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Wendt B, Cremers M, Ista E, van Dijk M, Schoonhoven L, Nieuwboer MS, Vermeulen H, Van Dulmen SA, Huisman-de Waal G. Low-value home-based nursing care: A national survey study. J Adv Nurs 2024; 80:1891-1901. [PMID: 37983754 DOI: 10.1111/jan.15970] [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: 06/23/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
AIMS To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care. DESIGN A quantitative, cross-sectional design. METHODS An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. RESULTS A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're-use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care. CONCLUSION According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implementation strategy. REPORTING METHOD STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nursing care is increasingly shifting towards the home environment. Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low-value. Reducing low-value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system.
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Affiliation(s)
- Benjamin Wendt
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Milou Cremers
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Minke S Nieuwboer
- Academy of Health and Vitality, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Simone A Van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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Rajesh D, Witvoet S, Coppolecchia A, Scholl L, Chen AF. Length of Stay and Discharge Disposition after Total Hip Arthroplasty: A Large Multi-Center Propensity Matched Comparison of Robotic-Assisted and Manual Techniques. J Arthroplasty 2024:S0883-5403(24)00317-6. [PMID: 38604284 DOI: 10.1016/j.arth.2024.04.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Robotic-arm assistance continues to gain popularity in total hip arthroplasty (THA) for its potential to improve component placement accuracy and patient outcomes. Nonetheless, there is limited data on the impact of robotic-assisted THA (RA-THA) on hospital length of stay (LOS) and discharge location. This study thus aimed to compare LOS, discharge location, and readmission rate for propensity-matched cohorts of RA-THA versus manual THA (M-THA). METHODS A retrospective review of a multi-hospital database was performed to identify patients who underwent THA between January 2016 and December 2021 from surgeons who performed both RA-THA and M-THA at 77 geographically diverse hospitals. The RA-THA and M-THA cohorts were 1-to-1 matched based on patient sex, age, and body mass index, resulting in 8,536 patients per cohort. Insurance type, LOS, same-day discharge, discharge disposition, and 90-day all-cause readmission rate were compared using Mann-Whitney U and Chi-square tests. RESULTS Average LOS was significantly shorter for RA-THA patients (1.39 ± 0.85 days) than for M-THA patients (1.48 ± 0.91 days, P < 0.001). Compared to 5.6% of M-THA patients, 5.3% of RA-THA patients underwent same-day discharge (P = 0.38). There were statistically significant differences in discharge disposition between cohorts, with more RA-THA cases discharged home without home healthcare compared to M-THA (47.9 versus 45.5%, P = 0.001) and fewer RA-THA cases discharged to a skilled nursing facility (SNF) compared to M-THA (5.6 versus 6.9%, P = 0.001). The 90-day all-cause readmission rate for RA-THA cases was 3.0%, compared to 3.4% for M-THA cases (P = 0.26). CONCLUSION Compared to M-THA, RA-THA had a shorter average LOS, a similar percentage of patients with same-day discharge, fewer patients who had SNF discharge, and a similar all-cause 90-day readmission rate. These results may be of interest to surgeons participating in bundled payment programs and engaging in cost savings.
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Affiliation(s)
- Diviya Rajesh
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
| | - Sietske Witvoet
- Stryker, Amsterdam, The Netherlands, Herikerbergweg 145, 1101 CN, Amsterdam, Netherlands
| | | | - Laura Scholl
- Stryker Orthopaedics, 325 Corporate Dr, Mahwah, NJ, USA
| | - Antonia F Chen
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Department of Orthopaedics, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
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Osakwe ZT, Bollens-Lund E, Wang Y, Ritchie CS, Reckrey JM, Ornstein KA. Clinician Perception of Likelihood of Death in the Next Year Is Associated With 1-Year Mortality and Hospice Use Among Older Adults Receiving Home Health Care. J Palliat Med 2024; 27:481-486. [PMID: 38346312 PMCID: PMC10998701 DOI: 10.1089/jpm.2023.0043] [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] [Accepted: 11/01/2023] [Indexed: 04/06/2024] Open
Abstract
Background: Given the complex care needs of older adults receiving home health care (HHC), it is important for HHC clinicians to identify those with limited prognosis who may benefit from a transition to hospice care. Objectives: To assess the association between HHC clinician-identified likelihood of death and (1) 1-year mortality, and (2) hospice use. Methods: Prospective cohort study from the National Health and Aging Trends Study (NHATS) waves 2011-2018, linked to the Outcomes and Assessment Information Set (OASIS) HHC assessment and Medicare data among 915 community-dwelling NHATS respondents. HHC clinician-identified likelihood of death/decline was determined using OASIS item M1034. Multivariable logistic regression was used to assess the association between clinician-identified likelihood of death/decline and 1-year mortality and hospice use. Results: HHC clinicians identified 42% of the sample as at increased risk of decline or death. One year mortality was 22.3% (n = 548), and 15.88% (n = 303) used hospice within 12 months of HHC. HHC clinician-perceived likelihood of death/decline was associated with greater odds of 1-year mortality (odds ratio [OR], 6.57; confidence interval (95% CI), 2.56-16.90) and was associated with greater likelihood of hospice use (OR, 1.61; 95% CI, 1.00-2.62). Conclusion: HHC clinician perception of patients' risk of death or decline is associated with 1-year mortality. A better understanding of HHC patients at high risk for mortality can facilitate improved care planning and identification of homebound older adults who may benefit from hospice.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Evan Bollens-Lund
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Yihan Wang
