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Burgdorf JG, Ritchie CS, Reckrey JM, Liu B, McDonough C, Ornstein KA. Drivers of Community-Entry Home Health Care Utilization Among Older Adults. J Am Med Dir Assoc 2024; 25:697-703.e2. [PMID: 37931897 PMCID: PMC10990820 DOI: 10.1016/j.jamda.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES A growing proportion of Medicare home health (HH) patients are "community-entry," meaning referred to HH without a preceding hospitalization. We sought to identify factors that predict community-entry HH use among older adults to provide foundational information regarding care needs and circumstances that may prompt community-entry HH referral. DESIGN Nationally representative cohort study. SETTING AND PARTICIPANTS Health and Retirement Study (HRS) respondents who were aged ≥65 years, community-living, and enrolled in Medicare between 2012 and 2018 (n = 11,425 unique individuals providing 27,026 two-year observation periods). METHODS HRS data were linked with standardized HH patient assessments. Community-entry HH utilization was defined as incurring one or more HH episode with no preceding hospitalization or institutional post-acute care stay (determined via assessment item indicating institutional care within 14 days of HH admission) within 2 years of HRS interview. Weighted, multivariable logistic regression was used to model community-entry HH use as a function of individual, social support, and community characteristics. RESULTS The overall rate of community-entry HH utilization across observation periods was 13.4%. Older adults had higher odds of community-entry HH use if they were Medicaid enrolled [adjusted odds ratio (aOR) = 1.49, P = .001], had fair or poor overall health (aOR = 1.48, P < .001), 3+ activities of daily living limitations (aOR = 1.47, P = .007), and had fallen in the past 2 years (aOR = 1.43, P < .001). Compared with those receiving no caregiver help, individuals were more likely to use community-entry HH if they received family or unpaid help only (aOR = 1.81, P < .001), both family and paid help (aOR = 2.79, P < .001), or paid help only (aOR: 3.46, P < .001). CONCLUSIONS AND IMPLICATIONS Findings indicate that community-entry HH serves a population with long-term care needs and coexisting clinical complexity, making this an important setting to provide skilled care and prevent avoidable health care utilization. Results highlight the need for ongoing monitoring of community-entry HH accessibility as this service is a key component of home-based care for a high-need subpopulation.
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Affiliation(s)
- Julia G Burgdorf
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catherine McDonough
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, MD, USA.
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Landau AY, Venkatram C, Song J, Topaz M, Klitzman R, Shang J, Stone P, McDonald M, Cohen B. Home Care Clinicians' Perspectives on Advance Care Planning for Patients at Risk for Becoming Incapacitated With No Evident Advance Directives or Surrogates. J Hosp Palliat Nurs 2024; 26:74-81. [PMID: 38340056 PMCID: PMC10940180 DOI: 10.1097/njh.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Advance care planning is important and timely for patients receiving home health services; however, opportunities to facilitate awareness and engagement in this setting are often missed. This qualitative descriptive study elicited perspectives of home health nurses and social workers regarding barriers and facilitators to creating advance care plans in home health settings, with particular attention to patients with few familial or social contacts who can serve as surrogate decision-makers. We interviewed 15 clinicians employed in a large New York City-based home care agency in 2021-2022. Participants reported a multitude of barriers to supporting patients with advance care planning at the provider level (eg, lack of time and professional education, deferment, discomfort), patient level (lack of knowledge, mistrust, inadequate support, deferment, language barriers), and system level (eg, discontinuity of care, variations in advance care planning documents, legal concerns, lack of institutional protocols and centralized information). Participants noted that greater socialization and connection to existing educational resources regarding the intended purpose, scope, and applicability of advance directives could benefit home care patients.
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Ryvicker M, Barrón Y, Song J, Zolnoori M, Shah S, Burgdorf JG, Noble JM, Topaz M. Using Natural Language Processing to Identify Home Health Care Patients at Risk for Diagnosis of Alzheimer's Disease and Related Dementias. J Appl Gerontol 2024:7334648241242321. [PMID: 38556756 DOI: 10.1177/07334648241242321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
This study aimed to: (1) validate a natural language processing (NLP) system developed for the home health care setting to identify signs and symptoms of Alzheimer's disease and related dementias (ADRD) documented in clinicians' free-text notes; (2) determine whether signs and symptoms detected via NLP help to identify patients at risk of a new ADRD diagnosis within four years after admission. This study applied NLP to a longitudinal dataset including medical record and Medicare claims data for 56,652 home health care patients and Cox proportional hazard models to the subset of 24,874 patients admitted without an ADRD diagnosis. Selected ADRD signs and symptoms were associated with increased risk of a new ADRD diagnosis during follow-up, including: motor issues; hoarding/cluttering; uncooperative behavior; delusions or hallucinations; mention of ADRD disease names; and caregiver stress. NLP can help to identify patients in need of ADRD-related evaluation and support services.
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Affiliation(s)
- Miriam Ryvicker
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Jiyoun Song
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Shivani Shah
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Julia G Burgdorf
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - James M Noble
- Columbia University Medical Center, New York, NY, USA
| | - Maxim Topaz
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
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Wachtler C, Bergqvist M, Holmgren K, Mannheimer S, Bastholm-Rahmner P, Schmidt-Mende K. "Returning to the core tasks": a qualitative interview study about how general practitioners in home health care solved problems during the COVID-19 pandemic. Scand J Prim Health Care 2024; 42:91-100. [PMID: 38095568 PMCID: PMC10851823 DOI: 10.1080/02813432.2023.2291676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE Optimizing care at home, or home health care (HHC), is necessary as the population of care-dependent older people receiving care at home steadily increases. The COVID-19 pandemic tested Swedish primary care professionals as they provided HHC for a population of very frail older homebound people, but a better understanding of what healthcare workers did to manage the crisis may be useful for the further development of HHC. In this study, we aimed to understand how HHC physicians solved the problems of providing home healthcare during the pandemic to learn lessons on how to improve future HHC. METHODS This is a qualitative study of individual interviews with 11 primary care physicians working in HHC (8 women) from 7 primary care practices in Region Stockholm, Sweden. Interviews were conducted between 1 December 2020, and 11 March 2021. The data were analyzed using inductive thematic analysis. RESULTS We generated an overarching theme in our analysis: Physicians focus on core tasks and professional values in response to crisis. This theme incorporated three underlying subthemes describing this response: physicians prioritize and resolve ethically challenging situations in new ways, cultivate the patient perspective, and build on existing teams. CONCLUSION This study indicates that a healthcare system that gives HHC physicians agency to focus on core tasks and professional values could promote person-centered care.
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Affiliation(s)
- Caroline Wachtler
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Monica Bergqvist
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Stockholm Region, Sweden
| | - Katarina Holmgren
- Academic Primary Health Care Centre, Stockholm, Stockholm Region, Sweden
| | - Stina Mannheimer
- Institute of Health and Care Sciences, Sahlgrenska Akademin, University of Gothenburg, Gothenburg, Västra Götaland Region, Sweden
| | - Pia Bastholm-Rahmner
- Academic Primary Health Care Centre, Stockholm, Stockholm Region, Sweden
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katharina Schmidt-Mende
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Stockholm Region, Sweden
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Kim HD, Duberstein PR, Lin H, Wu B, Zafar A, Jarrín OF. Home Health Care and Hospice Use Among Medicare Beneficiaries With and Without a Diagnosis of Dementia. J Palliat Med 2024. [PMID: 38359388 DOI: 10.1089/jpm.2023.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Background: Home health care is a core benefit of Medicare and Medicaid insurance programs and includes services to improve health, maintain health, or slow health decline. Objective: To examine the relationship between home health care use during the last three years of life and hospice use in the last six months of life among Medicare beneficiaries with and without dementia. Design: Nationally representative retrospective cohort study. Setting/Subjects: Medicare beneficiaries with at least three years of continuous enrollment who died in 2019 in the United States (n = 2,169,422). Measurements: The primary outcome was hospice use, and the secondary outcome was hospice duration. The independent variable was a composite of the presence and timing of home health care initiation during the last three years of life. Results: Home health care was used by 46.4% of Medicare beneficiaries and hospice care was used by 53.1% of beneficiaries, with 28.3% using both. Compared with beneficiaries who did not use home health care, those who started home health care before the last year of life (odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.56-1.58) or during the last year of life (OR = 1.75, 95% CI = 1.74-1.77) were more likely to use hospice. The effects were stronger in those without a diagnosis of dementia (OR = 1.92, 95% CI = 1.90-1.94) compared with those without a dementia diagnosis (OR = 1.34, 95% CI = 1.32-1.35) who started home health in the final year of life. Conclusions: Receiving home health care in the final years of life is associated with increased hospice use at the end-of-life in Medicare beneficiaries with and without a dementia diagnosis.
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Affiliation(s)
- Hyosin Dawn Kim
- College of Health, Oregon State University, Corvallis, Oregon, USA
| | - Paul R Duberstein
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Haiqun Lin
- School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York, New York, USA
- NYU Aging Incubator, New York University, New York, New York, USA
| | - Anum Zafar
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Olga F Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Brenne BA, Hedlund M, Ingstad K. Nurses' professional discretion in the purchaser-provider split in home care in Norway. J Adv Nurs 2024; 80:612-627. [PMID: 37574768 DOI: 10.1111/jan.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
AIM To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser-provider organization in Norway. DESIGN A qualitative descriptive study. METHODS Semi-structured interviews with open-ended questions were used, and data were collected from in-depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six-step analysis was used to analyse the empirical data. RESULTS The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser-provider organisation of healthcare,' with five associated codes. CONCLUSION Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion. IMPACT The purchaser-provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser-provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy-makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust. IMPLICATIONS This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses.
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Yamao R, Babazono A, Liu N, Li Y, Ishihara R, Yoshida S, Kim SA, Jamal A. The Impact of Continuous Use of Home Health Care Resources on End-of-Life Care at Home in Older Patients with Cancer: A Retrospective Cohort Study in Fukuoka, Japan. Popul Health Manag 2024; 27:60-69. [PMID: 37910804 DOI: 10.1089/pop.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31-17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86-17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47-13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42-2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92-5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home.
