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Song J, Min SH, Chae S, Bowles KH, McDonald MV, Hobensack M, Barrón Y, Sridharan S, Davoudi A, Oh S, Evans L, Topaz M. Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care. J Am Med Inform Assoc 2023; 30:1801-1810. [PMID: 37339524 PMCID: PMC10586044 DOI: 10.1093/jamia/ocad101] [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: 03/06/2023] [Revised: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE This study aimed to identify temporal risk factor patterns documented in home health care (HHC) clinical notes and examine their association with hospitalizations or emergency department (ED) visits. MATERIALS AND METHODS Data for 73 350 episodes of care from one large HHC organization were analyzed using dynamic time warping and hierarchical clustering analysis to identify the temporal patterns of risk factors documented in clinical notes. The Omaha System nursing terminology represented risk factors. First, clinical characteristics were compared between clusters. Next, multivariate logistic regression was used to examine the association between clusters and risk for hospitalizations or ED visits. Omaha System domains corresponding to risk factors were analyzed and described in each cluster. RESULTS Six temporal clusters emerged, showing different patterns in how risk factors were documented over time. Patients with a steep increase in documented risk factors over time had a 3 times higher likelihood of hospitalization or ED visit than patients with no documented risk factors. Most risk factors belonged to the physiological domain, and only a few were in the environmental domain. DISCUSSION An analysis of risk factor trajectories reflects a patient's evolving health status during a HHC episode. Using standardized nursing terminology, this study provided new insights into the complex temporal dynamics of HHC, which may lead to improved patient outcomes through better treatment and management plans. CONCLUSION Incorporating temporal patterns in documented risk factors and their clusters into early warning systems may activate interventions to prevent hospitalizations or ED visits in HHC.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York City, New York, USA
| | - Se Hee Min
- Columbia University School of Nursing, New York City, New York, USA
| | - Sena Chae
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | | | - Mollie Hobensack
- Columbia University School of Nursing, New York City, New York, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sungho Oh
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York City, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Data Science Institute, Columbia University, New York City, New York, USA
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Dolu İ, Hayter M, Serrant L. Transitional care of older ethnic minority patients: An integrative review. J Adv Nurs 2023; 79:3225-3257. [PMID: 37248540 DOI: 10.1111/jan.15722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
AIMS To critically synthesize the empirical literature on practice in transitional care and how to meet the care needs of older ethnic minority populations who discharged from hospital to community. DESIGN An integrative literature review integrating empirical studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Web of Science, PsycINFO, EBSCO (including CINAHL and MEDLINE) and Scopus were searched for papers published between 2012 and September 2022. REVIEW METHODS Full-text papers were screened against inclusion and exclusion criteria subsequent to screening titles and abstracts. All included papers were evaluated for methodological quality using the Critical Appraisal Skills Programme Checklists. After extracting findings, themes were created by critically examining and synthesizing of findings. RESULTS The search yielded a total of 1180 studies, 1153 after removing duplicates and 27 papers meeting the inclusion criteria and exclusion criteria were included in the review. The main findings were categorized into four themes: (i) intervention-related outcomes; (ii) unmet needs of older minority people; (iii) transitional care-related characteristics of older minority people and (iv) challenges for healthcare providers. Findings indicated that the transitional care experience of ethnic minority older populations differed from natives to some extent which revealed unmet needs addressing how to provide culturally appropriate transitional care for this population. CONCLUSION This review gave insight into facilitators in the transitional care of ethnic minority older adults. Future transitional care interventions should incorporate needs of ethnic minority population. IMPACT This review highlighted the defined gaps between existing transitional care programmes and transitional care needs of older ethnic minority. Increasing follow-up completion, evidence defining deeply of ethnic phenomenon in the transitional care process, developing interventions that meet transitional care needs and increasing healthcare providers' cultural competency were featured headlines. No Patient or Public Contribution.
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Affiliation(s)
- İlknur Dolu
- Department of Nursing, Faculty of Health Science, Bartın University, Bartın, Turkey
| | - Mark Hayter
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Laura Serrant
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
- Health Education England, North East & Yorkshire, England, UK
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Song J, Chae S, Bowles KH, McDonald MV, Barrón Y, Cato K, Collins Rossetti S, Hobensack M, Sridharan S, Evans L, Davoudi A, Topaz M. The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care. J Adv Nurs 2023; 79:593-604. [PMID: 36414419 PMCID: PMC10163408 DOI: 10.1111/jan.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
AIMS To identify clusters of risk factors in home health care and determine if the clusters are associated with hospitalizations or emergency department visits. DESIGN A retrospective cohort study. METHODS This study included 61,454 patients pertaining to 79,079 episodes receiving home health care between 2015 and 2017 from one of the largest home health care organizations in the United States. Potential risk factors were extracted from structured data and unstructured clinical notes analysed by natural language processing. A K-means cluster analysis was conducted. Kaplan-Meier analysis was conducted to identify the association between clusters and hospitalizations or emergency department visits during home health care. RESULTS A total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Risk factors formed three clusters. Cluster 1 is characterized by a combination of risk factors related to "impaired physical comfort with pain," defined as situations where patients may experience increased pain. Cluster 2 is characterized by "high comorbidity burden" defined as multiple comorbidities or other risks for hospitalization (e.g., prior falls). Cluster 3 is characterized by "impaired cognitive/psychological and skin integrity" including dementia or skin ulcer. Compared to Cluster 1, the risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 (all p < .001). CONCLUSION Risk factors were clustered into three types describing distinct characteristics for hospitalizations or emergency department visits. Different combinations of risk factors affected the likelihood of these negative outcomes. IMPACT Cluster-based risk prediction models could be integrated into early warning systems to identify patients at risk for hospitalizations or emergency department visits leading to more timely, patient-centred care, ultimately preventing these events. PATIENT OR PUBLIC CONTRIBUTION There was no involvement of patients in developing the research question, determining the outcome measures, or implementing the study.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York City, New York, USA
| | - Sena Chae
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Kathryn H. Bowles
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
| | - Margaret V. McDonald
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
| | - Kenrick Cato
- Columbia University School of Nursing, New York City, New York, USA
- Emergency Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Sarah Collins Rossetti
- Columbia University School of Nursing, New York City, New York, USA
- Department of Biomedical Informatics, Columbia University, New York City, New York, USA
| | - Mollie Hobensack
- Columbia University School of Nursing, New York City, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
| | - Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York City, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York City, USA
- Data Science Institute, Columbia University, New York City, New York, USA
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Simning A, Orth J, Temkin-Greener H, Li Y, Simons KV, Conwell Y. Skilled Nursing Facility-to-Home Trajectories for Older Adults With Mental Illness or Dementia. Am J Geriatr Psychiatry 2022; 30:223-234. [PMID: 34284892 PMCID: PMC8710182 DOI: 10.1016/j.jagp.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 03/24/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To examine how mental illness (MI) and Alzheimer's disease and related dementias (ADRD) were associated with whether skilled nursing facility (SNF) residents returned to and remained in the community and if receipt of home health services was associated with post-SNF home time. DESIGN Retrospective cohort study based on secondary data analyses. SETTING New York State Medicare beneficiaries who were admitted to an SNF in 2014. PARTICIPANTS Total of 46,137 older adults admitted to SNFs and 25,357 discharged from SNFs to home. MEASUREMENTS We used Medicare claims and assessment databases to derive our outcomes (discharge to the community and home time [i.e., days alive in the community]), determine MI/ADRD status, and obtain socio-demographic and clinical characteristics. RESULTS Among SNF admissions, 22.9% had MI, 22.6% had ADRD, and 59.0% were discharged to the community. In analyses adjusting for socio-demographic and clinical characteristics, MI and ADRD were associated with decreased odds of community discharge and less home time during 90-days of follow-up. However, when we included depressive symptoms, aggressive behaviors, and daily functioning in the analyses, these associations were attenuated. Receipt of post-SNF home health services was associated with increased home time among those with MI or ADRD. CONCLUSION Newly admitted SNF residents with MI or ADRD were less likely to be discharged and, if discharged, spent less time in the community. Interventions targeting depressive symptoms, aggressive behaviors, and functioning and improving linkage with home health services may help decrease differences in post-acute care trajectories between those with and without MI and ADRD.