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer M. Reckrey
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Katherine A. Ornstein
- Center for Equity in Aging, Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA
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James I, Pejner MN, Kihlgren A. Nurse assistants' experiences and knowledge of how they create a meaningful daily life for older persons receiving municipal home healthcare. Scand J Caring Sci 2024; 38:159-168. [PMID: 37815122 DOI: 10.1111/scs.13219] [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: 02/10/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
AIMS AND OBJECTIVES To explore nurse assistants' experiences and knowledge of how they create a meaningful daily life for older people receiving municipal home healthcare. DESIGN A participatory appreciative action reflection approach. METHODS Interviews, participant observations and informal conversations with 23 nurse assistants in municipal home healthcare generated the data. A thematic analysis was used. RESULTS Two main themes were developed. The first main theme, building a reciprocal relationship, was structured by three subthemes: To strengthen the older person's self-esteem, to co-create care and to create equality. The second main theme, creating meaning, was structured by two subthemes: To create closeness and to receive appreciation. The two main themes are each other's prerequisite. Nursing assistants' building reciprocal relationships gives meaning; through the meaning, reciprocal relationships are achieved, and by that, meaningful daily lives for both the older people and the nurse assistants. CONCLUSION Nurse assistants built a reciprocal relationship both for the older people and for the nurse assistant. This contributes to create a meaningful daily life for the older people. The older person was the main character, and it seems that the nurse assistants apply person-centred care, which can represent a shared common vision that can be used in the encounter.
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Affiliation(s)
| | - Margaretha Norell Pejner
- Department of Home Care, Halmstad Municipality, Halmstad, Sweden
- Örebro University, Örebro, Sweden
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Gan S, Kim C, Lee DY, Park RW. Prediction Models for Readmission Using Home Healthcare Notes and OMOP-CDM. Stud Health Technol Inform 2024; 310:1438-1439. [PMID: 38269685 DOI: 10.3233/shti231233] [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: 01/26/2024]
Abstract
This study developed readmission prediction models using Home Healthcare (HHC) documents via natural language processing (NLP). An electronic health record of Ajou University Hospital was used to develop prediction models (A reference model using only structured data, and an NLP-enriched model with structured and unstructured data). Among 573 patients, 63 were readmitted to the hospital. Five topics were extracted from HHC documents and improved the model performance (AUROC 0.740).
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Affiliation(s)
- Sujin Gan
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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Karnehed S, Pejner MN, Erlandsson LK, Petersson L. Electronic medication administration record (eMAR) in Swedish home healthcare-Implications for Nurses' and nurse Assistants' Work environment: A qualitative study. Scand J Caring Sci 2024. [PMID: 38243649 DOI: 10.1111/scs.13237] [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] [Received: 08/03/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. AIM The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. METHOD We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. RESULTS NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. CONCLUSION Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare.
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Affiliation(s)
- Sara Karnehed
- School of Health & Welfare, Halmstad University, Halmstad, Sweden
| | | | | | - Lena Petersson
- School of Health & Welfare, Halmstad University, Halmstad, Sweden
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Zolnoori M, Sridharan S, Zolnour A, Vergez S, McDonald MV, Kostic Z, Bowles KH, Topaz M. Utilizing patient-nurse verbal communication in building risk identification models: the missing critical data stream in home healthcare. J Am Med Inform Assoc 2024; 31:435-444. [PMID: 37847651 PMCID: PMC10797261 DOI: 10.1093/jamia/ocad195] [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: 07/08/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND In the United States, over 12 000 home healthcare agencies annually serve 6+ million patients, mostly aged 65+ years with chronic conditions. One in three of these patients end up visiting emergency department (ED) or being hospitalized. Existing risk identification models based on electronic health record (EHR) data have suboptimal performance in detecting these high-risk patients. OBJECTIVES To measure the added value of integrating audio-recorded home healthcare patient-nurse verbal communication into a risk identification model built on home healthcare EHR data and clinical notes. METHODS This pilot study was conducted at one of the largest not-for-profit home healthcare agencies in the United States. We audio-recorded 126 patient-nurse encounters for 47 patients, out of which 8 patients experienced ED visits and hospitalization. The risk model was developed and tested iteratively using: (1) structured data from the Outcome and Assessment Information Set, (2) clinical notes, and (3) verbal communication features. We used various natural language processing methods to model the communication between patients and nurses. RESULTS Using a Support Vector Machine classifier, trained on the most informative features from OASIS, clinical notes, and verbal communication, we achieved an AUC-ROC = 99.68 and an F1-score = 94.12. By integrating verbal communication into the risk models, the F-1 score improved by 26%. The analysis revealed patients at high risk tended to interact more with risk-associated cues, exhibit more "sadness" and "anxiety," and have extended periods of silence during conversation. CONCLUSION This innovative study underscores the immense value of incorporating patient-nurse verbal communication in enhancing risk prediction models for hospitalizations and ED visits, suggesting the need for an evolved clinical workflow that integrates routine patient-nurse verbal communication recording into the medical record.