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Affiliation(s)
- Reiko Yamao
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yunfei Li
- Epidemiology and Prevention Department, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Ishihara
- Faculty of Human Sciences, Osaka University of Economics, Osaka, Japan
| | - Shinichiro Yoshida
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sung-A Kim
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- St. Mary's Research Center, St. Mary's Hospital, Kurume, Japan
| | - Aziz Jamal
- Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia
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Ho SC, Hsieh CJ, Lo LC, Lin JG. A suggested mortality benefit with integrated health care versus conventional home health care in Taiwan. Home Health Care Serv Q 2024; 43:1-17. [PMID: 37042246 DOI: 10.1080/01621424.2023.2195810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
In Taiwan, the Integrated Home Care (IHC) project was introduced for medically compromised patients living at home receiving Home Health Care (HHC) in 2016. The focus of the project was on organizing care teams and managing care for patients. The aim of this study was to investigate the benefits and impacts of IHC in Taiwan. The primary outcome measure was the mortality rate of patients who received IHC versus those who did not receive IHC (non-IHC). The secondary outcomes were medical utilization and expenditure. The results showed that IHC was associated with a statistically significant reduction in mortality compared to non-IHC for home-dwelling patients over 90-, 180-, and 365-days periods. Additionally, IHC users were less likely to be hospitalized and had shorter hospitalization times compared to non-IHC users. Furthermore, IHC was found to reduce medical expenditure compared to non-IHC.
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Affiliation(s)
- Shao-Chang Ho
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Taoyuan Chinese Medicine Association, Taoyuan, Taiwan
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Lun-Chien Lo
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Yokomaku K, Yasuhara T, Nagata M, Ueda M, Kushihata T, Sone T. [Validation of the Qualitative Study Findings using Quantitative Analyses on the Current Status of Pharmacists in Home Health Care in Medium-Sized Areas]. YAKUGAKU ZASSHI 2024; 144:329-338. [PMID: 38432942 DOI: 10.1248/yakushi.23-00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Although the issue of home medical care and pharmacists remains widespread, much of the discussion has concentrated on its state in urban areas. We believe that it is necessary to consider the state of home health care in medium-sized regions, that is separate from its urban form, with a population of approximately 100000. Thus, we conducted a qualitative study in Hikone City, Shiga Prefecture, to identify factors that impede pharmacists involved in home medical care. We conducted a questionnaire-based survey in an area of the same size to verify the generality of the concepts obtained from the qualitative study and validate the concepts using quantitative analyses. Two questionnaires on the role of community health care and home health care practice based on the concepts obtained from the qualitative study was sent to 342 pharmacies located in five regions. The number of valid responses was 170, and the data collection rate was 49.4%. We identified nine factors from the former and five from the latter. The current status of pharmacists in home health care in a medium-sized region, as identified by the quantitative study, was similar to that of the conceptual picture obtained from the qualitative study. Furthermore, the high versatility of the extracted concepts was verified.
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Affiliation(s)
- Kaori Yokomaku
- Department of Pharmacy, Hikone Municipal Hospital
- Faculty of Pharmaceutical Sciences, Setsunan University
| | | | - Misa Nagata
- Faculty of Pharmaceutical Sciences, Wakayama Medical University
| | - Masahiro Ueda
- Faculty of Pharmaceutical Sciences, Setsunan University
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Osundolire S, Mbrah A, Liu SH, Lapane KL. Association Between Patient and Facility Characteristics and Rehabilitation Outcomes After Joint Replacement Surgery in Different Rehabilitation Settings for Older Adults: A Systematic Review. J Geriatr Phys Ther 2024; 47:E1-E18. [PMID: 36598848 PMCID: PMC10318119 DOI: 10.1519/jpt.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE In the United States, an exponential increase in total hip arthroplasty (THA) and total knee arthroplasty (TKA) demand has occurred over the last 2 decades. Evidence suggesting patients receiving inpatient rehabilitation following a TKA or THA experience similar outcomes as those with rehabilitation in other settings led to dramatic shifts in postsurgical care settings owing to Centers for Medicare & Medicaid Services (CMS) payment reforms. A contemporary synthesis of evidence about the association between patient and facility factors and outcomes from older adults undergoing THA or TKA in the United States is needed. METHODS To identify eligible studies, we searched PubMed, Scopus, and CINAHL. We followed PRISMA guidelines to identify articles evaluating either patient or facility factors associated with outcomes after THA or TKA for older adults who may have been cared for in inpatient settings (ie, inpatient rehabilitation or skilled nursing facility [SNF]). Eligible articles were conducted in the United States and were published between January 1, 2000, and December 31, 2021. RESULTS We included 8 articles focused on patient factors and 9 focused on facility factors. Most included older adults and the majority were White (in those reporting race/ethnicity). Most studies evaluated outcomes at discharge and showed that patients admitted to inpatient rehabilitation facilities had either similar or better functional outcomes (mobility, self-care, and functional independence measure (FIM) score) and lower length of stay compared with those in SNFs. Few studies focused on home health care. CONCLUSIONS The systematic review focused on older adults showed that findings in these patients are consistent with previous research. Older adults undergoing THA/TKA had acceptable outcomes regardless of postsurgical, inpatient setting of care. Research conducted after CMS payment reforms, in home health care settings, and in more diverse samples is needed. Given the known racial/ethnic disparities in THA/TKA and the shifts to postsurgical home health care with little regulatory oversight of care quality, contemporary research on outcomes of postsurgical THA/TKA outcomes is warranted.
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Affiliation(s)
- Seun Osundolire
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Attah Mbrah
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Jones CD, Moss A, Sevick C, Roczen M, Sterling MR, Portz J, Lum HD, Yu A, Urban JA, Khazanie P. Factors Associated With Mortality and Hospice Use Among Medicare Beneficiaries With Heart Failure Who Received Home Health Services. J Card Fail 2023:S1071-9164(23)00921-1. [PMID: 38142043 DOI: 10.1016/j.cardfail.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Although many Medicare beneficiaries with heart failure (HF) are discharged with home health services, little is known about mortality rates and hospice use in this group. OBJECTIVES To identify risk factors for 6-month mortality and hospice use among patients hospitalized due to HF who receive home health care, which could inform efforts to improve palliative and hospice use for these patients. METHODS A retrospective cohort analysis was conducted in a 100% national sample of Medicare fee-for-service beneficiaries with HF who were discharged to home health care between 2017 and 2018. Multivariable Cox regression models examined factors associated with 6-month mortality, and multivariable logistic regression models examined factors associated with hospice use at the time of death. RESULTS A total of 285,359 Medicare beneficiaries were hospitalized with HF and discharged with home health care; 15.5% (44,174) died within 6 months. Variables most strongly associated with mortality included: age > 85 years (hazard ratio [HR] 1.66, 95% CI 1.61-1.71), urgent/emergency hospital admission (HR 1.68, 1.61-1.76), and "serious" condition compared to "stable" condition (HR 1.64, CI 1.52-1.78). Among 44,174 decedents, 48.2% (21,284) received hospice care at the time of death. Those with lower odds of hospice use at death included patients who were: < 65 years (odds ratio [OR] 0.65, CI 0.59-0.72); of Black (OR 0.64, CI 0.59-0.68) or Hispanic race/ethnicity (OR 0.79, CI 0.72-0.88); and Medicaid-eligible (OR 0.80, CI 0.76-0.85). CONCLUSIONS Although many patients hospitalized for HF are at risk of 6-month mortality and may benefit from palliative and/or hospice services, our findings indicate under-use of hospice care and important disparities in hospice use by race/ethnicity and socioeconomic status.
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Affiliation(s)
- Christine D Jones
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO; Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO.
| | - Angela Moss
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Carter Sevick
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | | | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine at Weill Cornell Medicine, New York, NY
| | - Jennifer Portz
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Hillary D Lum
- Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO
| | - Amy Yu
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Jacqueline A Urban
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Prateeti Khazanie
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
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Martins C, Escoval A, Lopes M, Mendonça S, Fonseca C. Quality and Safety of Proximity Care Centered on the Person and Their Domiciliation: Systematic Literature Review. Int J Environ Res Public Health 2023; 20:7189. [PMID: 38131740 PMCID: PMC10743136 DOI: 10.3390/ijerph20247189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
The quality and safety of health care are a priority for health organizations and social institutions to progressively provide people with a higher level of health and well-being. It is in the development of this path that home care currently represents an area of gradual investment and where health care services and the scientific community have shown interest in building circuits and instruments that can respond to needs. The purpose of this article is to identify areas and criteria for quality and safety in home care. The method used was a systematic review registered in PROSPERO (CRD42022380989). The search was systematically carried out in CINAHL Plus with Full Text, MEDLINE with Full Text and Psychology and Behavioral Sciences Collection, using the following criteria: articles published in Portuguese and English, from January 2017 to November 2022. The results of the analysis of the articles showed areas of quality and safety in home care with their respective dimensions and operational criteria. We concluded that there are three areas: the intervention with the patient, with proximity and patient-centered care, which integrates the individual care plan and the proximity of professionals to the patient and family; the intervention of care and service management, with care management and clinical governance that includes the integrated model of health care, goal management, and context management; and the intervention related to training and professional development, where we have the skills and training of professionals.
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Affiliation(s)
- Carlos Martins
- Cova da Beira Group of Health Centers, 6200-034 Covilhã, Portugal
- Comprehensive Health Research Centre, University of Évora (CHRC-UE), 7000-811 Évora, Portugal; (A.E.); (M.L.)
| | - Ana Escoval
- Comprehensive Health Research Centre, University of Évora (CHRC-UE), 7000-811 Évora, Portugal; (A.E.); (M.L.)
| | - Manuel Lopes
- Comprehensive Health Research Centre, University of Évora (CHRC-UE), 7000-811 Évora, Portugal; (A.E.); (M.L.)
| | - Susana Mendonça
- Comprehensive Health Research Centre, University of Évora (CHRC-UE), 7000-811 Évora, Portugal; (A.E.); (M.L.)
- Department of Nursing, University of Évora, 7000-811 Évora, Portugal; (S.M.); (C.F.)
| | - César Fonseca
- Comprehensive Health Research Centre, University of Évora (CHRC-UE), 7000-811 Évora, Portugal; (A.E.); (M.L.)
