavez S, Zhang M, Ornstein K. The team approach to home-based primary care: restructuring care to meet individual, program, and system needs. J Am Geriatr Soc 2015; 63:358-64. [PMID: 25645568 DOI: 10.1111/jgs.13196] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address individual, program, and system needs, a portion of a large, physician-led academic home-based primary care practice was restructured into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. The Team Approach is an innovative way to improve interdisciplinary, team-based care through practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound.
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Affiliation(s)
- Jennifer M Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai School of Medicine, New York City, New York; Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai School of Medicine, New York City, New York
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Ornstein KA, DeCherrie L, Gluzman R, Scott ES, Kansal J, Shah T, Katz R, Soriano TA. Significant unmet oral health needs of homebound elderly adults. J Am Geriatr Soc 2014; 63:151-7. [PMID: 25537919 DOI: 10.1111/jgs.13181] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health. DESIGN Cross-sectional analysis. SETTING Participants' homes in New York City. PARTICIPANTS Homebound elderly adults (N = 125). MEASUREMENTS A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index. RESULTS Participants who reported a high level of unmet oral health needs were more likely to be nonwhite, although this effect was not significant in multivariate analysis. Individual medical diagnoses and the presence of multiple comorbidities were not associated with unmet oral health needs. CONCLUSION The oral health status of homebound elderly adults was poor regardless of their medical diagnoses. High unmet oral health needs combined with strong desire to receive dental care suggests there is a need to improve access to dental care for this growing population. In addition to improving awareness of geriatricians and primary care providers who care for homebound individuals, the medical community must partner with the dental community to develop home-based programs for older adults.
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Affiliation(s)
- Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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20
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Mahon GM. Home care, need for increased physician involvement in the 21st century. J Am Med Dir Assoc 2014; 15:538-40. [PMID: 24930090 DOI: 10.1016/j.jamda.2014.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Gerald M Mahon
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
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Pedowitz EJ, Ornstein KA, Farber J, DeCherrie LV. Time providing care outside visits in a home-based primary care program. J Am Geriatr Soc 2014; 62:1122-6. [PMID: 24802078 DOI: 10.1111/jgs.12828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. DESIGN Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. SETTING MSVD, an academic home-visit program in Manhattan, New York. PARTICIPANTS All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. MEASUREMENTS Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. RESULTS Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. CONCLUSION Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care.
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Pittman P, Horton K, Terry M, Bass E. Residency Programs for Home Health and Hospice Nurses. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2014. [DOI: 10.1177/1084822313511457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” calls for “transition-to-practice” residencies for new nurses and nurses transferring to new types of settings. In this study, we examine the current residency landscape for home health and hospice nurses and compare it with responses from their peers in hospitals and nurse-led primary care clinics. We find that just 2% of surveyed home health and hospice settings offer residencies, while almost 49% of hospitals and 11% of nurse-led primary care clinics provide them. Major barriers cited include lack of available preceptors and financial costs. We discuss ways in which the federal government could help spur the development of residencies in this sector.
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Affiliation(s)
| | | | - Margaret Terry
- Visiting Nurse Associations of America, Washington, DC, USA
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Reckrey JM, Gettenberg G, Ross H, Kopke V, Soriano T, Ornstein K. The critical role of social workers in home-based primary care. SOCIAL WORK IN HEALTH CARE 2014; 53:330-43. [PMID: 24717182 PMCID: PMC4790723 DOI: 10.1080/00981389.2014.884041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.
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Reckrey JM, Decherrie LV, Kelley AS, Ornstein K. Health care utilization among homebound elders: does caregiver burden play a role? J Aging Health 2013; 25:1036-49. [PMID: 23922332 DOI: 10.1177/0898264313497509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe informal caregiver and patient characteristics associated with high caregiver burden in homebound elders and to examine associations between high caregiver burden and patient health care utilization at the practice level. METHOD We used a cross-sectional and prospective cohort design to study 214 caregiver-patient dyads in a home-based primary care program. RESULTS Informal caregivers with the highest burden were more likely to help with more activities of daily living and instrumental activities of daily living and spend >40 hr/week in caregiving. Patients whose caregivers experienced the highest burden were more likely to be non-White males without 24-hr paid homecare. There were no significant independent associations between high burden and high calls, high visits, or social work involvement. DISCUSSION In this medically complex and highly dependent population, further study of how families and other caregivers impact health care utilization is needed.