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Affiliation(s)
- Maryam Zolnoori
- School of Nursing, Columbia University, New York, NY 10032, United States
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| | | | - Ali Zolnour
- School of Electrical and Computer Engineering, University of Tehran, Tehran 14395-515, Iran
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| | - Margaret V McDonald
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
| | - Zoran Kostic
- Electrical Engineering Department, Columbia University, New York, NY 10027, United States
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, NY 10032, United States
- Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States
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De Micco F, De Benedictis A, Lettieri E, Tambone V. Editorial: Equitable digital medicine and home health care. Front Public Health 2023; 11:1251154. [PMID: 38192562 PMCID: PMC10773581 DOI: 10.3389/fpubh.2023.1251154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Winqvist I, Näppä U, Rönning H, Häggström M. Reducing risks in complex care transitions in rural areas: a grounded theory. Int J Qual Stud Health Well-being 2023; 18:2185964. [PMID: 36866630 PMCID: PMC9987724 DOI: 10.1080/17482631.2023.2185964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses' perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process. METHODS A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses. RESULTS The main concern in the transition process was "Care coordination in a complex context". The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category "Actively communicating to reduce patient safety risks" was explained by the three categories- "Collaborating on expected care needs", "Anticipating obstacles" and "Timing the departure". CONCLUSIONS The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing.
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Affiliation(s)
- Idun Winqvist
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Helén Rönning
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
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Lekman J, Lindén E, Ekstedt M. The challenge of risk prevention in home healthcare-An interview study with nurses in municipal care. Scand J Caring Sci 2023; 37:1067-1078. [PMID: 37222406 DOI: 10.1111/scs.13181] [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: 11/28/2022] [Revised: 04/26/2023] [Accepted: 05/07/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Safety in home healthcare has garnered increased attention as more people are receiving care for complex conditions at home. The prerequisites for providing safe care at home differ from those in hospitals. Malnutrition, falls, pressure ulcers and inappropriate medication commonly follow poor risk assessments, causing unnecessary suffering and costs. Therefore, risk prevention in home healthcare needs to be prioritised and studied more closely. AIM To describe nurses' experiences of performing risk prevention in municipal home healthcare. METHODS Qualitative inductive approach, using semi-structured interviews with 10 registered nurses in a municipality in southern Sweden. Data underwent qualitative content analysis. FINDINGS The analysis resulted in three main categories and one overarching theme describing nurses' experiences of risk prevention in home healthcare. Getting everyone onboard comprises the categories: Managing safety while respecting the patient's self-determination, which covers patient participation, the strategic importance of respecting different views of risks and information and the fact that healthcare workers are guests in the patient's home. Finding ways to make it work touches upon the relational aspect, including next-of-kin and promoting a common understanding to prevent risks. Being squeezed between resources and requirements refers to ethical dilemmas, teamwork, leadership and organisational prerequisites. CONCLUSION Patient habits, living conditions and limited awareness of risks is a challenge in risk prevention in home healthcare, where patient participation plays a pivotal role. Risk prevention in home healthcare needs to be initiated at an early stage of disease and ageing and should be seen as a process where early health-promoting interventions can prevent the development and accumulation of risks over time. Long-term cross-organisational collaborations and patients' physical, mental and psychosocial conditions also need to be taken into account.