- Department of Nursing, University of Évora, 7000-811 Évora, Portugal; (S.M.); (C.F.)
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Hobensack M, Song J, Oh S, Evans L, Davoudi A, Bowles KH, McDonald MV, Barrón Y, Sridharan S, Wallace AS, Topaz M. Social Risk Factors are Associated with Risk for Hospitalization in Home Health Care: A Natural Language Processing Study. J Am Med Dir Assoc 2023; 24:1874-1880.e4. [PMID: 37553081 PMCID: PMC10839109 DOI: 10.1016/j.jamda.2023.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This study aimed to develop a natural language processing (NLP) system that identified social risk factors in home health care (HHC) clinical notes and to examine the association between social risk factors and hospitalization or an emergency department (ED) visit. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We used standardized assessments and clinical notes from one HHC agency located in the northeastern United States. This included 86,866 episodes of care for 65,593 unique patients. Patients received HHC services between 2015 and 2017. METHODS Guided by HHC experts, we created a vocabulary of social risk factors that influence hospitalization or ED visit risk in the HHC setting. We then developed an NLP system to automatically identify social risk factors documented in clinical notes. We used an adjusted logistic regression model to examine the association between the NLP-based social risk factors and hospitalization or an ED visit. RESULTS On the basis of expert consensus, the following social risk factors emerged: Social Environment, Physical Environment, Education and Literacy, Food Insecurity, Access to Care, and Housing and Economic Circumstances. Our NLP system performed "very good" with an F score of 0.91. Approximately 4% of clinical notes (33% episodes of care) documented a social risk factor. The most frequently documented social risk factors were Physical Environment and Social Environment. Except for Housing and Economic Circumstances, all NLP-based social risk factors were associated with higher odds of hospitalization and ED visits. CONCLUSIONS AND IMPLICATIONS HHC clinicians assess and document social risk factors associated with hospitalizations and ED visits in their clinical notes. Future studies can explore the social risk factors documented in HHC to improve communication across the health care system and to predict patients at risk for being hospitalized or visiting the ED.
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Affiliation(s)
| | - Jiyoun Song
- Columbia University School of Nursing, New York City, NY, USA
| | - Sungho Oh
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA; Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Andrea S Wallace
- The University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York City, NY, USA; Center for Home Care Policy & Research, VNS Health, New York, NY, USA; Data Science Institute, Columbia University, New York City, NY, USA
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Osakwe ZT, Calixte R, Bubu OM, Reckrey JM. Association Between Documented Severe Pain and Cognitive Impairment in Home Health Care Patients: Results from the National Outcome and Assessment Information Set Data. J Palliat Med 2023; 26:1662-1670. [PMID: 37751588 PMCID: PMC10714109 DOI: 10.1089/jpm.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 09/28/2023] Open
Abstract
Background: Despite the growing importance of home health care (HHC) in the care of older adults with cognitive impairment, limited evidence exists about factors associated with documented severe pain among older adults receiving HHC. Methods: This secondary data analysis used a 5% random national sample of the 2017 national Outcome and Assessment Information Set (OASIS) data. Multivariable Poisson regression model was used to examine the association between documented severe pain, cognitive impairment, and a range of sociodemographic, clinical, and cognitive factors. Results: HHC patients (n = 183,038) were mean age 79.7 years, 61.7% female, and 78.6% non-Hispanic White. In multivariable models, cognitive impairment was associated with lower likelihood of documented severe pain (prevalence ratio [PR] = 0.96, confidence interval [CI] = [0.94-0.98]). Other factors independently associated with less documented severe pain included Hispanic ethnicity (PR = 0.92, CI = [0.89-0.95]), the oldest (≥85 years) groups (PR = 0.65, CI = [0.63-0.66]), male patients (PR = 0.83, CI = [0.82-0.85]), those with a formal diagnosis of Alzheimer's Disease Related Dementias (PR = 0.67, CI = [0.65-0.69]), and patients with verbal- and speech-related difficulty (PR = 0.83, CI = [0.80-0.86]). Patients with history of falls (PR = 1.18, CI = [1.16-1.20]), positive screen on the Patient Health Questionnaire-2 (PR = 1.36, CI = [1.31-1.41]), shortness of breath (PR = 1.14, CI = [1.12-1.14]), anxiety daily (PR = 1.16, CI = [1.14-1.18]), and anxiety daily or more often (PR = 1.40, CI = [1.37-1.43]) were more likely to have documented severe pain. Conclusions: HHC patients with cognitive impairment were less likely to have documented severe pain even with a range of sociodemographic, clinical, functional, and cognitive characteristics were considered. These findings may reflect a link between cognitive impairment missed opportunities for clinicians to provide pain management. Tailored interventions are needed to better assess and manage pain in this vulnerable group of HHC patients.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences, University, Brooklyn, New York, USA
| | - Omonigho Michael Bubu
- Department of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jennifer M. Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Wang J, Shen JY, Conwell Y, Yu F, Nathan K, Heffner KL, Li Y, Caprio TV. Antipsychotic use among older patients with dementia receiving home health care services: Prevalence, predictors, and outcomes. J Am Geriatr Soc 2023; 71:3768-3779. [PMID: 37671461 PMCID: PMC10841208 DOI: 10.1111/jgs.18555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. METHODS In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60-day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. RESULTS The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (β = -0.70, p < 0.001). CONCLUSIONS HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York, USA
| | - Kathi L Heffner
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Home Care, Rochester, New York, USA
- Finger Lakes Geriatric Education Center, Rochester, New York, USA
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Hamada S, Iwagami M, Sakata N, Hattori Y, Kidana K, Ishizaki T, Tamiya N, Akishita M, Yamanaka T. Changes in Polypharmacy and Potentially Inappropriate Medications in Homebound Older Adults in Japan, 2015-2019: a Nationwide Study. J Gen Intern Med 2023; 38:3517-3525. [PMID: 37620717 PMCID: PMC10713963 DOI: 10.1007/s11606-023-08364-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND With rising worldwide population aging, the number of homebound individuals with multimorbidity is increasing. Improvement in the quality of home medical care (HMC), including medications, contributes to meeting older adults' preference for "aging in place" and securing healthcare resources. OBJECTIVE To evaluate the changes in drug prescriptions, particularly potentially inappropriate medications (PIMs), among older adults receiving HMC in recent years, during which measures addressing inappropriate polypharmacy were implemented, including the introduction of clinical practice guidelines and medical fees for deprescribing. DESIGN A cross-sectional study. PARTICIPANTS Using data from the national claims database in Japan, this study included older adults aged ≥ 75 years who received HMC in October 2015 (N = 499,850) and October 2019 (N = 657,051). MAIN MEASURES Number of drugs, prevalence of polypharmacy (≥ 5 regular drugs), major drug categories/classes, and PIMs according to Japanese guidelines were analyzed. Random effects logistic regression models were used to evaluate the differences in medications between 2015 and 2019, considering the correlation within individuals who contributed to the analysis in both years. KEY RESULTS The number of drugs remained unchanged from 2015 to 2019 (median: 6; interquartile range: 4, 9). The prevalence of polypharmacy also remained unchanged at 70.0% in both years (P = 0.93). However, the prescription of some drugs (e.g., direct oral anticoagulants, new types of hypnotics, acetaminophen, proton pump inhibitors, and β-blockers) increased, whereas others (e.g., warfarin, vasodilators, H2 blockers, acetylcholinesterase inhibitors, and benzodiazepines) decreased. Among the frequently prescribed PIMs, benzodiazepines/Z-drugs (25.6% in 2015 to 21.1% in 2019; adjusted odds ratio: 0.52) and H2 blockers (11.2 to 7.3%; 0.45) decreased, whereas diuretics (23.8 to 23.6%; 0.90) and antipsychotics (9.7 to 10.5%; 1.11) remained unchanged. CONCLUSIONS We observed some favorable changes but identified some continuous and new challenges. This study suggests that continued attention to medication optimization is required to achieve safe and effective HMC.
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Affiliation(s)
- Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Iwagami
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiwami Kidana
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Tietbohl CK, Dafoe A, Jordan SR, Huebschmann AG, Lum HD, Bowles KH, Jones CD. Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff. Am J Hosp Palliat Care 2023; 40:1371-1378. [PMID: 36908002 PMCID: PMC10495535 DOI: 10.1177/10499091231163156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. METHODS Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). RESULTS Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient's care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. CONCLUSIONS A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.
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Affiliation(s)
- Caroline K. Tietbohl
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Sarah R. Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy G. Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women’s Health Research, University of Colorado School of Medicine, Department of Medicine, Aurora, CO, USA
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn H. Bowles
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
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Althobiani MA, Ranjan Y, Jacob J, Orini M, Dobson RJB, Porter JC, Hurst JR, Folarin AA. Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study. JMIR Form Res 2023; 7:e51507. [PMID: 37999935 DOI: 10.2196/51507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. OBJECTIVE This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. METHODS In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post-COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses-base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. RESULTS Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8% of the day), 123.91 (SD 33.73) hours weekly (72.6% of the week), and 463.82 (SD 156.70) hours monthly (64.4% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59%) were performed. Of these, 90.3% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. CONCLUSIONS Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/28873.
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Affiliation(s)
- Malik A Althobiani
- Respiratory Medicine, University College London, London, United Kingdom
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yatharth Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Joseph Jacob
- Respiratory Medicine, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Richard James Butler Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, London, United Kingdom
| | - Joanna C Porter
- Respiratory Medicine, University College London, London, United Kingdom
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
| | - John R Hurst
- Respiratory Medicine, University College London, London, United Kingdom
| | - Amos A Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, London, United Kingdom
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Candon M, Bergman A, Rose A, Song H, David G, Spetz J. The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health. J Am Med Dir Assoc 2023; 24:1773-1778.e2. [PMID: 37634547 PMCID: PMC10735229 DOI: 10.1016/j.jamda.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides. DESIGN A retrospective, cross-sectional analysis. SETTING AND PARTICIPANTS The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018. METHODS We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution). RESULTS Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses. CONCLUSION AND IMPLICATIONS The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.