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Affiliation(s)
- Adam Simning
- University of Rochester, Department of Psychiatry, Rochester, NY; University of Rochester, Department of Public Health Sciences, Rochester, NY.
| | | | | | - Yue Li
- UR, Department of Public Health Sciences
| | | | - Yeates Conwell
- University of Rochester (UR), Department of Psychiatry,UR, Office for Aging Research and Health Services
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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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Kim MH, Xiang X. Hospitalization Trajectories in Home- and Community-Based Services Recipients: The Influence of Physician and Social Care Density. J Gerontol B Psychol Sci Soc Sci 2021; 76:1679-1690. [PMID: 33170274 DOI: 10.1093/geronb/gbaa199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership. METHODS The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression. RESULTS Four distinct hospitalization trajectory groups emerged: "never" (43.1%)-individuals who were rarely hospitalized during the study period, "increasing" (19.9%)-individuals who experienced an increased risk of hospitalization, "decreasing" (21.6%)-individuals with a decreased risk, and "frequent" (15.8%)-individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the "frequent" trajectory relative to the "decreasing" trajectory. The density of primary care physicians was not associated with the trajectory group membership. DISCUSSION Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.
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Affiliation(s)
- Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor
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Home Healthcare Clinical Notes Predict Patient Hospitalization and Emergency Department Visits. Nurs Res 2021; 69:448-454. [PMID: 32852359 DOI: 10.1097/nnr.0000000000000470] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND About 30% of home healthcare patients are hospitalized or visit an emergency department (ED) during a home healthcare (HHC) episode. Novel data science methods are increasingly used to improve identification of patients at risk for negative outcomes. OBJECTIVES The aim of the study was to identify patients at heightened risk hospitalization or ED visits using HHC narrative data (clinical notes). METHODS This study used a large database of HHC visit notes (n = 727,676) documented for 112,237 HHC episodes (89,459 unique patients) by clinicians of the largest nonprofit HHC agency in the United States. Text mining and machine learning algorithms (Naïve Bayes, decision tree, random forest) were implemented to predict patient hospitalization or ED visits using the content of clinical notes. Risk factors associated with hospitalization or ED visits were identified using a feature selection technique (gain ratio attribute evaluation). RESULTS Best performing text mining method (random forest) achieved good predictive performance. Seven risk factors categories were identified, with clinical factors, coordination/communication, and service use being the most frequent categories. DISCUSSION This study was the first to explore the potential contribution of HHC clinical notes to identifying patients at risk for hospitalization or an ED visit. Our results suggest that HHC visit notes are highly informative and can contribute significantly to identification of patients at risk. Further studies are needed to explore ways to improve risk prediction by adding more data elements from additional data sources.
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Kang Y, Sheng X, Stehlik J, Mooney K. Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain. Home Healthc Now 2020; 38:24-30. [PMID: 31895894 PMCID: PMC7678889 DOI: 10.1097/nhh.0000000000000830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL), and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome and Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, whereas patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p value = 0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.
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Affiliation(s)
- Youjeong Kang
- Youjeong Kang, PhD, MPH, CCRN, is an Assistant Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Xiaoming Sheng, PhD, is a Research Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Josef Stehlik, MD, is a Professor, University of Utah School of Medicine, Salt Lake City, Utah. Kathi Mooney, PhD, RN, FAAN, is a Distinguished Professor, University of Utah College of Nursing, Salt Lake City, Utah
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Edelman LS, McConnell ES, Kennerly SM, Alderden J, Horn SD, Yap TL. Mitigating the Effects of a Pandemic: Facilitating Improved Nursing Home Care Delivery Through Technology. JMIR Aging 2020; 3:e20110. [PMID: 32412909 PMCID: PMC7252197 DOI: 10.2196/20110] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/25/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has been particularly challenging for nursing home staff and residents. Centers for Medicare & Medicaid Services regulation waivers are burdening staff and affecting how care is delivered. Residents are experiencing social isolation, which can result in physical and behavioral health issues, particularly for persons with dementia. These challenges can be addressed in part through technology adaptations. Full integration of electronic health record systems can improve workflow and care quality. Telehealth can improve access to outside providers, provide remote monitoring, and improve social connectedness. Electronic and audiovisual programs can be used for end-of-life planning and information sharing between nursing home staff and families. Online learning systems and other online resources provide flexible options for staff education and training. Investing in and adapting technology can help mitigate workforce stress and improve the quality of nursing home care during and after the COVID-19 crisis.
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Affiliation(s)
- Linda S Edelman
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Eleanor S McConnell
- School of Nursing, Duke University, Durham, NC, United States.,Geriatric Research, Education and Clinical Center (GRECC), Durham VA Healthcare System, Department of Veterans Affairs, Durham, NC, United States
| | - Susan M Kennerly
- College of Nursing, East Carolina University, Greenville, NC, United States
| | - Jenny Alderden
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Susan D Horn
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Tracey L Yap
- School of Nursing, Duke University, Durham, NC, United States
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Factors Affecting Patient Prioritization Decisions at Admission to Home Healthcare. ACTA ACUST UNITED AC 2020; 38:88-98. [DOI: 10.1097/cin.0000000000000576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chase JAD, Russell D, Huang L, Hanlon A, O'Connor M, Bowles KH. Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients. J Appl Gerontol 2020; 39:201-213. [PMID: 29457521 PMCID: PMC6344331 DOI: 10.1177/0733464818758453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 (N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.