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Affiliation(s)
- Jonatan Lekman
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Abstract
BACKGROUND Providing care for a home-dwelling person with dementia who resists care is an ethical and practical complex and challenging task. Faced with a growing number of persons with dementia, the healthcare professional's understanding of how to best care for and prevent unnecessary use of coercion with persons with dementia is of key importance. RESEARCH AIM The aim of this study was to explore the use of trust-building interventions in home-dwelling persons with dementia resisting care, as described by health professionals in documents of decisions of forced treatment and care. RESEARCH DESIGN A qualitative thematic document analysis inspired by critical realism was conducted. PARTICIPANTS AND RESEARCH CONTEXT Descriptions of trust-building interventions were extracted from 88 documents of forced treatment and care for home-dwelling persons with dementia, receiving home healthcare, in 2015 and 2016. ETHICAL CONSIDERATIONS Approved by the Regional Committee for Medical and Health Research Ethics, reference number 2017/788, and controlled by the Norwegian Centre for Research Data, reference number 54897. The study adhered to the guidelines of the Declaration of Helsinki. FINDINGS We found that "balancing safe care with the person's integrity" was an overarching theme that permeated the descriptions of trust-building interventions in the study. Three main themes were identified when the data were analyzed: safeguarding care, protecting integrity, and optimizing the environment. DISCUSSION AND CONCLUSION Health professionals balanced on a thin line between care and integrity when met with resistance from person with dementia. However, the trust-building interventions used in the most challenging situations did not differ from the interventions used in general in dementia care. Two knowledge gaps were identified: how to perform appropriate assessments of situations of home-dwelling persons with dementia when met with resistance to care, and whether environmental initiatives may also benefit home-dwelling persons with dementia who are not easily cared for.
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Affiliation(s)
- Åshild Gjellestad
- Åshild Gjellestad, Faculty of Health Studies, VID Specialized University, Ulriksdal 10, 5009 Bergen, Norway.
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Leland NE, Rouch SA, Prusynski RA, Shore AD, Kaufman H, Hoover LP, Mroz TM, Freburger JK, Saliba D. Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol. Int J Environ Res Public Health 2023; 20:6959. [PMID: 37887697 PMCID: PMC10606322 DOI: 10.3390/ijerph20206959] [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] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.
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Affiliation(s)
- Natalie E. Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Stephanie A. Rouch
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
- The Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rachel A. Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Amanda D. Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Hannah Kaufman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Lorelei P. Hoover
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Debra Saliba
- Veterans Affairs (VA) Greater Los Angeles Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, CA 90095, USA;
- Borun Center, University of California, Los Angeles, CA 90095, USA
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13
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Abstract
BACKGROUND Type II workplace violence in health care, perpetrated by patients/clients toward home healthcare nurses, is a serious health and safety issue. A significant portion of violent incidents are not officially reported. Natural language processing can detect these "hidden cases" from clinical notes. In this study, we computed the 12-month prevalence of Type II workplace violence from home healthcare nurses' clinical notes by developing and utilizing a natural language processing system. METHODS Nearly 600,000 clinical visit notes from two large U.S.-based home healthcare agencies were analyzed. The notes were recorded from January 1, 2019 to December 31, 2019. Rule- and machine-learning-based natural language processing algorithms were applied to identify clinical notes containing workplace violence descriptions. RESULTS The natural language processing algorithms identified 236 clinical notes that included Type II workplace violence toward home healthcare nurses. The prevalence of physical violence was 0.067 incidents per 10,000 home visits. The prevalence of nonphysical violence was 3.76 incidents per 10,000 home visits. The prevalence of any violence was four incidents per 10,000 home visits. In comparison, no Type II workplace violence incidents were recorded in the official incident report systems of the two agencies in this same time period. CONCLUSIONS AND APPLICATION TO PRACTICE Natural language processing can be an effective tool to augment formal reporting by capturing violence incidents from daily, ongoing, large volumes of clinical notes. It can enable managers and clinicians to stay informed of potential violence risks and keep their practice environment safe.
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Affiliation(s)
- Ha Do Byon
- University of Virginia School of Nursing
| | | | - Mary Crandall
- University of Virginia School of Nursing
- Continuum Home Health Care, UVA Health
| | | | - Maxim Topaz
- Columbia University School of Nursing
- Columbia University Data Science Institute
- VNS Health
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14
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Bélanger E, Rosendaal N, Gutman R, Lake D, Santostefano CM, Meyers DJ, Gozalo PL. Identifying Medicare beneficiaries with Alzheimer's disease and related dementia using home health OASIS assessments. J Am Geriatr Soc 2023; 71:3229-3236. [PMID: 37358283 PMCID: PMC10592468 DOI: 10.1111/jgs.18487] [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: 12/19/2022] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Home health services are an important site of care following hospitalization among Medicare beneficiaries, providing health assessments that can be leveraged to detect diagnoses that are not available in other data sources. In this work, we aimed to develop a parsimonious and accurate algorithm using home health outcome and assessment information set (OASIS) measures to identify Medicare beneficiaries with a diagnosis of Alzheimer's disease and related dementia (ADRD). METHODS We conducted a retrospective cohort study of Medicare beneficiaries with a complete OASIS start of care assessment in 2014, 2016, 2018, or 2019 to determine how well the items from various versions could identify those with an ADRD diagnosis by the assessment date. The prediction model was developed iteratively, comparing the performance of different models in terms of sensitivity, specificity, and accuracy of prediction, from a multivariable logistic regression model using clinically relevant variables, to regression models with all available variables and predictive modeling techniques, to estimate the best performing parsimonious model. RESULTS The most important predictors of having a diagnosis of ADRD by the start of care OASIS assessment were a prior discharge diagnosis of ADRD among those admitted from an inpatient setting, and frequently exhibiting symptoms of confusion. Results from the parsimonious model were consistent across the four annual cohorts and OASIS versions with high specificity (above 96%), but poor sensitivity (below 58%). The positive predictive value was high, over 87% across study years. CONCLUSIONS The proposed algorithm has high accuracy, requires a single OASIS assessment, is easy to implement without sophisticated statistical models, and can be used across four OASIS versions and in situations where claims are not available to identify individuals with a diagnosis of ADRD, including the growing population of Medicare Advantage beneficiaries.