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Ornstein K, Wajnberg A, Kaye-Kauderer H, Winkel G, DeCherrie L, Zhang M, Soriano T. Reduction in symptoms for homebound patients receiving home-based primary and palliative care. J Palliat Med 2013; 16:1048-54. [PMID: 23746230 DOI: 10.1089/jpm.2012.0546] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods. OBJECTIVES The purpose of this study was to determine whether high symptom burden decreases following HBPC enrollment. METHODS All patients newly enrolled in an HBPC program who reported at least one symptom on the Edmonton Symptom Assessment Scale (ESAS) were eligible for telephone ESAS follow-up. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow-up care, interdisciplinary care management including social work, and urgent in-home care as necessary. Multivariate linear mixed models with repeated measures were used to assess the impact of HBPC on pain, depression, anxiety, tiredness, and loss of appetite among patients with moderate to severe symptom levels at baseline. RESULTS One hundred forty patients were followed. Patient pain, anxiety, depression, and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks. (p<0.01) Loss of appetite trended toward an overall significant decrease and showed significant reductions at 12 week follow-up. CONCLUSION In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.
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Affiliation(s)
- Katherine Ornstein
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
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Abstract
PURPOSE OF REVIEW To summarize the current United States healthcare system and describe current models of palliative care delivery. RECENT FINDINGS Palliative care services in the USA have been heavily influenced by the public-private fee-for-service reimbursement system. Hospice provides care for 46% of adults at the end-of-life under the Medicare hospice benefit. Palliative care teams in hospitals have rapidly expanded to provide care for seriously ill patients irrespective of prognosis. To date, over two-thirds of all hospitals and over 85% of mid to large size hospitals report a palliative care team. With the passage of the Patient Protection and Affordable Care Act of 2010, healthcare reform provides an opportunity for new models of care. SUMMARY Palliative care services are well established within hospitals and hospice. Future work is needed to develop quality metrics, create care models that provide services in the community, and increase the palliative care workforce.
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Affiliation(s)
- R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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Gluzman R, Meeker H, Agarwal P, Patel S, Gluck G, Espinoza L, Ornstein K, Soriano T, Katz RV. Oral health status and needs of homebound elderly in an urban home-based primary care service. SPECIAL CARE IN DENTISTRY 2012; 33:218-26. [PMID: 23980554 DOI: 10.1111/j.1754-4505.2012.00316.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program. METHODS Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team. RESULTS Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58). CONCLUSION Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.
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Affiliation(s)
- R Gluzman
- Department of Epidemiology & Health Promotion, NYU College of Dentistry, NY, USA
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Wajnberg A, Ornstein K, Zhang M, Smith KL, Soriano T. Symptom burden in chronically ill homebound individuals. J Am Geriatr Soc 2012. [PMID: 23205716 DOI: 10.1111/jgs.12038] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To document the degree of symptom burden in an urban homebound population. DESIGN Cross-sectional survey. SETTING The Mount Sinai Visiting Doctors (MSVD) program. PARTICIPANTS All individuals newly enrolled in the MSVD. MEASUREMENTS Edmonton Symptom Assessment Scale (ESAS), which consists of 10 visual analogue scales scored from 0 to 10; symptoms include pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, shortness of breath, and other. RESULTS ESAS scores were completed for 318 participants. Most participants were aged 80 and older (68%) and female (75%); 36% were white, 22% black, and 32% Hispanic. Forty-three percent had Medicaid, and 32% lived alone. Ninety-one percent required assistance with one or more activities of daily living, 45% had a Karnofsky Performance Scale score between 0 and 40 (unable to care for self), and 43% reported severe burden on one or more symptoms. The most commonly reported symptoms were loss of appetite, lack of well-being, tiredness, and pain; the symptoms with the highest scores were depression, pain, appetite, and shortness of breath. Participants were more likely to have severe symptom burden if they self-reported their ESAS, had chronic obstructive pulmonary disease or diabetes mellitus with end organ damage, or had a Charlson Comorbidity Index greater than 3 and less likely to have severe burden if they had dementia. CONCLUSION In chronically ill homebound adults, symptom burden is a serious problem that needs to be addressed alongside primary and specialty care needs.