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Affiliation(s)
- Jo-Ana D. Chase
- University of Pennsylvania, 338G School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, Assistant Professor, University of Missouri – Columbia,
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 1250 Broadway, 7th Floor, New York, NY 10001,
| | - Liming Huang
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Alexandra Hanlon
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Melissa O'Connor
- National Hartford Center for Gerontological Nursing Excellence, Assistant Professor, College of Nursing, Villanova University, Driscoll Hall, Office #316, 800 Lancaster Avenue, Villanova, PA 19085,
| | - Kathryn H. Bowles
- University of Pennsylvania, 418 Curie Boulevard Room 340, Philadelphia, PA 19104; Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York,
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Hospital Readmissions in Medicare Home Healthcare: What Are the Leading Risk Indicators? Home Healthc Now 2020; 37:213-221. [PMID: 31274584 DOI: 10.1097/nhh.0000000000000765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A large sample of all 2011 home healthcare users in traditional Medicare was analyzed to identify the risk indicators at start-of-care that were associated with the highest probability of readmission (N = 597,493). Thirty-five patient characteristics found in Outcome and Assessment Information Set, claims history, or other administrative data were associated with a 30-day readmission risk 30% to 100% above the average in the sample. Most of these characteristics were associated with a 30-day readmission probability of approximately 1 in 5, and several were associated with a readmission probability approaching 1 in 10 during the first 7 days. A majority of the high-risk characteristics were uncommon, and they tended not to occur together, suggesting they can be useful flags for clinicians in prioritizing cases to reduce readmissions. Readmission risk grows most quickly early in the episode of care; typically one-third of the readmissions in the first 30 days occurred by the end of 7 days. High-risk markers at 7 and 30 days were substantially the same, illustrating the importance of the early days at home in influencing the 30-day outcome. A variety of domains and characteristics are represented among the highest-risk markers, suggesting challenges to home healthcare clinicians in maintaining the knowledge and skills needed to address readmission prevention. We suggest possible responses to this problem as strategies to consider, and also discuss implications for assessment practices in home healthcare.
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Narayan MC. Cultural Competence in Home Healthcare Nursing: Disparity, Cost, Regulatory, Accreditation, Ethical, and Practice Issues. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822319883818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Home healthcare patients, who are members of minority, marginalized, or vulnerable patient populations, are at risk for healthcare disparities. Inadequate attention to the needs of the many different types of diverse patient populations seen by home health agencies could compromise an agency’s outcome indicators, reimbursement in value-based payment programs and responsibility to deliver equitable quality care. Culturally competent home health nurses may have a role in decreasing disparities and improving patient outcomes. This article discusses the incidence of disparities in home health care and highlights literature about the economic, regulatory, accrediting, policy, social justice, and ethical issues surrounding disparate and inequitable care for home healthcare patients. Patients in need of culturally competent care include those characterized by diversity related to race, ethnicity, language, religion, socioeconomic status, sexual orientation, gender identification, mental and physical disabilities, and stigmatized diagnoses (e.g., obesity and substance abuse). Home healthcare nurses who strengthen the cultural competence of their care may be able to decrease the incidence of disparate outcomes. By investing in the cultural competence of their home healthcare nurses, agencies may strengthen their commitment to their missions and the financial health of their agencies.
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Squires A, Miner S, Liang E, Lor M, Ma C, Witkoski Stimpfel A. How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data. Int J Nurs Stud 2019; 99:103394. [PMID: 31479983 PMCID: PMC8273738 DOI: 10.1016/j.ijnurstu.2019.103394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. OBJECTIVES To explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care. DESIGN A qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data. SETTING A large urban home health care agency located on the East Coast of the United States. PARTICIPANTS Thirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist]. RESULTS A total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety. CONCLUSIONS Home health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient's language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, 433 First Avenue, Office 658, New York, NY, 10010, USA.
| | - Sarah Miner
- Wegmans School of Nursing, St. John Fisher College, Rochester, NY, USA
| | - Eva Liang
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Maichou Lor
- School of Nursing, Columbia University, New York, NY, USA
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York, USA
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15
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Dowding DW, Russell D, Onorato N, Merrill JA. Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study. J Healthc Qual 2019; 40:236-246. [PMID: 28885241 PMCID: PMC5832509 DOI: 10.1097/jhq.0000000000000104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care. PURPOSE To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure. METHODS Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states. RESULTS In total, there were 61 participants across 6 focus groups. Three overarching themes emerged: continuity of care and communication on care transitions, maintaining continuity of care during a home care episode (with subthemes tracking signs and symptoms and patient teaching), and health information technology (HIT) characteristics to support communication and care continuity. CONCLUSIONS Our study highlights areas of improvement for HIT solutions that could support care delivery for patients with heart failure in a home care setting. IMPLICATIONS Home care agencies planning to introduce technology can use these findings to assess if and how potential systems can support nurses to provide continuity of care across healthcare organizations and home care visits.
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16
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Lohman MC, Scherer EA, Whiteman KL, Greenberg RL, Bruce ML. Factors Associated With Accelerated Hospitalization and Re-hospitalization Among Medicare Home Health Patients. J Gerontol A Biol Sci Med Sci 2019; 73:1280-1286. [PMID: 28329251 DOI: 10.1093/gerona/glw335] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
Background Preventing hospitalizations and re-hospitalizations of older adults receiving Medicare home health (HH) services is a key goal for patients and care providers. This study aimed to identify factors related to greater risk of and earlier hospitalizations from HH, a key step in targeting preventive efforts. Methods Data come from Medicare mandated start-of-care assessments from 87,780 HH patients served by 132 agencies in 32 states, collected from January 2013 to March 2015. Using parametric accelerated failure time (AFT) survival models, we evaluated the association between key patient and environmental characteristics and the hazard of and time until hospitalization and re-hospitalization. Results In total, 15,030 hospitalizations, including 6,539 re-hospitalizations, occurred in the sample within 60 days of start of HH. Factors most strongly associated with substantially greater risk of and earlier hospitalization included male gender, history of hospitalization, polypharmacy, elevated depressive symptoms, greater functional disability, primary diagnoses of heart disease, chronic obstructive pulmonary disease, and urinary tract infection, and government-controlled agency care. In addition to these factors, black race and primary diagnosis of skin wounds were uniquely related to risk of earlier re-hospitalization. Conclusions Results suggest that factors collected during routine HH patient assessments can provide important information to predict risk of earlier hospitalization and re-hospitalization among Medicare HH patients. Identified factors can help identify patients at greatest risk of early hospitalization and may be important targets for agencies and care providers to prevent avoidable hospitalizations.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
| | - Emily A Scherer
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen L Whiteman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
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17
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Osakwe ZT, Larson E, Shang J. Urinary tract infection-related hospitalization among older adults receiving home health care. Am J Infect Control 2019; 47:786-792.e1. [PMID: 30772048 PMCID: PMC7477896 DOI: 10.1016/j.ajic.2018.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Urinary tract infection (UTI)- related hospitalizations are a poor patient outcome in the rapidly growing home health care (HHC) arena that serves a predominantly elderly population. We examined the association between activities of daily living (ADL) and risk of UTI-related hospitalization among this population. METHODS Using a retrospective cohort design, we conducted a secondary data analysis of a 5% random sample of a national HHC dataset, the Outcome and Assessment Information Set for the year 2013. Andersen's Behavioral Model of Health Service Utilization was used as a guiding framework for statistical modeling. We used logistic regression to examine the association between UTI-related hospitalization and predisposing, enabling, or need factors. RESULTS Among beneficiaries (n = 24,887) hospitalized in 2013, 1,133 had UTI-related hospitalizations. HHC patients with a UTI-related hospitalization were more likely to have severe ADL dependency, impaired decision making, and lower Charlson Comorbidity Index, than those with a non UTI-related hospitalization (P < .001). Risk factors for UTI-related hospitalization included female sex, (adjusted odds ratio [AOR], 1.44; 95% confidence interval [CI], 1.25-1.66), Medicaid recipient (AOR, 1.99; 95% CI, 1.09-3.64), severe ADL dependency (AOR, 1.50; 95% CI, 1.16-1.94), the presence of a caregiver to assist with supervision and safety (AOR, 1.26; 95% CI, 1.06-1.49), treatment for UTI in the previous 14 days (AOR, 2.85; 95% CI, 2.46-3.29), presence of a urinary catheter (AOR, 3.77; 95% CI, 2.98-4.77), and prior history of indwelling or suprapubic catheter (AOR, 1.44; 95% CI, 1.06-1.94). CONCLUSIONS ADL dependency levels are a potentially modifiable risk factor for UTI-related hospitalization on admission to HHC. ADL dependency levels can inform clinical interventions to ameliorate ADL dependency in HHC settings and identify groups of patients at high risk for UTI-related hospitalization.