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Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Nicole Rosendaal
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Derek Lake
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Christopher M Santostefano
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David J Meyers
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Pedro L Gozalo
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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15
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Zolnoori M, Vergez S, Sridharan S, Zolnour A, Bowles K, Kostic Z, Topaz M. Is the patient speaking or the nurse? Automatic speaker type identification in patient-nurse audio recordings. J Am Med Inform Assoc 2023; 30:1673-1683. [PMID: 37478477 PMCID: PMC10531109 DOI: 10.1093/jamia/ocad139] [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: 03/23/2023] [Revised: 06/06/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVES Patient-clinician communication provides valuable explicit and implicit information that may indicate adverse medical conditions and outcomes. However, practical and analytical approaches for audio-recording and analyzing this data stream remain underexplored. This study aimed to 1) analyze patients' and nurses' speech in audio-recorded verbal communication, and 2) develop machine learning (ML) classifiers to effectively differentiate between patient and nurse language. MATERIALS AND METHODS Pilot studies were conducted at VNS Health, the largest not-for-profit home healthcare agency in the United States, to optimize audio-recording patient-nurse interactions. We recorded and transcribed 46 interactions, resulting in 3494 "utterances" that were annotated to identify the speaker. We employed natural language processing techniques to generate linguistic features and built various ML classifiers to distinguish between patient and nurse language at both individual and encounter levels. RESULTS A support vector machine classifier trained on selected linguistic features from term frequency-inverse document frequency, Linguistic Inquiry and Word Count, Word2Vec, and Medical Concepts in the Unified Medical Language System achieved the highest performance with an AUC-ROC = 99.01 ± 1.97 and an F1-score = 96.82 ± 4.1. The analysis revealed patients' tendency to use informal language and keywords related to "religion," "home," and "money," while nurses utilized more complex sentences focusing on health-related matters and medical issues and were more likely to ask questions. CONCLUSION The methods and analytical approach we developed to differentiate patient and nurse language is an important precursor for downstream tasks that aim to analyze patient speech to identify patients at risk of disease and negative health outcomes.
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Affiliation(s)
- Maryam Zolnoori
- School of Nursing, Columbia University, New York, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sasha Vergez
- 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
| | - Ali Zolnour
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Kathryn Bowles
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Zoran Kostic
- Department of Electrical Engineering, Columbia University, New York, New York, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
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16
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Dowthwaite L, Cruz GR, Pena AR, Pepper C, Jäger N, Barnard P, Hughes AM, Nair RD, Crepaz-Keay D, Cobb S, Lang A, Benford S. Examining the Use of Autonomous Systems for Home Health Support Using a Smart Mirror. Healthcare (Basel) 2023; 11:2608. [PMID: 37830645 PMCID: PMC10572232 DOI: 10.3390/healthcare11192608] [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] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
The home is becoming a key location for healthcare delivery, including the use of technology driven by autonomous systems (AS) to monitor and support healthcare plans. Using the example of a smart mirror, this paper describes the outcomes of focus groups with people with multiple sclerosis (MS; n = 6) and people who have had a stroke (n = 15) to understand their attitudes towards the use of AS for healthcare in the home. Qualitative data were analysed using a thematic analysis. The results indicate that the use of such technology depends on the level of adaptability and responsiveness to users' specific circumstances, including their relationships with the healthcare system. A smart mirror would need to support manual entry, responsive goal setting, the effective aggregation of data sources and integration with other technology, have a range of input methods, be supportive rather than prescriptive in messaging, and give the user full control of their data. The barriers to its adoption include a perceived lack of portability and practicality, a lack of accessibility and inclusivity, a sense of redundancy, feeling overwhelmed by multiple technological devices, and a lack of trust in data sharing. These results inform the development and deployment of future health technologies based on the lived experiences of people with health conditions who require ongoing care.
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Affiliation(s)
- Liz Dowthwaite
- Horizon Digital Economy Research, University of Nottingham, Nottingham NG7 2TU, UK (P.B.)