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Affiliation(s)
- Ania Wajnberg
- Mount Sinai Visiting Doctors Program, Division of General Internal Medicine, Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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DeCherrie LV, Soriano T, Hayashi J. Home-Based Primary Care: A Needed Primary-Care Model for Vulnerable Populations. ACTA ACUST UNITED AC 2012; 79:425-32. [DOI: 10.1002/msj.21321] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ballard J, Mooney M, Dempsey O. Prevalence of frailty-related risk factors in older adults seen by community nurses. J Adv Nurs 2012; 69:675-84. [DOI: 10.1111/j.1365-2648.2012.06054.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosenberg T. Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community-Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home. J Am Geriatr Soc 2012; 60:1340-6. [DOI: 10.1111/j.1532-5415.2012.03965.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ted Rosenberg
- Department of Family Medicine; University of British Columbia and Island Medical Program; University of Victoria; Victoria; British Columbia; Canada
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Suter E, Deutschlander S, Mickelson G, Nurani Z, Lait J, Harrison L, Jarvis-Selinger S, Bainbridge L, Achilles S, Ateah C, Ho K, Grymonpre R. Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis. J Interprof Care 2012; 26:261-8. [DOI: 10.3109/13561820.2012.663014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Foer D, Ornstein K, Soriano TA, Kathuria N, Dunn A. Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population. J Hosp Med 2012; 7:73-8. [PMID: 22173979 DOI: 10.1002/jhm.992] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/20/2011] [Accepted: 09/16/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prolonged length of stay (LOS) is a major concern for hospitalized populations at risk for adverse events. Homebound patients are at particular risk for long stays and may have unique discharge needs because of their commitment to be cared for at home despite poor functional status. OBJECTIVE The goal of this study was to describe factors contributing to long hospitalizations in the homebound population. DESIGN This retrospective observational pilot study included all 2007 discharges that occurred for patients at The Mount Sinai Hospital enrolled in the Mount Sinai Visiting Doctors Program. MEASURES Long-stay patients were defined as those having an LOS 2 standard deviations above the mean. Hospitalization days were defined as "nonmedical" when patients medically ready for discharge remained in the hospital. Patients discharged immediately after determination of medical readiness were characterized as "medical stay" cases. The University HealthSystems Consortium Database was used to calculate expected LOS and the LOS ratio. Chart reviews were performed to describe long-stay cases as nonmedical or medical. RESULTS The average LOS for 479 discharges was 7.84 days, with a mean LOS Ratio of 1.23. Seventeen cases were determined to be long stays. Eight of these cases (47%) were defined as nonmedical stays. These accounted for 136 days of hospitalization and 32% of total long-stay days. The most common reason for a nonmedical stay was nursing facility placement delay. CONCLUSIONS Nonmedical factors accounted for nearly one-third of all long-stay days in the hospitalized homebound population. Increased interdisciplinary collaboration may help address homebound patient LOS.
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Affiliation(s)
- Dinah Foer
- Yale University School of Medicine, New Haven, CT, USA.
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Jain R, Dasari S, Soriano T, DeCherrie L, Kerr LD. Rheumatologists on the road: A subspecialist's role in caring for the homebound. Arthritis Care Res (Hoboken) 2011; 63:1482-5. [DOI: 10.1002/acr.20539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Banach DB, Ornstein K, Factor SH, Soriano TA. Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City. J Community Health 2011; 37:10-4. [DOI: 10.1007/s10900-011-9409-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chang HT, Lai HY, Hwang IH, Ho MM, Hwang SJ. Home healthcare services in Taiwan: a nationwide study among the older population. BMC Health Serv Res 2010; 10:274. [PMID: 20854692 PMCID: PMC2955015 DOI: 10.1186/1472-6963-10-274] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 09/21/2010] [Indexed: 12/01/2022] Open
Abstract
Background Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan. Methods Patients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored. Results Among 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9%) patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%). More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%). Conclusions Nine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.