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Affiliation(s)
- Molly Candon
- Departments of Psychiatry and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alon Bergman
- Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber Rose
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Hummy Song
- Department of Operations, Information, and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Guy David
- Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Ponsignon F, Mathieu L, Durrieu F. Understanding the drivers of patient satisfaction with home health care services: An empirical study of two care pathways. Int J Health Plann Manage 2023; 38:1644-1656. [PMID: 37491716 DOI: 10.1002/hpm.3687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/08/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023] Open
Abstract
This research aims to empirically determine the drivers of patient satisfaction with home health care services and to develop an instrument for measuring patient satisfaction in this context. The empirical study focuses on insulin and respiratory assistance therapies. Two large patient samples of a private home care provider in France are surveyed. Two distinct, yet complementary, analytical procedures are performed to maximize the validity and reliability of the results. We identify four core concepts (interpersonal relationship, support and guidance, delivery of consumables, and equipment use) that play a key role in influencing patient satisfaction across the two therapies studied. The results also reveal that the relative role of each factor in driving overall patient satisfaction varies across these therapies, possibly due to differences in the characteristics of the therapies and related care services. Our empirical results enrich the existing literature, largely focused on hospital and primary care settings, by providing evidence to capture patient satisfaction drivers at the level of specificity required to account for the unique context of home care services. The article's main theoretical contribution is to establish, from the patient's perspective, a core set of drivers that determine patient satisfaction in the context of home health care services. The instrument provides practitioners and policy makers with a practical tool that supports them in achieving patient satisfaction and in understanding why and how such satisfaction is achieved. The suitability of the patient satisfaction instrument to other forms of home care services needs examining.
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Ojagbemi A, Daley S, Feeney Y, Elugbadebo O, Kola L, Gureje O. Participatory development of a home-based depression care model with lived experience older Nigerians and their caregivers: A theory of change. Int J Geriatr Psychiatry 2023; 38:e6019. [PMID: 37909145 PMCID: PMC7615294 DOI: 10.1002/gps.6019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES There is a huge treatment gap for late-life depression in sub-Saharan Africa. Building on prior work to scale-up mental healthcare with the aid of the WHO Mental Health Gap Action Programme Intervention Guide electronic version (emhGAP-IG), this study aims to involve older people in the iterative development of innovations to overcome challenges in the detection and clinical management of late-life depression by frontline non-specialist primary healthcare workers (PHCW) in Nigeria. METHODS There were 43 participants in the study. We conducted formative qualitative research using 15 in-depth key informant interviews with persons who were 60 years or older and had a recent experience of depression. We also conducted two focus group discussions comprising 13 of their caregivers. Through a full day stakeholders workshop comprising 15 participants, we drew on the results of our qualitative explorations to identify the pathway to impact of an intervention package (emhGAP-Age) appropriate for the specific needs of persons with late-life depression in Nigeria. RESULTS A Theory of Change (ToC) map was produced. It highlights the expected long-term outcomes of emhGAP-Age to include the potential for improvement of the mental health and wellbeing of older people living in Nigeria and the generation of interest among governmental agencies concerned with policy and planning for mental healthcare. Key resources that serve as preconditions were identified to consist of the availability of PHCW who are skilled in the identification and treatment of depression and have interest in and commitment to providing care to older people. Required community resources include support from immediate family, neighbours, and informal groups. Interventions that are appropriate for depression in old age need to incorporate these community resources and address not only the symptoms of the condition but also comorbid physical health problems. CONCLUSIONS A participatory ToC process led to the identification of the key components of an age-appropriate version of the emhGAP-IG for delivering care to older persons with depression by PHCW in Nigeria.
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Affiliation(s)
- Akin Ojagbemi
- World Health Organization collaborating centre for research and training in mental health, neuroscience, and substance abuse, Department of psychiatry, College of Medicine, University of Ibadan, Nigeria
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Yvonne Feeney
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Olufisayo Elugbadebo
- World Health Organization collaborating centre for research and training in mental health, neuroscience, and substance abuse, Department of psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Lola Kola
- World Health Organization collaborating centre for research and training in mental health, neuroscience, and substance abuse, Department of psychiatry, College of Medicine, University of Ibadan, Nigeria
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London
| | - Oye Gureje
- World Health Organization collaborating centre for research and training in mental health, neuroscience, and substance abuse, Department of psychiatry, College of Medicine, University of Ibadan, Nigeria
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22
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Emeryk A, Derom E, Janeczek K, Kuźnar-Kamińska B, Zelent A, Łukaszyk M, Grzywalski T, Pastusiak A, Biniakowski A, Szarzyński K, Botteldooren D, Kociński J, Hafke-Dys H. Home Monitoring of Asthma Exacerbations in Children and Adults With Use of an AI-Aided Stethoscope. Ann Fam Med 2023; 21:517-525. [PMID: 38012028 PMCID: PMC10681685 DOI: 10.1370/afm.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE The advent of new medical devices allows patients with asthma to self-monitor at home, providing a more complete picture of their disease than occasional in-person clinic visits. This raises a pertinent question: which devices and parameters perform best in exacerbation detection? METHODS A total of 149 patients with asthma (90 children, 59 adults) participated in a 6-month observational study. Participants (or parents) regularly (daily for the first 2 weeks and weekly for the next 5.5 months, with increased frequency during exacerbations) performed self-examinations using 3 devices: an artificial intelligence (AI)-aided home stethoscope (providing wheezes, rhonchi, and coarse and fine crackles intensity; respiratory and heart rate; and inspiration-to-expiration ratio), a peripheral capillary oxygen saturation (SpO2) meter, and a peak expiratory flow (PEF) meter and filled out a health state survey. The resulting 6,029 examinations were evaluated by physicians for the presence of exacerbations. For each registered parameter, a machine learning model was trained, and the area under the receiver operating characteristic curve (AUC) was calculated to assess its utility in exacerbation detection. RESULTS The best single-parameter discriminators of exacerbations were wheezes intensity for young children (AUC 84% [95% CI, 82%-85%]), rhonchi intensity for older children (AUC 81% [95% CI, 79%-84%]), and survey answers for adults (AUC 92% [95% CI, 89%-95%]). The greatest efficacy (in terms of AUC) was observed for a combination of several parameters. CONCLUSIONS The AI-aided home stethoscope provides reliable information on asthma exacerbations. The parameters provided are effective for children, especially those younger than 5 years of age. The introduction of this tool to the health care system might enhance asthma exacerbation detection substantially and make remote monitoring of patients easier.
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Affiliation(s)
- Andrzej Emeryk
- Department of Paediatric Pulmonology and Rheumatology, Faculty of Medicine, Medical University of Lublin, Lublin, Poland (A.E., K.J.)
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium (E.D.)
| | - Kamil Janeczek
- Department of Paediatric Pulmonology and Rheumatology, Faculty of Medicine, Medical University of Lublin, Lublin, Poland (A.E., K.J.);
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology, and Respiratory Oncology, Poznań University of Medical Sciences, Poznań, Poland (B.K.K.)
| | - Anna Zelent
- Department of Pediatric Pneumonology, Allergology, and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland (A.Z.)
| | - Mateusz Łukaszyk
- 1st Department of Lung Diseases and Tuberculosis, Faculty of Medicine, Medical University of Bialystok, Białystok, Poland (M.Ł.)
| | - Tomasz Grzywalski
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- WAVES Research Group, Department of Information Technology, Ghent University, Ghent, Belgium (T.G., D.B.)
| | - Anna Pastusiak
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
| | - Adam Biniakowski
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
| | | | - Dick Botteldooren
- WAVES Research Group, Department of Information Technology, Ghent University, Ghent, Belgium (T.G., D.B.)
| | - Jędrzej Kociński
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
| | - Honorata Hafke-Dys
- StethoMe Sp. z o.o., Poznań, Poland (T.G., A.P., A.B., K.S., J.K., H.H.D)
- Department of Acoustics, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland (A.P., J.K., H.H.D)
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Kim E, Yoon JY, Woo K, Kim A, Kim H, Lee J. Development and evaluation of a problem-based learning simulation module for home-visit nursing. Public Health Nurs 2023; 40:857-867. [PMID: 37551850 DOI: 10.1111/phn.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Although home-visit healthcare programs in Korea are expected to expand, providing hands-on experience to nursing students may be limited. This study aimed to develop and evaluate a problem-based learning (PBL) simulation module that reflects home-visit healthcare services provided by public health centers for pre-frail older adults. DESIGN AND SAMPLE The simulation module, including PBL as prebriefing, was developed by the researchers and revised based on expert reviews. The module was evaluated using a mixed-method embedded one-group post-test-only design with focus group interviews (FGIs). Quantitative data (n = 29) were collected between April and June, 2021. FGIs (n = 10) were conducted twice in June 2021, and qualitative data were analyzed using an inductive content analysis approach. RESULTS The average score of the Simulation Design Scale was 4.67 ± 0.36. The overall mean score of the Educational Practices Questionnaire was 4.75 ± 0.37. Three themes emerged from the FGIs: immersive learning experience, changes in perspective on nursing, and enhanced nursing competency. CONCLUSION This PBL-based simulation module was evaluated as a systematic learning process in which nursing students could become self-directed learners, interacting and collaborating with colleagues, instructors, and environments. The module encourages them to practice home visit services.
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Affiliation(s)
- Eunjoo Kim
- College of Nursing, Jeju National University, Jeju, Republic of Korea
- Health and Nursing Research Institute, Jeju National University, Jeju, Republic of Korea
| | - Ju Young Yoon
- Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Kyungmi Woo
- Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Aeri Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hyori Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Juna Lee
- College of Nursing, Catholic University of Pusan, Busan, Republic of Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sezek I, Cubukcu M, Muderrısoglu S. Care Burden and Life Satisfaction of Caregivers Who are Providing Home Health Care to Patients. Risk Manag Healthc Policy 2023; 16:2139-2150. [PMID: 37868020 PMCID: PMC10588659 DOI: 10.2147/rmhp.s426598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
Background This study aims to evaluate the care burden and life satisfaction in caregivers who are providing home health care to patients and determine the relationship between life satisfaction and care burden. Methods This cross-sectional descriptive study was performed on 133 caregivers who provided home health care to patients and 133 control groups between February and December 2020. Care burden was evaluated using the Zarit Burden Inventory (ZBI), and life satisfaction was evaluated using the Satisfaction with Life Scale (SWLS). Results The mean age of hundred thirty-three caregivers was 52.5±10.5 years, and that of the control group was 51.2±9.9 years. The mean ZBI score of the caregivers was 47.0±16.4. According to the ZBI score, 46.6% of the caregivers had a moderate care burden and 21.8% had a heavy caregiver burden. The caregiver burden was higher in those with a low education level, those without social insurance, those who felt insufficient in care, and those who did not receive help from other family members. The SWLS score of caregivers was significantly lower than that of control group (p<0.001). The SWLS score was lower in those with a low education level and those without an employee as a caregiver. There was a negative correlation between SWLS and ZBI score (p<0.001). Conclusion Caregivers of patients receiving home health-care services are exposed to a significant care burden. The care burden was higher in those with a low education level, those without social insurance, those who felt insufficient in care, and those who did not receive help from other family members. The care burden affects the satisfaction of life.