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18
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Casucci S, Zhou Y, Bhattacharya B, Sun L, Nikolaev A, Lin L. Causal analysis of the impact of homecare services on patient discharge disposition. Home Health Care Serv Q 2019; 38:162-181. [PMID: 31125291 DOI: 10.1080/01621424.2019.1617215] [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: 12/20/2022]
Abstract
This study uses observational causal inference to evaluate the impact of different combinations of home care services (nursing, therapies, social work, home aides) on end-of-episode disposition for individuals with chronic diseases associated with the circulatory, endocrine, and musculoskeletal systems. The potential to generate actionable recommendations for personalizing home care services, or treatment plans, from limited clinical and care needs data is demonstrated. For patients with chronic disease in the circulatory or musculoskeletal systems, a 2.91% and 3.38% decrease, respectively, in acute care hospitalization rates could be obtained by providing patients with therapy and nursing services, rather than therapy services alone.
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Affiliation(s)
- Sabrina Casucci
- a Industrial and Systems Engineering , University at Buffalo, State University of New York , Buffalo , New York , USA
| | - Yuan Zhou
- b Industrial, Manufacturing & Systems Engineering , University of Texas Arlington , Arlington , Texas , USA
| | - Biplab Bhattacharya
- a Industrial and Systems Engineering , University at Buffalo, State University of New York , Buffalo , New York , USA
| | - Lei Sun
- a Industrial and Systems Engineering , University at Buffalo, State University of New York , Buffalo , New York , USA
| | - Alexander Nikolaev
- a Industrial and Systems Engineering , University at Buffalo, State University of New York , Buffalo , New York , USA
| | - Li Lin
- a Industrial and Systems Engineering , University at Buffalo, State University of New York , Buffalo , New York , USA
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19
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Cunha Ferré MF, Gallo Acosta CM, Dawidowski AR, Senillosa MB, Scozzafava SM, Saimovici JM. 72-hour hospital readmission of older people after hospital discharge with home care services. Home Health Care Serv Q 2019; 38:153-161. [PMID: 31106701 DOI: 10.1080/01621424.2019.1616024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this retrospective cohort study in Argentina, risk factors for hospital readmission of older adults, within 72 hours after hospital discharge with home care services, were analyzed. Fifty-three percent of unplanned emergency room visits within 72 hours after hospital discharge resulted in hospital readmissions, 65% of which were potentially avoidable. By multivariate logistic regression, low functionality, pressure ulcers, and age over 83 years predicted hospital readmission among emergency room attendees. It is important to identify and analyze barriers in current home care services and the high-risk population of hospital readmission to improve the strategies to avoid adverse outcomes.
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Affiliation(s)
- María Florencia Cunha Ferré
- a Home Care Services Section of the Internal Medicine Service , Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires , Buenos Aires , Argentina
| | - Cristian Matías Gallo Acosta
- a Home Care Services Section of the Internal Medicine Service , Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires , Buenos Aires , Argentina
| | - Adriana Ruth Dawidowski
- b Epidemiology Section of Research Department , Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires , Buenos Aires , Argentina
| | - Mónica Beatríz Senillosa
- a Home Care Services Section of the Internal Medicine Service , Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires , Buenos Aires , Argentina
| | - Silvana María Scozzafava
- a Home Care Services Section of the Internal Medicine Service , Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires , Buenos Aires , Argentina
| | - Javier Matías Saimovici
- a Home Care Services Section of the Internal Medicine Service , Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires , Buenos Aires , Argentina
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20
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Bick I, Dowding D. Hospitalization risk factors of older cohorts of home health care patients: A systematic review. Home Health Care Serv Q 2019; 38:111-152. [PMID: 31100045 DOI: 10.1080/01621424.2019.1616026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nearly one million Medicare home health care beneficiaries are hospitalized annually of which one-quarter are considered preventable. Older hospitalized patients are at risk for nosocomial complications and poorer outcomes and incur higher health care costs. This paper reports the results of a systematic review of 28 studies on hospitalization risk factors of older home health care patients. It found that males, Blacks, and non-Asian minorities are at greater hospitalization risk. Factors associated with higher risk included skin ulcers, psychiatric conditions, dyspnea/COPD, cardiovascular conditions, diabetes, functional deficits, more comorbidities, and higher medication usage. These findings can inform practice, research, and policy.
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Affiliation(s)
- Irene Bick
- a Department of Scholarship and Research , Columbia University School of Nursing , New York , NY , USA
| | - Dawn Dowding
- b Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health , The University of Manchester , Manchester , UK
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Dowding D, Merrill JA, Onorato N, Barrón Y, Rosati RJ, Russell D. The impact of home care nurses' numeracy and graph literacy on comprehension of visual display information: implications for dashboard design. J Am Med Inform Assoc 2019; 25:175-182. [PMID: 28460091 DOI: 10.1093/jamia/ocx042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/31/2017] [Indexed: 12/17/2022] Open
Abstract
Objective To explore home care nurses' numeracy and graph literacy and their relationship to comprehension of visualized data. Materials and Methods A multifactorial experimental design using online survey software. Nurses were recruited from 2 Medicare-certified home health agencies. Numeracy and graph literacy were measured using validated scales. Nurses were randomized to 1 of 4 experimental conditions. Each condition displayed data for 1 of 4 quality indicators, in 1 of 4 different visualized formats (bar graph, line graph, spider graph, table). A mixed linear model measured the impact of numeracy, graph literacy, and display format on data understanding. Results In all, 195 nurses took part in the study. They were slightly more numerate and graph literate than the general population. Overall, nurses understood information presented in bar graphs most easily (88% correct), followed by tables (81% correct), line graphs (77% correct), and spider graphs (41% correct). Individuals with low numeracy and low graph literacy had poorer comprehension of information displayed across all formats. High graph literacy appeared to enhance comprehension of data regardless of numeracy capabilities. Discussion and Conclusion Clinical dashboards are increasingly used to provide information to clinicians in visualized format, under the assumption that visual display reduces cognitive workload. Results of this study suggest that nurses' comprehension of visualized information is influenced by their numeracy, graph literacy, and the display format of the data. Individual differences in numeracy and graph literacy skills need to be taken into account when designing dashboard technology.