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Gisela Reyes Cruz
- Horizon Digital Economy Research, University of Nottingham, Nottingham NG7 2TU, UK (P.B.)
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Ana Rita Pena
- Horizon Centre for Doctoral Training, University of Nottingham, Nottingham NG8 1BB, UK; (A.R.P.); (C.P.)
| | - Cecily Pepper
- Horizon Centre for Doctoral Training, University of Nottingham, Nottingham NG8 1BB, UK; (A.R.P.); (C.P.)
| | - Nils Jäger
- Department of Architecture and Built Environment, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Pepita Barnard
- Horizon Digital Economy Research, University of Nottingham, Nottingham NG7 2TU, UK (P.B.)
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Ann-Marie Hughes
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK;
| | - Roshan das Nair
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK;
- Health Division, Stiftelsen for Industriell og Teknisk Forskning (SINTEF), 0314 Oslo, Norway
| | | | - Sue Cobb
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.)
| | - Alexandra Lang
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.)
| | - Steve Benford
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK;
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17
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Tai PC, Chang S. Exploring Internal Conflicts and Collaboration of a Hospital Home Healthcare Team: A Grounded Theory Approach. Healthcare (Basel) 2023; 11:2478. [PMID: 37761676 PMCID: PMC10530701 DOI: 10.3390/healthcare11182478] [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: 07/26/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
An aging society is on the rise, leading to a variety of caregiving issues. The Taiwanese government has been implementing a home healthcare integration plan since 2015, aimed at integrating and forming interdisciplinary care teams with medical institutions. This study explores the internal conflict factors among hospital home healthcare team members at a district teaching hospital in Taichung, Taiwan, and it seeks a better collaboration model between them. Semi-structured in-depth interviews were conducted with seven hospital home healthcare team members. Data analysis was based on grounded theory, with research quality relying on the triangulation and consistency analysis methods. The results show that "work overload", "resource overuse", "inconsistent assessment", "limited resources", "communication cost", and "lack of incentives" are the major conflicts among the team. This study proposed the following collaboration model, including "identifying the internal stakeholders of a home healthcare team" and "the key stakeholders as referral coordinators", "patient-centered resource allocation", and "teamwork orientation". The study recommends that within a teamwork-oriented home healthcare team, its members should proactively demonstrate their role responsibilities and actively provide support to one another. Only through patient-centered resource allocation and mutual respect can the goal of seamless home healthcare be achieved. The content of the research and samples were approved by the hospital ethics committee (REC108-18).
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Affiliation(s)
- Pei-Chun Tai
- Department of Quality Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Shofang Chang
- Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy & Science, Tainan 71710, Taiwan
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18
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Min SH, Song J, Evans L, Bowles KH, McDonald MV, Chae S, Topaz M. Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis. Clin Nurs Res 2023; 32:1021-1030. [PMID: 37345951 DOI: 10.1177/10547738231183026] [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: 06/23/2023]
Abstract
One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
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Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Sena Chae
- University of Iowa College of Nursing, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- Data Science Institute, Columbia University, New York, NY, USA
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19
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Handa N, Horie S, Akishita M. The role of portable electrocardiogram for elderly patients who were managed in home healthcare. Geriatr Gerontol Int 2023; 23:643-645. [PMID: 37439435 DOI: 10.1111/ggi.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Nobuhiro Handa
- Department of Geriatric Medicine, Clinic Ian South Center, Yokohama, Japan
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shigeo Horie
- Department of Digital Therapeutics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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20
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Elsman EBM, Lee SQ, van der Aa HPA, van Nassau F, Wisse RPL, Maarsingh OR, Keunen JEE, van Rens GHMB, van Nispen RMA. The evaluation of an online nurse-assisted eye-screening tool in older adults receiving home healthcare. Ophthalmic Physiol Opt 2023. [PMID: 36807604 DOI: 10.1111/opo.13110] [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: 08/08/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To investigate the agreement between an online nurse-assisted eye-screening tool and reference tests in older adults receiving home healthcare and to collect user experiences. METHODS Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye-screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye-screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable. RESULTS A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye-screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye-screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye-screening tool, although remarks for further improvements were made. CONCLUSIONS The eye-screening tool is promising for nurse-assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye-screening tool in practice, cost-effectiveness needs to be investigated.
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Affiliation(s)
- Ellen B M Elsman
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Quality of Care, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Shan Qi Lee
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Femke van Nassau
- Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands.,Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Otto R Maarsingh
- General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Aging & Later Life, Amsterdam Public Health, Amsterdam, the Netherlands
| | | | - Ger H M B van Rens
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Quality of Care, Amsterdam Public Health, Amsterdam, the Netherlands
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21
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Melby L, Lyngstad M, Ose SO. Consequences of the Early Phase of the COVID-19 Pandemic for Home-Healthcare Recipients in Norway: A Nursing Perspective. Healthcare (Basel) 2023; 11. [PMID: 36766920 DOI: 10.3390/healthcare11030346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies.