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Affiliation(s)
- Isa Sezek
- Yesil Kent Family Health Center, Samsun, Turkey
| | - Mahcube Cubukcu
- Department of Family Medicine, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Secıl Muderrısoglu
- Department of Biochemistry, Ondokuz Mayis University, Health Sciences Institute, Samsun, Turkey
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Karmarkar AM, Roy I, Lane T, Shaibi S, Baldwin JA, Kumar A. Home health services for minorities in urban and rural areas with Alzheimer's and related dementia. Home Health Care Serv Q 2023; 42:265-281. [PMID: 37128943 DOI: 10.1080/01621424.2023.2206368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Timely access and continuum of care in older adults with Alzheimer's Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01-1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12-1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03-1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas.
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Affiliation(s)
- Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Research Department, Sheltering Arms Institute, Richmond, Virginia, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Taylor Lane
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Stefany Shaibi
- Physical Therapy Department, Creighton University, Phoenix, Arizona, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Amit Kumar
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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Sabbe K, Van Der Mast R, Van Rompaey B. Delirium in Home Care: A Case Report. Cureus 2023; 15:e47094. [PMID: 38021756 PMCID: PMC10646439 DOI: 10.7759/cureus.47094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Delirium is a challenging medical problem, particularly in the home care setting, and greatly affects both patients and family caregivers. When delirium is not immediately detected and effectively managed, various outcomes are adversely affected. This report describes delirium in an older home-bound man and offers strategies for detecting and managing delirium in a home care setting. The patient is a frail 86-year-old man with multiple medical comorbidities and functional decline after bronchitis that was diagnosed by a general practitioner. Following the diagnosis and subsequent treatment of bronchitis, the patient suffered a major decline in cognitive and physical functioning during normal daily activities. Medical screening revealed confusion, apathy, and extreme fatigue. Using the assessment tool of the Functional Independence Measures and Delirium Observation Screening Scale (DOSS), the presence of functional decline and delirious symptoms were found. Through multidisciplinary collaboration, a treatment plan was initiated. It consisted of hydration following a fixed schedule, adapted nutrition, a temporary adapted medication schedule for pre-diabetes, and an exercise plan. No specific pharmaceuticals were given. The patient made a full recovery over time. All professional and informal caregivers should be aware of the potential presence of delirium when an older patient with a deteriorating physical or mental condition presents itself. Good diagnostics for delirium and possible underlying diseases are necessary. Adequate treatment, with the help of paramedics such as dieticians, physiotherapists, etc. must be provided when necessary.
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Affiliation(s)
- Kelly Sabbe
- Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
| | - Roos Van Der Mast
- Psychiatry and Behavioral Sciences, University of Leiden, Leiden, NLD
| | - Bart Van Rompaey
- Family Medicine and Population Health, University of Antwerp, Antwerp, BEL
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Mun M, Park Y, Hwang J, Woo K. Types and Effects of Telenursing in Home Health Care: A Systematic Review and Meta-Analysis. Telemed J E Health 2023. [PMID: 37707998 DOI: 10.1089/tmj.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Purpose: This systematic review aimed to identify the types and effectiveness of telenursing in home health care (HHC) compared to conventional HHC. Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guidelines. A random-effects meta-analysis was performed. The risk of bias was assessed using the Risk of Bias 2.0 tool. The quality of bias was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: A total of 17 studies published between 2003 and 2022 were included in the review. The majority of the targeted health conditions of the patients were chronic obstructive pulmonary disease or congestive heart failure (70%). We categorized telenursing interventions according to different technology (N = 4) and nursing (N = 7) types. Among the identified types of nursing, fundamental nursing to monitor patients' symptoms was the most representative. Telemonitoring was found to be the most common technology type, followed by synchronous technology using video or telephone. The telenursing outcomes, including health care utilization, physiological/psychological outcomes, and quality of life, varied. In the meta-analysis, participants who received telenursing reported fewer hospital admissions (standardized mean difference [SMD]: -0.18; confidence interval [95% CI]: -0.43 to -0.02) and emergency department visits (SMD: -0.28; 95% CI: -0.45 to -0.10). Conclusion: Telenursing in HHC tends to improve the quality of life and could result in many benefits, including a reduction in health care utilization and facilitating the management of chronic diseases. These results ultimately represent the potential effectiveness of telenursing in community health care settings.
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Affiliation(s)
- Minji Mun
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, South Korea
| | - Youngsun Park
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, South Korea
| | - Jinkyoung Hwang
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Kyungmi Woo
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, South Korea
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Squires A, Engel P, Ma C, Miner S, Feldman PH, McDonald MV, Jones S. Continuity of Care Versus Language Concordance as an Intervention to Reduce Hospital Readmissions From Home Health Care. Med Care 2023; 61:605-610. [PMID: 37561604 PMCID: PMC10421624 DOI: 10.1097/mlr.0000000000001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. OBJECTIVE The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. DESIGN A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. PARTICIPANTS The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. MEASURES The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. RESULTS When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). CONCLUSION In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.
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Affiliation(s)
| | | | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University
| | - Sarah Miner
- Wegman’s School of Nursing, New York University
| | | | | | - Simon Jones
- Director of Analytics, Center for Delivery Systems Science Department of Population Health, Grossman School of Medicine, New York University
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30
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Burgdorf JG, Mroz TM, Reckrey JM, Barrón Y, Ryvicker M. Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode. Alzheimers Dement 2023; 19:3936-3945. [PMID: 37057687 PMCID: PMC10523879 DOI: 10.1002/alz.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Home health (HH) may be an important source of care for those with early-stage/undiagnosed Alzheimer's Disease and Related Dementias (ADRD), but little is known regarding prevalence or predictors of incident ADRD diagnosis following HH. METHODS Using 2010-2012 linked Master Beneficiary Summary File (MBSF) and HH assessment data for 40,596 Medicare HH patients, we model incident ADRD diagnosis within 1 year of HH via multivariable logistic regression. RESULTS Among HH patients without diagnosed ADRD, 10% received an incident diagnosis within 1 year. In adjusted models, patients were three times more likely to receive an incident ADRD diagnosis if they had HH clinician-reported impaired overall cognition (compared to patients without reported impairment) and twice as likely if they were community-referred (compared to hospital-referred patients). DISCUSSION There is a pressing need to develop tailored HH clinical pathways and protect access to community-referred HH to support community-living older adults with early-stage/undiagnosed ADRD.
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Affiliation(s)
- Julia G. Burgdorf
- Center for Home Care Policy & Research at VNS Health, 220 E. 42 St, 6 Floor, New York, NY 10017
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195-6490
| | - Jennifer M. Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place Box 1216, New York NY 10029
| | - Yolanda Barrón
- Center for Home Care Policy & Research at VNS Health, 220 E. 42 St, 6 Floor, New York, NY 10017
| | - Miriam Ryvicker
- Center for Home Care Policy & Research at VNS Health, 220 E. 42 St, 6 Floor, New York, NY 10017
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Alkeridy WA, Alquaydheb H, Almuhaidib S, Sindi NA, Aljasser A, Kushner Kow J, Alqahtani AS. Determinants of Vaccine Hesitancy among Home Health Care Service Recipients in Saudi Arabia. Vaccines (Basel) 2023; 11:1436. [PMID: 37766113 PMCID: PMC10534424 DOI: 10.3390/vaccines11091436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Vaccine hesitancy has been identified by the World Health Organization (WHO) as a major worldwide health threat. Home Health Care (HHC) service recipients represent a vulnerable group and were prioritized to receive coronavirus disease (COVID-19) vaccination during the national vaccine campaigns in Saudi Arabia. We aimed to investigate the most frequent reasons for vaccine hesitancy among home health care recipients in Saudi Arabia. METHODS This cross-sectional survey was conducted among home health care (HHC) service recipients in Saudi Arabia from February 2022 to September 2022. The behavioral and social drivers (BeSD) model developed by the WHO was used to understand the factors affecting vaccination decision making in our cohort. RESULTS Of the 426 HHC service recipients enrolled in the study, a third were hesitant to complete the COVID-19 vaccination series. The most prevalent reported reason for COVID-19 vaccine refusal was concerns about the vaccine side effects (41.6%). Factors independently associated with COVID-19 vaccination hesitancy were: having chronic conditions (odds ratio [OR] = 2.59; 95% confidence interval [CI] = 1.33-5.05, p = 0.005), previous COVID-19 diagnosis (OR = 0.48; 95% CI: 0.28-0.82, p = 0.008), ease of getting the COVID-19 vaccine by themselves (OR = 0.49; 95% CI: 0.28-0.89, p = 0.018), belief in the importance of COVID-19 vaccine in protecting their health (OR = 0.60; 95% CI: 0.38-0.96, p = 0.032), and confidence in the safety of COVID-19 vaccination (OR = 0.38; 95% CI: 0.21-0.69, p = 0.001). CONCLUSION Only one-third of the study participants were hesitant to complete the series of COVID-19 vaccination. Understanding the factors underpinning vaccine hesitancy among this group would help healthcare workers and policymakers in developing personalized health awareness campaigns aimed at improving vaccine acceptance levels.