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Affiliation(s)
- Dawn Dowding
- Columbia University School of Nursing, New York, NY, USA.,Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
| | | | - Nicole Onorato
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Yolanda Barrón
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
| | | | - David Russell
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
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22
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Jeffery AD, Hewner S, Pruinelli L, Lekan D, Lee M, Gao G, Holbrook L, Sylvia M. Risk prediction and segmentation models used in the United States for assessing risk in whole populations: a critical literature review with implications for nurses' role in population health management. JAMIA Open 2019; 2:205-214. [PMID: 31984354 DOI: 10.1093/jamiaopen/ooy053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/03/2018] [Accepted: 11/23/2018] [Indexed: 01/17/2023] Open
Abstract
Objective We sought to assess the current state of risk prediction and segmentation models (RPSM) that focus on whole populations. Materials Academic literature databases (ie MEDLINE, Embase, Cochrane Library, PROSPERO, and CINAHL), environmental scan, and Google search engine. Methods We conducted a critical review of the literature focused on RPSMs predicting hospitalizations, emergency department visits, or health care costs. Results We identified 35 distinct RPSMs among 37 different journal articles (n = 31), websites (n = 4), and abstracts (n = 2). Most RPSMs (57%) defined their population as health plan enrollees while fewer RPSMs (26%) included an age-defined population (26%) and/or geographic boundary (26%). Most RPSMs (51%) focused on predicting hospital admissions, followed by costs (43%) and emergency department visits (31%), with some models predicting more than one outcome. The most common predictors were age, gender, and diagnostic codes included in 82%, 77%, and 69% of models, respectively. Discussion Our critical review of existing RPSMs has identified a lack of comprehensive models that integrate data from multiple sources for application to whole populations. Highly depending on diagnostic codes to define high-risk populations overlooks the functional, social, and behavioral factors that are of great significance to health. Conclusion More emphasis on including nonbilling data and providing holistic perspectives of individuals is needed in RPSMs. Nursing-generated data could be beneficial in addressing this gap, as they are structured, frequently generated, and tend to focus on key health status elements like functional status and social/behavioral determinants of health.
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Affiliation(s)
- Alvin D Jeffery
- Department of Veterans Affairs and Vanderbilt University Department of Biomedical Informatics, Nashville, Tennessee, USA
| | - Sharon Hewner
- Family, Community and Health Systems Science Department, University at Buffalo School of Nursing, Buffalo, New York, USA
| | - Lisiane Pruinelli
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deborah Lekan
- School of Nursing, University of North Carolina, Greensboro, North Carolina, USA
| | - Mikyoung Lee
- College of Nursing, Texas Woman's University, Denton, Texas, USA
| | - Grace Gao
- Department of Nursing, St. Catherine University, St. Paul, Minnesota, USA
| | | | - Martha Sylvia
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Dowding D, Merrill JA, Barrón Y, Onorato N, Jonas K, Russell D. Usability Evaluation of a Dashboard for Home Care Nurses. Comput Inform Nurs 2019; 37:11-19. [PMID: 30394879 PMCID: PMC6326881 DOI: 10.1097/cin.0000000000000484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The introduction of electronic health records has produced many challenges for clinicians. These include integrating technology into clinical workflow and fragmentation of relevant information across systems. Dashboards, which use visualized data to summarize key patient information, have the potential to address these issues. In this article, we outline a usability evaluation of a dashboard designed for home care nurses. An iterative design process was used, which consisted of (1) contextual inquiry (observation and interviews) with two home care nurses; (2) rapid feedback on paper prototypes of the dashboard (10 nurses); and (3) usability evaluation of the final dashboard prototype (20 nurses). Usability methods and assessments included observation of nurses interacting with the dashboard, the system usability scale, and the Questionnaire for User Interaction Satisfaction short form. The dashboard prototype was deemed to have high usability (mean system usability scale, 73.2 [SD, 18.8]) and was positively evaluated by nurse users. It is important to ensure that technology solutions such as the one proposed in this article are designed with clinical users in mind, to meet their information needs. The design elements of the dashboard outlined in this article could be translated to other electronic health records used in home care settings.
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Affiliation(s)
- Dawn Dowding
- Author Affiliations: School of Health Sciences, University of Manchester, England (Dr Dowding); School of Nursing and Department of Biomedical Informatics, Columbia University, New York (Dr Merrill); Center for Home Care Policy and Research, Visiting Nurse Service of New York (Mss Barrón and Onorato); Rory Meyers College of Nursing, New York University (Ms Jonas); and Department of Sociology, Appalachian State University, Boone, North Carolina (Dr Russell)
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24
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Dowding D, Merrill J, Russell D. Using Feedback Intervention Theory to Guide Clinical Dashboard Design. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:395-403. [PMID: 30815079 PMCID: PMC6371234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The provision of feedback to clinicians and organizations on the quality of care they provide is thought to influence clinician and organizational behavior leading to care improvements. Clinical Dashboards use data visualization techniques to provide feedback to individuals on their performance compared to quality metrics. In this paper we outline a theoretical approach to the design of a clinical dashboard; Feedback Intervention Theory (FIT). Priorities for feedback were identified using focus groups with home care nurses (n=61). Individual variation in graph literacy and numeracy among nurses and their ability to comprehend visualized data displays were evaluated using an online survey. The results from the focus group and survey were used to inform a prototype dashboard which was evaluated for usability with a separate sample of home care nurses. FIT provided a theoretical base for the dashboard design to ensure feedback that should positively impact clinician behavior.
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25
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Eliciting nurses' perspectives to improve health information exchange between hospital and home health care. Geriatr Nurs 2018; 40:277-283. [PMID: 30503605 DOI: 10.1016/j.gerinurse.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 12/27/2022]
Abstract
Despite patient safety initiatives to improve care transitions, prior research largely neglects to elicit feedback from home health nurses regarding health information exchange. The goal of this quality improvement study was to identify opportunities to facilitate information transfer during hospital-to-home-health-care transitions for older adults with heart failure. We conducted focus groups with 19 nurses employed by a single healthcare system using two commercially available electronic health record (EHR) vendors. We analyzed interview transcripts following an immersion/crystallization approach to identify themes. Average participants were females in their mid-fifties with 15 years of home health experience. Nurses reported challenges with hospital-to-home-health-care information exchange, specifically: 1) poor medication management, 2) ineffective communication, 3) technology issues, and 4) patient factors. Nurses identified several opportunities for improvement, including discordant EHR-generated medication lists, which may be amenable to technological solutions. Local quality improvement efforts should incorporate nurses' suggestions and leverage existing best practices.