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22
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Felix HM, Cowdell JC, Paulson MR, Maita KC, Dugani SB, Avila FR, Torres-Guzman RA, Forte AJ, Matcha GV, Maniaci MJ. Impact of an Acquisition Advanced Practice Provider on Home Hospital Patient Volumes and Length of Stay. Healthcare (Basel) 2023; 11:healthcare11030282. [PMID: 36766857 PMCID: PMC9914253 DOI: 10.3390/healthcare11030282] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
In July 2020, Mayo Clinic introduced a hospital-at-home program, known as Advanced Care at Home (ACH) as an alternate option for clinically stable medical patients requiring hospital-level care. This retrospective cohort study evaluates the impact of the addition of a dedicated ACH patient acquisition Advanced Practice Provider (APP) on average length of stay (ALOS) and the number of patients admitted into the program between in Florida and Wisconsin between 6 July 2020 and 31 January 2022. Patient volumes and ALOS of 755 patients were analyzed between the two sites both before and after a dedicated acquisition APP was added to the Florida site on 1 June 2021. The addition of a dedicated acquisition APP did not affect the length of time a patient was in the emergency department or hospital ward prior to ACH transition (2.91 days [Florida] vs. 2.59 days [Wisconsin], p = 0.22), the transition time between initiation of the ACH consult to patient transfer home (0.85 days [Florida] vs. 1.16 days [Wisconsin], p = 0.28), or the total ALOS (6.63 days [Florida] vs. 6.34 days [Wisconsin], p = 0.47). The average number of patients acquired monthly was significantly increased in Florida (38.3 patients per month) compared with Wisconsin (21.6 patients per month) (p < 0.01). The addition of a dedicated patient acquisition APP resulted in significantly higher patient volumes but did not affect transition time or ALOS. Other hospital-at-home programs may consider the addition of an acquisition APP to maximize patient volumes.
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Affiliation(s)
- Heidi M. Felix
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Jed C. Cowdell
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, 1221 Whipple St, Eau Claire, WI 54701, USA
| | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Gautam V. Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
- Correspondence: ; Tel.: +904-956-0081; Fax: +904-953-2848
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23
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Liljas AE, Agerholm J, Schön P, Burström B. Risk factors for infection in older adults who receive home healthcare and/or home help: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31772. [PMID: 36397381 PMCID: PMC9666220 DOI: 10.1097/md.0000000000031772] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The shift towards home-based care has resulted in increased provision of home healthcare and home help to older adults. Infections acquired in older adults while receiving home care have increased too, resulting in unplanned yet avoidable hospitalizations. In recent years, several studies have reported an array of factors associated with risk of infection; however, no previous systematic review has compiled such evidence, which is important to better protect older adults. Therefore, we have outlined the work of a systematic review that aims to identify risk factors for infection in older adults receiving home healthcare and/or home help. METHODS Searches for relevant studies will be conducted in five databases [MEDLINE, EMBASE (Excerpta Medica Database), Web of Science Core Collection, Cinahl (Cumulative Index to Nursing & Allied Health Literature) and Sociological Abstracts]. All types of studies will be included. Exposures considered refer to medical, individual, social/behavioral and environmental risk factors for infection (outcome). Two researchers will independently go through the records generated. Eligible studies will be assessed for risk of biases using the Cochrane risk of bias assessment tool and an overall interpretation of the biases will be provided. If the data allow, a meta-analysis will be conducted. It is possible that both quantitative and qualitative studies will be identified and eligible. Therefore, for the analysis, the Joanna Briggs Institute Reviewers' Manual for mixed methods systematic reviews will be used as it allows for two or more single method reviews (e.g., one quantitative and one qualitative) to be conducted separately and then combined in a joint overarching synthesis. RESULTS The findings of the planned systematic review are of interest to healthcare professionals, caregivers, older adults and their families, and policy- and decisions makers in the health and social care sectors as the review will provide evidence-based data on multiple factors that influence the risk of infection among older adults receiving care in their homes. CONCLUSION The results could guide future policy on effective infection control in the home care sector.
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Affiliation(s)
- Ann E.M. Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * Correspondence: Ann E.M. Liljas, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden (e-mail: )
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pär Schön
- Institution for Social Work, Stockholm University, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Larsson R, Erlingsdóttir G, Persson J, Rydenfält C. Teamwork in home care nursing: A scoping literature review. Health Soc Care Community 2022; 30:e3309-e3327. [PMID: 35862714 PMCID: PMC10084131 DOI: 10.1111/hsc.13910] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/22/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.