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Affiliation(s)
- Walid A. Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
- Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh 12382, Saudi Arabia;
| | - Hisham Alquaydheb
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Shadan Almuhaidib
- Scientific Research Center, Ministry of Defense Health Services, Riyadh 12426, Saudi Arabia;
| | - Nawal A. Sindi
- General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh 12382, Saudi Arabia;
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Janet Kushner Kow
- Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Alhawsawi EMF, Hariri GA, Alfakeh SA, Alkhatieb MT. Predictors of burden perceived by informal caregivers of patients registered in the home health-care unit. Ann Afr Med 2023; 22:309-315. [PMID: 37417018 PMCID: PMC10445695 DOI: 10.4103/aam.aam_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 07/08/2023] Open
Abstract
Context Studies have reported multiple variables that can affect the level of burden on informal caregivers. The need for informal caregivers is expected to increase in the upcoming years. Informal caregivers are an important extension of the formal health-care system. Aims The aim of this study was to discover the characteristics of informal caregivers of adult patients, to determine the socioeconomic, psychological, and physical consequences facing informal caregivers, and to measure caregivers' burdens and needs. Settings and Design An analytical cross-sectional study that was carried out in Saudi Arabia, in the home health-care unit of King Abdelaziz University Hospital in the city of Jeddah. Subjects and Methods A. validated self-administered questionnaire in Arabic and English was used. The required sample size was 122 participants. Ethical approval was obtained. Statistical Analysis Used Descriptive statistics consisted of means, standard deviations, frequency tables, cross-tabulation, and charts. Categorical variables were compared using the Chi-square test to determine significant relationships between variables. Results A. total of 124 participants responded to a request to participate in the study. The majority of the caregivers (92) were family members. There was a significant relationship between the nature of the connection between the caregiver and the recipient in association with the burden scale (P = 0.001). No significant relationship was found between caregivers' gender, marital status, or income level and the burden score. Conclusions Most of the caregivers reported no burden to minimal burden. The relationship with the care recipient has a negative impact on the burden scale.
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Affiliation(s)
| | - Ghufran A. Hariri
- Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sulhi A. Alfakeh
- Department of Psychiatry, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Maram T. Alkhatieb
- Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Li CM, Yang KC, Lee YH, Chen YH, Lin IW, Huang KC. One-Year Medical Utilization and Mortality in Home Health and Nursing Home Care Recipients from Northern Taiwan. J Am Med Dir Assoc 2023; 24:991-996. [PMID: 37268015 DOI: 10.1016/j.jamda.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Home health care (HHC) and nursing home care (NHC) are mainstays of long-term service in the aged population. Therefore, we aimed to investigate the factors associated with 1-year medical utilization and mortality in HHC and NHC recipients in Northern Taiwan. DESIGN This study employed a prospective cohort design. SETTING AND PARTICIPANTS We enrolled 815 HHC and NHC participants who started receiving medical care services from the National Taiwan University Hospital, Beihu Branch between January 2015 and December 2017. METHODS Multivariate Poisson regression modeling was used to quantify the relationship between care model (HHC vs NHC) and medical utilization. Cox proportional-hazards modeling was used to estimate hazard ratios and factors associated with mortality. RESULTS Compared with NHC recipients, HHC recipients had higher 1-year utilization of emergency department services [incidence rate ratio (IRR) 2.04, 95% CI 1.16-3.59] and hospital admissions (IRR 1.49, 95% CI 1.14-1.93), as well as longer total hospital length of stay (LOS) (IRR 1.61, 95% CI 1.52-1.71) and LOS per hospital admission (IRR 1.31, 95% CI 1.22-1.41). Living at home or in a nursing home did not affect the 1-year mortality. CONCLUSIONS AND IMPLICATIONS Compared with NHC recipients, HHC recipients had a higher number of emergency department services and hospital admissions, as well as longer hospital LOS. Policies should be developed to reduce emergency department and hospitalization utilization in HHC recipients.
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Affiliation(s)
- Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuen-Cheh Yang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsin Chen
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - I-Wen Lin
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Community and Geriatric Medicine Research Center, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
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Al Mutair A, Saha C, Alhuqbani W, Alhuqbani MN, AlQahtani MN, Abogosh AK, Alsedrah AM, Alhindi AH, Alfehaid RH, Al-Omari A. Utilization of Telemedicine during COVID-19 in Saudi Arabia: A Multicenter Study. Cureus 2023; 15:e41541. [PMID: 37554605 PMCID: PMC10404792 DOI: 10.7759/cureus.41541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The outbreak of the novel Coronavirus disease 2019 (COVID-19) has influenced all aspects of life and significantly impacted healthcare services. It has collectively necessitated the use of telemedicine in providing healthcare. Through this study, we aim to report the statistics on telemedicine utilization and satisfaction across the Kingdom of Saudi Arabia during COVID-19. METHODS This is a cross-sectional study to report the utilization and patient satisfaction with telemedicine services across Saudi Arabia. The data was collected retrospectively from March 2020 to July 2020 on 22,620 patients who used telemedicine services for consultations, medicine refills, and home healthcare visits during COVID-19. RESULTS The patients received a quick response to their calls within a mean (± SD) waiting time of 2.54 (± 6.8) minutes corresponding to a median (IQR) of 0 (0-1) minutes. Home healthcare services were presented within a median (IQR) time of 20.16 (4.64 - 42.28) hours, and patients received medication at home with a median (IQR) time of 18.8 (12.15 - 36.1) hours. Conversations over the phone varied for a median (IQR) time of 5 (3-7) minutes. The highest number of telemedicine calls were for family medicine consultations, i.e., 6729 (29.7%), and the lowest was for infectious diseases 04 (0.1%), followed by cardiology consultations, i.e., 635 (2.8%). A total of 13,154 (58.15) rated their overall satisfaction, of which 11,684 (88.82%) found telemedicine services satisfactory. CONCLUSION The utilization of telemedicine across Saudi Arabia results have shown telemedicine to be a satisfactory service for convenient and safe communication between patients and their healthcare providers. It can thus be established as a smart and indissoluble service across the kingdom. However, there is a need to raise awareness of insurance coverage for such services to make them more feasible and accessible to the public.
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Affiliation(s)
| | - Chandni Saha
- Research Center, Almoosa Health Group, Al Ahsa, SAU
| | - Waad Alhuqbani
- Research, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | - Ahmad K Abogosh
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | | | | | - Reema H Alfehaid
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
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Liu CJ, Burch H, Glover S, Donofrio A, Oliveros G, DeMeo G. Practice Patterns and Responses to the Patient-Driven Groupings Model and Coronavirus Disease 2019 Pandemic in Home Health Occupational Therapy: A Pilot Survey Study. Occup Ther Health Care 2023:1-15. [PMID: 37021967 DOI: 10.1080/07380577.2023.2196691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The purpose of the pilot survey was to understand current practice patterns and responses to the Patient-Driven Groupings Model and the coronavirus disease 2019 (COVID-19) pandemic in home health occupational therapy care. Fifty home health occupational therapy practitioners from 27 states in the United States completed the survey. Descriptive analysis was used to organize and summarize survey responses. The survey items on practice patterns included assessment tools, treatment approaches, and care coordination with physical therapy colleagues. The most reported assessment of occupational performance was the Barthel Index. The common treatment approaches included activities of daily living retraining, energy conservation, and functional mobility and transfer. The majority of respondents (n = 44) communicated with their physical therapy colleagues at least once a week. The communications were often related to scheduling and changes in a patient's condition. Seventy percent of practitioners experienced a reduction in home visits during the recent Medicare payment reform and the pandemic. These practitioners perceived that some patients might have been discharged from home health care prematurely. Additional studies to investigate the impact of policy changes and the pandemic on therapy intensity and patients' functional outcomes are warranted.
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Affiliation(s)
- Chiung-Ju Liu
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Hannah Burch
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Sabrina Glover
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Abigail Donofrio
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Gianna Oliveros
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Gianna DeMeo
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
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Bawazeer M, Alsowailmi B, Masud N, BenSalih A, Alfaraidi L, Said F. Immediate outcome assessment of the rapid response team of home health care services at King Abdulaziz Medical City in Riyadh. J Family Med Prim Care 2023; 12:686-693. [PMID: 37312785 PMCID: PMC10259559 DOI: 10.4103/jfmpc.jfmpc_1653_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/24/2022] [Accepted: 12/30/2022] [Indexed: 06/15/2023] Open
Abstract
Background Paediatrics rapid response team (RRT) is a newly developed service under paediatrics home health care (HHC) programme which is a standby visiting team that responds to non-critical emergency calls. The current study aimed to compare the total emergency visits and hospital admissions before and after implementation of RRT project. Method A retrospective chart review was conducted from December 2018 to December 2020. Paediatric patients registered under the home health care (HHC) programme were the target population. The admission and hospitalization rates were assessed before and after the implantation of an RRT. The variables related to patient profile were assessed to explore the association between hospitalization and admission. Result Data for 117 patients and a total of 114 calls attended under HHC covered by RRT were analysed. In the first year after the implementation of RRT, the mean number of ER visits per patient per year was reduced from 4.78 ± 6.10 to 3.93 ± 4.12 with (P value, 0.06). Also, a slight decrease in the mean number of admissions from 3.74 ± 4.43 to a mean of 3.46 ± 4.1 with (P value, 0.29). Follow-up after receiving an RRT call for an initial complaint was statistically significant in reducing both ER visits and hospital admissions within 7 days with a P value of 0.03 and 0.04, respectively. Conclusion The RRT was effective in decreasing the ER visits and hospital admissions for a very special group of patients. Additionally, the emplacement of proper triaging code at the time of attending to patients helped in reducing unnecessary ER visit and hospital admission.
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Affiliation(s)
- Manal Bawazeer
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
- Saudi Scientific Home Healthcare Society, Riyadh, Saudi Arabia
| | - Banan Alsowailmi
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
| | - Nazish Masud
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, Georgia, USA
| | - Ayah BenSalih
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
| | - Lama Alfaraidi
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
| | - Feryal Said
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh, Saudi Arabia
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Martins C, Escoval A, Lopes M, Mendonça S, Fonseca C. Quality and Safety of Proximity Care Centered on the Person and Their Home: A Systematic Review Protocol. Int J Environ Res Public Health 2023; 20:4504. [PMID: 36901513 PMCID: PMC10001688 DOI: 10.3390/ijerph20054504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
The quality and safety of health care is a priority, a requirement and a demand of health organizations and social institutions with concrete purposes of progressively providing people with a higher level of health and well-being. It is in the development of this path that home care currently represents an area of gradual investment and where health care services and the scientific community have shown interest in building circuits and instruments that can respond to needs. It is essencial that care must be centered and in close proximity to the person and their family, their context. On the other hand, in Portugal, there are already quality and safety models for the institutionalization context however it is non-existent for home care. In this sense, our objective is to identify, through a systematic review of the literature, particularly from the last 5 years, areas of quality and safety in home care.