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26
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Gjestsen MT, Brønnick K, Testad I. Characteristics and predictors for hospitalizations of home-dwelling older persons receiving community care: a cohort study from Norway. BMC Geriatr 2018; 18:203. [PMID: 30176794 PMCID: PMC6122216 DOI: 10.1186/s12877-018-0887-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older persons are substantial consumers of both hospital- and community care, and there are discussions regarding the potential for preventing hospitalizations through high quality community care. The present study report prevalence and factors associated with admissions to hospital for community-dwelling older persons (> 67 years of age), receiving community care in a Norwegian municipality. METHODS This was a cohort study of 1531 home-dwelling persons aged ≥67 years, receiving community care. We retrospectively scrutinized admissions to hospital for the study cohort over a one-year period in 2013. The frequency of admissions was evaluated with regard to association with age (age groups 67-79 years, 80-89 years and ≥ 90 year) and gender. The hospital admission incidence was calculated by dividing the number of admissions by the number of individuals included in the study cohort, stratified by age and gender. The association between age and gender as potential predictors and hospitalization (outcome) was first examined in univariate analyses followed by multinomial regression analyses in order to investigate the associations between age and gender with different causes of hospitalization. RESULTS We identified a total of 1457 admissions, represented by 739 unique individuals, of which 64% were women, and an estimated mean age of 83 years. Mean admission rate was 2 admissions per person-year (95% confidence interval (CI): 1.89-2.11). The admission rate varied with age, and hospital incidents rates were higher for men in all age groups. The overall median length of stay was 4 days. The most common reason for hospitalization was the need for further medical assessment (23%). We found associations between increasing age and hospitalizations due to physical general decline, and associations between male gender and hospitalizations due to infections (e.g., airways infections, urinary tract infections). CONCLUSIONS We found the main reasons for hospitalizations to be related to falls, infections and general decline/pain/unspecified dyspnea. Men were especially at risk for hospitalization as they age. Our study have identified some clinically relevant factors that are vital in understanding what health care personnel in community care need to be especially aware of in order to prevent hospitalizations for this population.
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Affiliation(s)
- Martha Therese Gjestsen
- Centre for age-related medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- University of Stavanger, Faculty of Health Sciences, Centre for Resilience in Healthcare (SHARE), Stavanger, Norway
| | - Kolbjørn Brønnick
- Centre for Clinical Research in Psychosis (TIPS), Stavanger University Hospital, Stavanger, Norway
- University of Stavanger, Faculty of Health Sciences, Stavanger, Norway
| | - Ingelin Testad
- Centre for age-related medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- University of Exeter Medical School, Exeter, Devon UK
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Ayatollahi Y, Liu X, Namazi A, Jaradat M, Yamashita T, Shen JJ, Lee YJ, Upadhyay S, Kim SJ, Yoo JW. Early Readmission Risk Identification for Hospitalized Older Adults With Decompensated Heart Failure. Res Gerontol Nurs 2018; 11:190-197. [PMID: 29634848 DOI: 10.3928/19404921-20180322-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/06/2018] [Indexed: 12/25/2022]
Abstract
The current study evaluated risk factors of early hospital readmission in geriatric patients with acute heart failure (HF) and analyzed 2,279 consecutively hospitalized older adults with decompensated HF from November 2013 to October 2014 across 15 U.S. hospitals. The eTracker-HF was designed to make risk factors known to treating clinicians in electronic health records. Multilevel multivariate logistic regression was applied to examine the association between risk factors and all-cause and HF 30-day readmission rates. All-cause and HF 30-day readmission rates were 22.3% and 9.8%, respectively. Old age, non-White ethnicity, delirium, physical impairment, ejection fraction <40%, advanced chronic kidney disease, and previous myocardial infarction were associated with all-cause and HF readmission. Home health care use was inversely associated with early readmission. In addition to demographic and cardiovascular risk factors, geriatric syndromes were associated with early readmission. Discharge to home health care may reduce early readmission in these patients. [Res Gerontol Nurs. 2018; 11(4):190-197.].
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Crist JD, Montgomery ML, Pasvogel A, Phillips LR, Ortiz-Dowling EM. The association among knowledge of and confidence in home health care services, acculturation, and family caregivers' relationships to older adults of Mexican descent. Geriatr Nurs 2018; 39:689-695. [PMID: 29880443 DOI: 10.1016/j.gerinurse.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/18/2018] [Indexed: 12/15/2022]
Abstract
The purposes of this study were to examine the relationships among knowledge of and confidence in health care services (HHCS), acculturation, characteristics of family caregivers of Mexican descent, and differences by caregivers' relationship (spouse or adult child). A sample of Mexican-descent older adults and their caregivers was recruited (n = 74 dyads) in Arizona. Each participant completed questionnaires on knowledge, confidence, and acculturation. There were moderate but significant associations among higher Anglo Orientation with Knowledge and with Confidence. Fear of HHCS was positively associated with higher Anglo Orientation and English Language Preference; and negatively associated with Mexican Orientation and Spanish Language Preference. For Spouse caregivers, Fear of HHCS was positively correlated with higher Anglo Orientation and English Language Preference; for Offspring caregivers, Fear of HHCS was negatively correlated with Mexican Orientation and Spanish Language Preference. Results support assessing caregiver cohort and socio-cultural context to decrease HHCS use disparities by Mexican-descent caregiving families.
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Affiliation(s)
- Janice D Crist
- College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721-0203.
| | | | - Alice Pasvogel
- College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721-0203
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Siclovan DM. The effectiveness of home health care for reducing readmissions: an integrative review. Home Health Care Serv Q 2018; 37:187-210. [DOI: 10.1080/01621424.2018.1472702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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The scope of drug-related problems in the home care setting. Int J Clin Pharm 2018; 40:325-334. [DOI: 10.1007/s11096-017-0581-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022]
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Lohman MC, Cotton BP, Zagaria AB, Bao Y, Greenberg RL, Fortuna KL, Bruce ML. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients. J Gen Intern Med 2017; 32:1301-1308. [PMID: 28849426 PMCID: PMC5698223 DOI: 10.1007/s11606-017-4157-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. OBJECTIVE To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. DESIGN Cross-sectional analysis using data from 132 home health agencies in the US. SUBJECTS Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). MAIN MEASURES Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. KEY RESULTS In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. CONCLUSIONS Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Dartmouth Centers for Health and Aging, Lebanon, NH, USA.
| | - Brandi P Cotton
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Alexandra B Zagaria
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Karen L Fortuna
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
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Narayan MC, Scafide KN. Systematic Review of Racial/Ethnic Outcome Disparities in Home Health Care. J Transcult Nurs 2017; 28:598-607. [DOI: 10.1177/1043659617700710] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Umegaki H, Asai A, Kanda S, Maeda K, Shimojima T, Nomura H, Kuzuya M. Factors associated with unexpected admissions and mortality among low-functioning older patients receiving home medical care. Geriatr Gerontol Int 2017; 17:1623-1627. [DOI: 10.1111/ggi.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/04/2016] [Accepted: 09/20/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
| | | | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital; Nagoya Aichi Japan
| | - Keiko Maeda
- Department of Home Medical Care; Mokuren Clinic; Nagoya Aichi Japan
| | | | | | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
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Utilizing Home Healthcare Electronic Health Records for Telehomecare Patients With Heart Failure: A Decision Tree Approach to Detect Associations With Rehospitalizations. Comput Inform Nurs 2016; 34:175-82. [PMID: 26848645 DOI: 10.1097/cin.0000000000000223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Heart failure is a complex condition with a significant impact on patients' lives. A few studies have identified risk factors associated with rehospitalization among telehomecare patients with heart failure using logistic regression or survival analysis models. To date, there are no published studies that have used data mining techniques to detect associations with rehospitalizations among telehomecare patients with heart failure. This study is a secondary analysis of the home healthcare electronic medical record called the Outcome and Assessment Information Set-C for 552 telemonitored heart failure patients. Bivariate analyses using SAS and a decision tree technique using Waikato Environment for Knowledge Analysis were used. From the decision tree technique, the presence of skin issues was identified as the top predictor of rehospitalization that could be identified during the start of care assessment, followed by patient's living situation, patient's overall health status, severe pain experiences, frequency of activity-limiting pain, and total number of anticipated therapy visits combined. Examining risk factors for rehospitalization from the Outcome and Assessment Information Set-C database using a decision tree approach among a cohort of telehomecare patients provided a broad understanding of the characteristics of patients who are appropriate for the use of telehomecare or who need additional supports.