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Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou Dist, Taipei City 11217, Taiwan
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Olsan TH, Shore B, Coleman PD. A Clinical Microsystem Model to Evaluate the Quality of Primary Care for Homebound Older Adults. J Am Med Dir Assoc 2009; 10:304-13. [DOI: 10.1016/j.jamda.2009.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Revised: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
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Beck RA, Arizmendi A, Purnell C, Fultz BA, Callahan CM. House calls for seniors: building and sustaining a model of care for homebound seniors. J Am Geriatr Soc 2009; 57:1103-9. [PMID: 19457154 DOI: 10.1111/j.1532-5415.2009.02278.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Homebound seniors suffer from high levels of functional impairment and are high-cost users of acute medical services. This article describes a 7-year experience in building and sustaining a physician home visit program. The House Calls for Seniors program was established in 1999. The team includes a geriatrician, geriatrics nurse practitioner, and social worker. The program hosts trainees from multiple disciplines. The team provides care to 245 patients annually. In 2006, the healthcare system (62%), provider billing (36%), and philanthropy (2%) financed the annual program budget of $355,390. Over 7 years, the team has enrolled 468 older adults; the mean age was 80, 78% were women, and 64% were African American. One-third lived alone, and 39% were receiving Medicaid. Reflecting the disability of this cohort, 98% had impairment in at least one instrumental activity of daily living (mean 5.2), 71% had impairment in at least one activity of daily living (mean 2.6), 53% had a Mini-Mental State Examination score of 23 or less, 43% were receiving services from a home care agency, and 69% had at least one new geriatric syndrome diagnosed by the program. In the year after intake into the program, patients had an average of nine home visits; 21% were hospitalized, and 59% were seen in the emergency department. Consistent with the program goals, primary care, specialty care, and emergency department visits declined in the year after enrollment, whereas access and quality-of-care targets improved. An academic physician house calls program in partnership with a healthcare system can improve access to care for homebound frail older adults, improve quality of care and patient satisfaction, and provide a positive learning experience for trainees.
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Affiliation(s)
- Robin A Beck
- Division of General Internal Medicine and Geriatrics, Department of Medicine, School of Medicine, Indiana University, 1001 West 10th Street, WOP-M200, Indianapolis, IN 46202, USA.
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Ornstein K, Smith KL, Boal J. Understanding and Improving the Burden and Unmet Needs of Informal Caregivers of Homebound Patients Enrolled in a Home-Based Primary Care Program. J Appl Gerontol 2009; 28:482-503. [DOI: 10.1177/0733464808329828] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing homebound population is heavily reliant on informal caregivers, who are increasingly burdened by their roles. This study describes informal caregivers of the homebound who remain caregivers at a 9-month follow-up and examines the impact of a home-based primary care (HBPC) program on caregiver burden and unmet needs using a prospective design with a pre—post intervention assessment. Informal caregivers of the urban homebound are similar to caregivers of other populations and have a broad range of unmet needs. The intervention described is the regular provision of multidisciplinary HBPC. Hundred fourteen caregivers of newly admitted patients complete a baseline interview. For the 56 caregivers who complete a 9-month follow-up interview, participation in HBPC is associated with a statistically significant decrease in overall caregiver burden. At 9 months, caregivers demonstrate an overall decrease in unmet needs, with a statistically significant decrease across two measured domains. These results suggest that the regular provision of multidisciplinary care in the home can mitigate the deleterious impact of informal caregiving.
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Affiliation(s)
| | - Kristofer L. Smith
- The Samuel Bronfman Department of Medicine, The Mount
Sinai School of Medicine, New York
| | - Jeremy Boal
- Long Island Jewish Medical Center, North Shore-LIJ Health
System
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Kao H, Conant R, Soriano T, McCormick W. The Past, Present, and Future of House Calls. Clin Geriatr Med 2009; 25:19-34, v. [DOI: 10.1016/j.cger.2008.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chang C, Jackson SS, Bullman TA, Cobbs EL. Impact of a Home-Based Primary Care Program in an Urban Veterans Affairs Medical Center. J Am Med Dir Assoc 2009; 10:133-7. [DOI: 10.1016/j.jamda.2008.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 07/17/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
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