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Affiliation(s)
- Carlos Martins
- Cova da Beira Group of Health Centers, 6200-034 Covilhã, Portugal
| | - Ana Escoval
- Comprehensive Health Research Center, University of Évora (CHRC-UE), 7000-811 Évora, Portugal
| | - Manuel Lopes
- Comprehensive Health Research Center, University of Évora (CHRC-UE), 7000-811 Évora, Portugal
| | - Susana Mendonça
- Department of Nursing, University of Évora, 7000-811 Évora, Portugal
| | - César Fonseca
- Department of Nursing, University of Évora, 7000-811 Évora, Portugal
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Sterling MR, Lau J, Rajan M, Safford M, Akinyelure OP, Kern LM. Self-reported gaps in care coordination and preventable adverse outcomes among older adults receiving home health care. J Am Geriatr Soc 2023; 71:810-820. [PMID: 36468538 PMCID: PMC10023304 DOI: 10.1111/jgs.18135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Older adults see multiple outpatient providers and increasingly use home health care (HHC) services. Previous studies attempting to draw inferences about the association between HHC use and patient outcomes have been mixed. Whether HHC is associated with care coordination and how both influence outcomes are unknown. In addition, prior studies have not taken the patient perspective into account. We examined the association between receiving HHC and self-reported gaps in care coordination and separately, preventable adverse outcomes. METHODS The analysis for this cross-sectional study was conducted between October 2021 and June 2022, using data on 4296 Medicare beneficiaries from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who completed a survey on care coordination from 2017 to 2018. The associations between the receipt of HHC and two outcomes (a gap in care coordination, and separately, a preventable adverse event) were examined with Poisson models with robust standard errors. Potential confounders were accounted for through propensity score-based inverse probability weighting. RESULTS Among 4296 participants, 430 (10%) received HHC and they were older and had more comorbidities and ambulatory visits than those without HHC. HHC was not associated with differences in self-reported gaps in care coordination (33.3% HHC vs. 32.5% no-HHC, p = 0.70). HHC recipients reported more preventable drug-drug interactions (9.1% vs. 4.0%, p < 0.001) but not more preventable ED visits or hospital admissions. In IPW-adjusted models, HHC was not associated with gaps in care coordination (p = 0.60) but was associated with double the risk of a preventable adverse outcome (aRR 2.06; CI: 1.37, 3.10, p < 0.001). CONCLUSIONS HHC recipients were significantly more likely (than those without HHC) to report a potentially preventable adverse event (particularly a drug-drug interaction), suggesting an opportunity to improve patient safety by leveraging the observations of older adults receiving HHC.
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Affiliation(s)
| | - Jennifer Lau
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Mangala Rajan
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Monika Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | | | - Lisa M. Kern
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lindberg C, Fock J, Nilsen P, Schildmeijer K. Registered nurses' efforts to ensure safety for home-dwelling older patients. Scand J Caring Sci 2022; 37:571-581. [PMID: 36582025 DOI: 10.1111/scs.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/23/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care. AIM The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care. METHOD We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis. FINDINGS The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care. CONCLUSIONS It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.
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Affiliation(s)
- Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Jenni Fock
- Centre for Healthcare Development, University Hospital Linköping, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lorenz G. [Diagnostic predictive value of liver biopsy for clinical aspects]. Z Arztl Fortbild (Jena) 2022; 72:793-6. [PMID: 362741 PMCID: PMC9736764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices. Objective We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method’s performance and to compare its performance to that of existing approaches. Methods We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient’s chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis. Results The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG. Conclusions Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices’ cost-effectiveness and contributes to their widespread application.
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Mirabnejad M, Mohammadi H, Mirzabaghi M, Aghsami A, Jolai F, Yazdani M. Home Health Care Problem with Synchronization Visits and Considering Samples Transferring Time: A Case Study in Tehran, Iran. Int J Environ Res Public Health 2022; 19:15036. [PMID: 36429755 PMCID: PMC9690415 DOI: 10.3390/ijerph192215036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Health care facilities have not increased in response to the growing population. Therefore, government and health agencies are constantly seeking cost-effective alternatives so they can provide effective health care to their constituents. Around the world, health care organizations provide home health care (HHC) services to patients, especially the elderly, as an efficient alternative to hospital care. In addition, recent pandemics have demonstrated the importance of home health care as a means of preventing infection. This study is the first to simultaneously take into account nurses' working preferences and skill levels. Since transferring samples from the patient's home to the laboratory may affect the test results, this study takes into account the time it takes to transfer samples. In order to solve large instances, two metaheuristic algorithms are proposed: Genetic Algorithms and Particle Swarm Optimization. Nurses are assigned tasks according to their time windows and the tasks' time windows in a three-stage scheduling procedure. Using a case study set in Tehran, Iran, the proposed model is demonstrated. Even in emergencies, models can generate effective strategies. There are significant implications for health service management and health policymakers in countries where home health care services are receiving more attention. Furthermore, they contribute to the growing body of knowledge regarding health system strategies by providing new theoretical and practical insights.
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Affiliation(s)
- Mahyar Mirabnejad
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran 1439955961, Iran
| | - Hadi Mohammadi
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran 1439955961, Iran
| | - Mehrdad Mirzabaghi
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran 1439955961, Iran
| | - Amir Aghsami
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran 1439955961, Iran
- School of Industrial Engineering, K.N. Toosi University of Technology (KNTU), Tehran 1999143344, Iran
| | - Fariborz Jolai
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran 1439955961, Iran
| | - Maziar Yazdani
- Research Centre for Integrated Transport Innovation, School of Civil and Environmental Engineering, The University of New South Wales, Sydney 2052, Australia
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Sterling MR, Cho J, Leung PB, Silva AF, Ringel J, Wiggins F, Herring N, Powell A, Toro O, Lee A, Loughman J, Obodai M, Poon A, Goyal P, Kern LM, Safford MM. Development and Piloting of a Community-Partnered Heart Failure Training Course for Home Health Care Workers. Circ Cardiovasc Qual Outcomes 2022; 15:e009150. [PMID: 36378772 PMCID: PMC9674373 DOI: 10.1161/circoutcomes.122.009150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite their unique contributions to heart failure (HF) care, home healthcare workers (HHWs) have unmet educational needs and many lack HF caregiving self-efficacy. To address this, we used a community-partnered approach to develop and pilot a HF training course for HHWs. METHODS We partnered with the Training and Employment Fund, a benefit fund of the largest healthcare union in the United States, to develop a 2-hour virtual HF training course that met HHWs' job-specific needs. English and Spanish-speaking HHWs interested in HF training, with access to Zoom, were eligible. We used a mixed methods design with pre/postsurveys and semi-structured interviews to evaluate the course: (a) feasibility, (b) acceptability, and (c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale range 0-100]). RESULTS Of the 210 HHWs approached, 100 were eligible and agreed, and 70 enrolled. Of them, 53 (employed by 15 different home care agencies) participated. Posttraining data showed significant improvements (pretraining mean [SD] versus posttraining mean [SD]; P value) in HF knowledge (11.21 [1.90] versus 12.21 [1.85]; P=0.0000) and HF caregiving self-efficacy (75.21 [16.57] versus 82.29 [16.49]; P=0.0017); the greatest gains occurred among those with the lowest pre-training scores. Participants found the course engaging, technically feasible, and highly relevant to their scope of care. CONCLUSIONS We developed and piloted the first HF training course for HHWs, which was feasible, acceptable, and improved their HF knowledge and caregiving self-efficacy. Our findings warrant scalability to the workforce at large with a train-the-trainer model.
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Affiliation(s)
| | | | | | | | | | - Faith Wiggins
- 1199SEIU-Training and Employment Funds, New York, NY
| | | | | | - Oscar Toro
- 1199SEIU-Training and Employment Funds, New York, NY
| | - Ann Lee
- 1199SEIU-Training and Employment Funds, New York, NY
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Yasuhara T, Usui H, Kinoshita A, Yasuda M, Kushihata T, Ueda M, Nagata M, Sone T. [Survey in Hyogo Prefecture on the Current Status of Pharmacists in Home Health Care and Exploration of Factors Causing Psychological Burden]. YAKUGAKU ZASSHI 2022; 142:1115-1123. [PMID: 36184445 DOI: 10.1248/yakushi.22-00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is a need for pharmacists to be actively involved in home healthcare through a wide range of collaboration in healthcare and welfare. However, insufficient evidence is available to search for factors that prevent pharmacists from being proactive in home healthcare. In this study, we conducted an extensive questionnaire survey among pharmacists engaged in home pharmacy work who belong to the Hyogo Pharmaceutical Society regarding the current status of pharmacists' work in home medical care and their psychological burden; we also explored the factors that may hinder the future development of home medical care. As a result, 925 (44%) valid responses were obtained, and seven factors- "current multidisciplinary cooperation", "relationships with patients and their families", "emotional burden for home healthcare", "attitude toward patients", "ideal of multidisciplinary cooperation", "anxiety about aggressive intervention", and "anxiety about talking to and dealing with patients"- were extracted. Furthermore, it was suggested that pharmacists' mental burden and anxiety are closely related to their successful experiences in building relationships with patients and patients' families as well as with multidisciplinary cooperation in home healthcare. Therefore, to train pharmacists to be actively involved in home healthcare, it is important not only to impart knowledge and skills but also for them to gain experience practicing their contributions as pharmacists in the field of home healthcare with multiple professions, patients, and patients' families.