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Finkelstein J, Friedman C, Hripcsak G, Cabrera M. Pharmacogenetic polymorphism as an independent risk factor for frequent hospitalizations in older adults with polypharmacy: a pilot study. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2016; 9:107-116. [PMID: 27789970 PMCID: PMC5072537 DOI: 10.2147/pgpm.s117014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pharmacogenetic testing identifies genetic biomarkers that are predictive of individual sensitivity to particular drugs. A significant proportion of medications that are widely prescribed for older adults are metabolized by enzymes that are encoded by highly polymorphic genes. Pharmacogenetic testing is increasingly used to optimize the medication regimen; however, its potential in older adults with polypharmacy has not been systematically explored. Following the initial case-series study, this study hypothesized that frequently hospitalized older adults with polypharmacy have higher frequency of pharmacogenetic polymorphism as compared to older adults with polypharmacy who are rarely admitted to a hospital. To test this hypothesis, a nested case-control study was conducted with pharmacogenetic polymorphism as an exposure and hospitalization rate as an outcome. In this study, frequently hospitalized older adults (≥65 years of age) with polypharmacy were matched with rarely hospitalized older adults with poly-pharmacy by age, gender, race, ethnicity, and chronic disease score. Average age and number of prescription drugs did not differ in cases and controls (77.2±5.0 and 78.3±5.1 years, 14.3±5.3 and 14.0±2.9 medications, respectively). No statistically significant difference in sociodemographic, clinical, and behavioral characteristics that are known to affect hospitalization risk was found between the cases and controls. Major pharmacogenetic polymorphism defined as presence of at least one allelic combination resulting in poor or rapid metabolizer status was identified in all the cases. No major pharmacogenetic polymorphisms were detected in controls. Based on the exact McNemar's test, the difference in major pharmacogenetic polymorphism frequency between cases and controls was statistically significant (p<0.05). In 50% of cases, more than one major pharmacogenetic polymorphism was found. The frequency of CYP2C19 rapid metabolizer, CYP3A4/5 poor metabolizer, VKORC1 low sensitivity, and CYP2D6 rapid metabolizer status in cases was 67%, 33%, 33%, and 17%, respectively, which significantly exceeded respective prevalence in general population. The mean number of major gene-drug interactions found in cases was 2.8±2.2, whereas no major drug-gene interactions were identified in controls. The difference in the number of major drug-gene interactions between cases and controls was statistically significant (p<0.05). The pilot data supported the hypothesis that pharmacogenetic polymorphism may represent an independent risk factor for frequent hospitalizations in older adults with polypharmacy. Due to small sample size, the results of this proof-of-concept study cannot be conclusive. Further work on the utility of pharmacogenetic testing for optimization of medication regimens in this vulnerable group of older adults is warranted.
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Affiliation(s)
| | | | | | - Manuel Cabrera
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Bruce ML, Lohman MC, Greenberg RL, Bao Y, Raue PJ. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial. J Am Geriatr Soc 2016; 64:2196-2203. [PMID: 27739067 DOI: 10.1111/jgs.14440] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. PARTICIPANTS Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). INTERVENTION The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. MEASUREMENTS Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. RESULTS The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services.
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Affiliation(s)
- Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Psychiatry, Weill Cornell Medical College, New York City, New York
| | - Matthew C Lohman
- Department of Psychiatry, Weill Cornell Medical College, New York City, New York
| | - Rebecca L Greenberg
- Department of Psychiatry, Weill Cornell Medical College, New York City, New York
| | - Yuhua Bao
- Department of Psychiatry, Weill Cornell Medical College, New York City, New York.,Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York
| | - Patrick J Raue
- Department of Psychiatry, Weill Cornell Medical College, New York City, New York
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Kang Y, McHugh MD, Chittams J, Bowles KH. Risk Factors for All-Cause Rehospitalization Among Medicare Recipients with Heart Failure Receiving Telehomecare. Telemed J E Health 2016; 23:305-312. [PMID: 27689956 DOI: 10.1089/tmj.2016.0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify potential risk factors associated with rehospitalization among Medicare recipients with heart failure (HF) receiving telehomecare. MATERIALS AND METHODS This study is a nonexperimental, cross-sectional secondary data analysis of the Centers for Medicare and Medicaid (CMS) mandated assessment called the Outcome and Assessment Information Set (OASIS)-C, provided by a large home care company. A total of 526 patients who received telehomecare from January 1, 2011 to August 31, 2013 were included in the analyses, which used multiple logistic regression. RESULTS The overall rate of rehospitalization was 36% while patients were receiving telehomecare. Moderately frail health status (p = 0.01), the presence of severe pain (p = 0.01), the presence of dermatologic problems (p = 0.03), and independence in dressing one's lower body (compared to slightly dependent [p = 0.01] or mostly dependent patient groups [p = 0.02]) were identified as risk factors for rehospitalization. CONCLUSIONS The risk factors identified from this study may be used to drive more effective telehomecare placements, and referrals for additional services among telehomecare patients with HF.
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Affiliation(s)
- Youjeong Kang
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Matthew D McHugh
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,2 Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Jesse Chittams
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Kathryn H Bowles
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,3 vanAmeringen Professor in Nursing Excellence, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,4 Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York
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38
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Markle-Reid M, McAiney C. Depression Care Management Interventions for Older Adults with Depression Using Home Health Services: Moving the Field Forward. J Am Geriatr Soc 2016; 64:2193-2195. [PMID: 27564537 DOI: 10.1111/jgs.14437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Carrie McAiney
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Ylli A, Miszkurka M, Phillips SP, Guralnik J, Deshpande N, Zunzunegui MV. Clinically relevant depression in old age: An international study with populations from Canada, Latin America and Eastern Europe. Psychiatry Res 2016; 241:236-41. [PMID: 27183110 DOI: 10.1016/j.psychres.2016.04.096] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/15/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
Our aim is to assess cross-national variations in prevalence of clinically relevant depression and to examine the relationships of social and health factors with depression in five diverse populations of older adults, from Canada, Brazil, Colombia and Albania. We used the data from the International Mobility in Aging Study. Clinically relevant depression was defined as a score of ≥16 on the Center for Epidemiologic Study Depression Scale (CES-D). Poisson regressions with robust covariance correction were used to estimate prevalence ratios associated with potential risk factors. Prevalence of clinically relevant depression across research sites varied widely, being consistently higher in women than in men. It was lowest in men from Brazil (6.3%) and highest in women from Albania (46.6%). Low education and insufficient income, living alone, multiple chronic conditions, and poor physical performance were all significantly associated with depression prevalence. Poor physical performance was more strongly associated with depression in men than in women. Similar factors are associated with clinically relevant depression among men and women and across research sites. The large variation in depression prevalence population rates is unexplained by the classical individual factors considered in the study suggesting the impact of country characteristics on depression among older populations.