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Affiliation(s)
| | - Haruka Usui
- Faculty of Pharmaceutical Sciences, Setsunan University
| | | | | | | | - Masahiro Ueda
- Faculty of Pharmaceutical Sciences, Setsunan University
| | - Misa Nagata
- Faculty of Pharmaceutical Sciences, Wakayama Medical University
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45
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Quigley DD, Chastain AM, Kang JA, Bronstein D, Dick AW, Stone PW, Shang J. Systematic Review of Rural and Urban Differences in Care Provided by Home Health Agencies in the United States. J Am Med Dir Assoc 2022; 23:1653.e1-1653.e13. [PMID: 36108785 PMCID: PMC9880873 DOI: 10.1016/j.jamda.2022.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Home health care agencies (HHAs) are skilled care providers for Medicare home health beneficiaries in the United States. Rural HHAs face different challenges from their urban counterparts in delivering care (eg, longer distances to travel to patient homes leading to higher fuel/travel costs and fewer number of visits in a day, impacting the quality of home health care for rural beneficiaries). We review evidence on differences in care outcomes provided by urban and rural HHAs. DESIGN Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the Newcastle-Ottawa Scale (NOS) for quality appraisal. SETTING Care provided by urban and rural HHAs. METHODS We conducted a systematic search for English-language peer-reviewed articles after 2010 on differences in urban and rural care provided by U.S. HHAs. We screened 876 studies, conducted full-text abstraction and NOS quality review on 36 articles and excluded 2 for poor study quality. RESULTS Twelve studies were included; 7 focused on patient-level analyses and 5 were HHA-level. Nine studies were cross-sectional and 3 used cohorts. Urban and rural differences were measured primarily using a binary variable. All studies controlled for agency-level characteristics, and two-thirds also controlled for patient characteristics. Rural beneficiaries, compared with urban, had lower home health care utilization (4 of 5 studies) and fewer visits for physical therapy and/or rehabilitation (3 of 5 studies). Rural agencies had lower quality of HHA services (3 of 4 studies). Rural patients, compared with urban, visited the emergency room more often (2 of 2 studies) and were more likely to be hospitalized (2 of 2 studies), whereas urban patients with heart failure were more likely to have 30-day preventable hospitalizations (1 study). CONCLUSION AND IMPLICATIONS This review highlights similar urban/rural disparities in home health care quality and utilization as identified in previous decades. Variables used to measure the access to and quality of care by HHAs varied, so consensus was limited. Articles that used more granular measures of rurality (rather than binary measures) revealed additional differences. These findings point to the need for consistent and refined measures of rurality in studies examining urban and rural differences in care from HHAs.
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Affiliation(s)
- Denise D. Quigley
- Health Unit, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407
| | - Ashley M. Chastain
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
| | - Jung A. Kang
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
| | - David Bronstein
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
| | - Andrew W. Dick
- Health Unit, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
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Alkeridy WA, Aljasser A, Alayed KM, Alsaad SM, Alqahtani AS, Lim CA, Alamri SH, Mekkawy DZ, Al-Sofiani M. Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia. J Multidiscip Healthc 2022; 15:1997-2005. [PMID: 36101552 PMCID: PMC9464450 DOI: 10.2147/jmdh.s379782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design Retrospective cross-sectional descriptive study. Setting and Participants A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods Only individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.
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Affiliation(s)
- Walid A Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada.,General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad M Alsaad
- Department of Family & Community medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani S Alqahtani
- Research department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Claire Ann Lim
- Department of Medical Rehabilitation, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan H Alamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Saudi Geriatrics Society, Riyadh, Saudi Arabia
| | - Doaa Zainhom Mekkawy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Sofiani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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Khankeh HR, Ebadi A, Norouzi Tabrizi K, Moradian ST. Home health care for mechanical ventilation-dependent patients: A grounded theory study. Health Soc Care Community 2022; 30:e2157-e2168. [PMID: 34791719 DOI: 10.1111/hsc.13654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 10/16/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.
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Affiliation(s)
- Hamid Raza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kian Norouzi Tabrizi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Hayashi S, Shirahige Y, Fujioka S, Tsugihashi Y, Iida H, Hirose M, Yasunaka M, Kurita N. Relationship between patient-centred care and advance care planning among home medical care patients in Japan: the Zaitaku evaluative initiatives and outcome study. Fam Pract 2022; 40:211-217. [PMID: 35899787 DOI: 10.1093/fampra/cmac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a growing need to realize high-quality end-of-life care at home that respects the patient's wishes. OBJECTIVE To examine the association between the quality of primary care and advance care planning (ACP) participation among patients receiving home-based medical care. METHODS In this multicentre, cross-sectional study, 29 home medical care clinics in Japan were included. Adult Japanese patients receiving home medical care were surveyed to assess their consideration of ACP. The quality of primary care, which reflects patient-centredness, was assessed with the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF). Information on the clinical conditions that require home medical care was collected from physicians. RESULTS Of the 194 patients surveyed from 29 home medical services, 62 patients (32%) showed signs of ACP participation. Lack of opportunities was the most common reason for not participating in the ACP. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP participation (per 10-point increase, adjusted odds ratio: 1.96, 95% confidence interval: 1.51-2.56). In addition, all domains of the JPCAT-SF were associated with ACP participation. CONCLUSIONS Patient-centredness in home medical care facilitates the initiation of ACP participation.
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Affiliation(s)
- Shinu Hayashi
- You Home Clinic, Bunkyo City, Japan.,You Home Clinic Heiwadai, Nerima City, Japan
| | - Yutaka Shirahige
- Dr.Net Nagasaki, Nagasaki City, Japan.,Shirahige Clinic, Nagasaki City, Japan
| | - Satoshi Fujioka
- Graduate School of Psychology, Kansai University, Suita City, Japan
| | - Yukio Tsugihashi
- Medical Home Care Center, Tenri Hospital Shirakawa Branch, Tenri City, Japan
| | - Hidezaku Iida
- You Home Clinic, Bunkyo City, Japan.,Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima City, Japan
| | - Misaki Hirose
- Dr.Net Nagasaki, Nagasaki City, Japan.,Hirose Clinic, Nagasaki City, Japan
| | - Masakazu Yasunaka
- Dr.Net Nagasaki, Nagasaki City, Japan.,Yasunaka Neurosurgery Clinic, Nagasaki City, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima City, Japan.,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima City, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima City, Japan
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Song J, Ojo M, Bowles KH, McDonald MV, Cato K, Rossetti SC, Adams V, Chae S, Hobensack M, Kennedy E, Tark A, Kang MJ, Woo K, Barrón Y, Sridharan S, Topaz M. Detecting Language Associated With Home Healthcare Patient's Risk for Hospitalization and Emergency Department Visit. Nurs Res 2022; 71:285-294. [PMID: 35171126 PMCID: PMC9246992 DOI: 10.1097/nnr.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND About one in five patients receiving home healthcare (HHC) services are hospitalized or visit an emergency department (ED) during a home care episode. Early identification of at-risk patients can prevent these negative outcomes. However, risk indicators, including language in clinical notes that indicate a concern about a patient, are often hidden in narrative documentation throughout their HHC episode. OBJECTIVE The aim of the study was to develop an automated natural language processing (NLP) algorithm to identify concerning language indicative of HHC patients' risk of hospitalizations or ED visits. METHODS This study used the Omaha System-a standardized nursing terminology that describes problems/signs/symptoms that can occur in the community setting. First, five HHC experts iteratively reviewed the Omaha System and identified concerning concepts indicative of HHC patients' risk of hospitalizations or ED visits. Next, we developed and tested an NLP algorithm to identify these concerning concepts in HHC clinical notes automatically. The resulting NLP algorithm was applied on a large subset of narrative notes (2.3 million notes) documented for 66,317 unique patients ( n = 87,966 HHC episodes) admitted to one large HHC agency in the Northeast United States between 2015 and 2017. RESULTS A total of 160 Omaha System signs/symptoms were identified as concerning concepts for hospitalizations or ED visits in HHC. These signs/symptoms belong to 31 of the 42 available Omaha System problems. Overall, the NLP algorithm showed good performance in identifying concerning concepts in clinical notes. More than 18% of clinical notes were detected as having at least one concerning concept, and more than 90% of HHC episodes included at least one Omaha System problem. The most frequently documented concerning concepts were pain, followed by issues related to neuromusculoskeletal function, circulation, mental health, and communicable/infectious conditions. CONCLUSION Our findings suggest that concerning problems or symptoms that could increase the risk of hospitalization or ED visit were frequently documented in narrative clinical notes. NLP can automatically extract information from narrative clinical notes to improve our understanding of care needs in HHC. Next steps are to evaluate which concerning concepts identified in clinical notes predict hospitalization or ED visit.
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50
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Sugiura S, Kitamura Y, Izushi Y, Ushio S, Sendo T. Factors Associated with Work Efficiency in Home Health Care by Pharmacists. Acta Med Okayama 2022; 76:307-315. [PMID: 35790361 DOI: 10.18926/amo/63740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In recent years, medical staff including physicians and nurses have been participating in home health care, reflecting the needs of an aging society in Japan. Pharmacists are also asked to work on home health care teams to ensure the medical safety of patients. It currently remains unclear whether direct communication, i.e. a meeting, between home-visiting physicians and pharmacists contributes to the proper use of medications and continuous medical care. We retrospectively analyzed the medication management guidance records of home-visited patients who received their first home visit between April 2014 and March 2017. We collected data on pharmacist inquiries, the duration of visits, and details from a meeting between home-visiting physicians and pharmacists. Thirty-five patients were included. At the first visit, the inquiry rate by pharmacists was 65.7%. The prescription question rate was significantly lower in patients with a meeting than in those without (p=0.033). The average duration of visits was significantly shorter for home-visited patients whose health care providers had a meeting (p=0.007). These results suggest that pharmacists who held a meeting with the home-visiting physician before the first patient visit were able to resolve drug-related issues earlier, which increased the work efficiency of home-visiting pharmacists.
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Affiliation(s)
- Satoshi Sugiura
- Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihisa Kitamura
- Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
- Department of Pharmacotherapy, School of Pharmacy, Shujitsu University
| | - Yasuhisa Izushi
- Department of Pharmacotherapy, School of Pharmacy, Shujitsu University
| | | | - Toshiaki Sendo
- Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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