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Affiliation(s)
- Alban Ylli
- Institute of Public Health, Tirana, Albania; University of Medicine, Tirana, Albania.
| | - Malgorzata Miszkurka
- Institut de recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Canada
| | - Susan P Phillips
- Department of Family Medicine, Queens University, Kingston, Ontario, Canada
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, USA
| | - Nandini Deshpande
- School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
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Crist JD, Koerner KM, Hepworth JT, Pasvogel A, Marshall CA, Cruz TP, Effken JA. Differences in Transitional Care Provided to Mexican American and Non-Hispanic White Older Adults. J Transcult Nurs 2016; 28:159-167. [DOI: 10.1177/1043659615613420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background:Transitional care, assisting patients to move safely through multiple health care settings, may be insufficient for older Hispanic patients. Purpose: Describe home health care services referral rates for Hispanic and non-Hispanic White (NHW) patients and factors that influence case managers’ (CMs’) discharge planning processes. Design: Organized by the Ethno-Cultural Gerontological Nursing Model, health records were reviewed ( n = 33,597 cases) and supplemented with qualitative description ( n = 8 CMs). Findings: Controlling for gender, insurance type, age, and hospital length of stay, NHW older adults received more home health care services referrals (odds ratio = 1.23). Insurance coverage was the most frequent determinant of CMs’ post–hospital care choices, rather than patients’ being Hispanic. NHW older adults were more likely to have insurance than Hispanic older adults. Implications: Insurance coverage being CMs’ primary consideration in determining patients’ dispositions is a form of systems-level discrimination for Hispanic vulnerable groups, which combined with other hospital-level constraints, should be addressed with policy-level interventions.
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Delaney C, Barrere C, Grimes R, Apostolidis B. Testing of a Statewide Initiative to Enhance Depression Care in Older Home Care Patients. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822316642752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late-life depression is becoming increasingly prevalent among older adults in the United States and is predictive of a wide range of negative health-related outcomes. Fourteen home care agencies participated in a quasi-experimental, pre-test, post-test design of a depression screening training program nested within a two-cycle, phased introduction of the intervention. The primary aim of this study was to evaluate the effects of the program at three levels of outcomes: the trainers, the trainees, and the agencies. There was a significant increase in the knowledge and self-efficacy of the trainers and trainees and a trend toward decreased hospitalization.
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Feld A, Madden-Baer R, McCorkle R. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care. Home Health Care Serv Q 2016; 35:53-68. [PMID: 27158856 DOI: 10.1080/01621424.2016.1184737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.
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Affiliation(s)
- April Feld
- a The Visiting Nurse Service of New York , New York , New York , USA.,b Yale University School of Nursing , New Haven , Connecticut , USA
| | - Rose Madden-Baer
- a The Visiting Nurse Service of New York , New York , New York , USA
| | - Ruth McCorkle
- b Yale University School of Nursing , New Haven , Connecticut , USA
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Chen HF, Carlson E, Popoola T, Suzuki S. The Impact of Rurality on 30-Day Preventable Readmission, Illness Severity, and Risk of Mortality for Heart Failure Medicare Home Health Beneficiaries. J Rural Health 2015; 32:176-87. [PMID: 26348123 DOI: 10.1111/jrh.12142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the impact of rurality on 30-day preventable readmission, and the illness severity and risk of mortality for 30-day preventable readmissions. METHODS We analyzed heart failure Medicare beneficiaries who received home health services for postacute care after hospital discharge in 2009. The study was a cross-sectional design with the unit of analysis as the home health episode for postacute care. Data sources included the following: Medicare Beneficiary Summary File, Medicare Provider Analysis Review, Outcome Assessment Information Set, Home Health Agency Research Identifiable File, and Area Health Resources File. The dependent variables were 30-day preventable readmission, and the extreme/major level of illness severity and of risk of mortality for a 30-day preventable readmission. The key independent variable was rurality defined as remote rural, adjacent rural, and micropolitan areas, with urban areas in the reference group. FINDINGS Home health beneficiaries in remote rural areas had 27% lower 30-day preventable readmission than those in urban areas. Home health beneficiaries in adjacent rural areas were 33% less likely to have high illness severity at readmission due to a preventable condition than those in urban areas. CONCLUSIONS Geographical location affects preventable readmission and illness severity of preventable readmission. Patients' geographic location along with patients' risk factors should be taken into consideration in the risk adjustment model for the financial incentive program that penalizes home health agencies with high preventable readmissions.
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Affiliation(s)
- Hsueh-Fen Chen
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Erin Carlson
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Taiye Popoola
- Department of Health Policy and Management, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sumihiro Suzuki
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
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Gaugler JE. 2014 Year in Review. J Appl Gerontol 2014; 33:919-22. [DOI: 10.1177/0733464814555626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Delaney C, Apostolidis B, Bartos S, Robbins R, Young AK. Pilot Testing of the Home Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities Intervention. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2014. [DOI: 10.1177/1084822314530991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The primary aim of this pilot study was to develop, implement, and test the feasibility and efficacy of the Home Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. A total of 50 patients with a primary diagnosis of heart failure (HF) were assigned to the intervention ( n = 26) or control group ( n = 24) according to geographical location in a large multibranch Medicare-certified home health agency. Forty-six patients completed the study. Patients participating in the HEART intervention demonstrated significantly improved HF knowledge ( F = 1.31, p < .001) in comparison with control group patients’ at the study endpoint. There was a non-significant trend toward improved quality of life (QOL) and lower hospital readmission rates (6 patients vs. 9 patients) in the intervention group.
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46
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Delaney C, Fortinsky R, Mills D, Doonan L, Grimes R, Rosenberg S, Pearson TL, Bruce ML. Pilot Study of a Statewide Initiative to Enhance Depression Care Among Older Home Care Patients. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2012. [DOI: 10.1177/1084822312465747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Late-life depression is prevalent in home care. This pilot study, part of a statewide initiative to enhance depression care, evaluated the influence of a 2-hour depression screening and intervention workshop on home care professionals’ knowledge, self-efficacy, and attitudes related to depression in older home care patients. A pretest, posttest design was used to evaluate the effects of the workshop with 280 home care professionals from 7 home care agencies. Following the depression workshop, participants’ knowledge levels in evidence-based screening and care for depressed older adults was significantly increased, t(280) = 16.49, p<.001. A significant increase in confidence and attitude ratings were found (p<.001). Findings from this pilot study support broader dissemination throughout Connecticut home care agencies.
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Affiliation(s)
- Colleen Delaney
- University of Connecticut School of Nursing, Storrs, CT, USA
| | | | - Dana Mills
- University of Connecticut Health Center, Farmington, CT, USA
| | | | - Rita Grimes
- Visiting Nurse and Health Services of Connecticut, Vernon, CT, USA
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