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Affiliation(s)
- Roger Larsson
- Department of Design SciencesLund UniversityLundSweden
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Foster C, Kaat AJ, Shaunfield S, Lin E, Coleman C, Storey M, Morales L, Davis MM. PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality. Acad Pediatr 2022; 22:1510-1519. [PMID: 35439604 DOI: 10.1016/j.acap.2022.04.004] [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] [Received: 06/08/2021] [Revised: 03/11/2022] [Accepted: 04/08/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE No validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC). METHODS A national multidisciplinary expert panel (N = 19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n = 12) and Spanish-speaking (n = 4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20-10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers. RESULTS The final measure included N = 28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n = 68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0-10 scale) and median scores on specific quality items ranged from 31-4 to 43-4 (0-4 scale). CONCLUSIONS PediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.
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Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Aaron J Kaat
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sara Shaunfield
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Elaine Lin
- Division of General Pediatrics, Department of Pediatrics (E Lin), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cara Coleman
- Family Voices National (C Coleman), Lexington, Mass
| | - Margaret Storey
- Ann & Robert H. Lurie Children's Hospital of Chicago Family Advisory Board (M Storey), Chicago, Ill
| | - Luis Morales
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine (MM Davis), Chicago, Ill
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Fhoula B, Hadid M, Elomri A, Kerbache L, Hamad A, Al Thani MHJ, Al-Zoubi RM, Al-Ansari A, Aboumarzouk OM, El Omri A. Home Cancer Care Research: A Bibliometric and Visualization Analysis (1990-2021). Int J Environ Res Public Health 2022; 19:13116. [PMID: 36293702 PMCID: PMC9603182 DOI: 10.3390/ijerph192013116] [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: 08/09/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Home cancer care research (HCCR) has accelerated, as considerable attention has been placed on reducing cancer-related health costs and enhancing cancer patients' quality of life. Understanding the current status of HCCR can help guide future research and support informed decision-making about new home cancer care (HCC) programs. However, most current studies mainly detail the research status of certain components, while failing to explore the knowledge domain of this research field as a whole, thereby limiting the overall understanding of home cancer care. We carried out bibliometric and visualization analyses of Scopus-indexed papers related to home cancer care published between 1990-2021, and used VOSviewer scientometric software to investigate the status and provide a structural overview of the knowledge domain of HCCR (social, intellectual, and conceptual structures). Our findings demonstrate that over the last three decades, the research on home cancer care has been increasing, with a constantly expanding stream of new papers built on a solid knowledge base and applied to a wide range of research themes.
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Affiliation(s)
- Boutheina Fhoula
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Majed Hadid
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Adel Elomri
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Laoucine Kerbache
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha 2713, Qatar
- Department of Chemistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Nawaz A, Abbas Y, Ahmad T, Mahmoud NF, Rizwan A, Samee NA. A Healthcare Paradigm for Deriving Knowledge Using Online Consumers' Feedback. Healthcare (Basel) 2022; 10:1592. [PMID: 36011249 DOI: 10.3390/healthcare10081592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 12/20/2022] Open
Abstract
Home healthcare agencies (HHCAs) provide clinical care and rehabilitation services to patients in their own homes. The organization’s rules regulate several connected practitioners, doctors, and licensed skilled nurses. Frequently, it monitors a physician or licensed nurse for the facilities and keeps track of the health histories of all clients. HHCAs’ quality of care is evaluated using Medicare’s star ratings for in-home healthcare agencies. The advent of technology has extensively evolved our living style. Online businesses’ ratings and reviews are the best representatives of organizations’ trust, services, quality, and ethics. Using data mining techniques to analyze HHCAs’ data can help to develop an effective framework for evaluating the finest home healthcare facilities. As a result, we developed an automated predictive framework for obtaining knowledge from patients’ feedback using a combination of statistical and machine learning techniques. HHCAs’ data contain twelve performance characteristics that we are the first to analyze and depict. After adequate pattern recognition, we applied binary and multi-class approaches on similar data with variations in the target class. Four prominent machine learning models were considered: SVM, Decision Tree, Random Forest, and Deep Neural Networks. In the binary class, the Deep Neural Network model presented promising performance with an accuracy of 97.37%. However, in the case of multiple class, the random forest model showed a significant outcome with an accuracy of 91.87%. Additionally, variable significance is derived from investigating each attribute’s importance in predictive model building. The implications of this study can support various stakeholders, including public agencies, quality measurement, healthcare inspectors, and HHCAs, to boost their performance. Thus, the proposed framework is not only useful for putting valuable insights into action, but it can also help with decision-making.
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Song J, Zolnoori M, Scharp D, Vergez S, McDonald MV, Sridharan S, Kostic Z, Topaz M. Do nurses document all discussions of patient problems and nursing interventions in the electronic health record? A pilot study in home healthcare. JAMIA Open 2022; 5:ooac034. [PMID: 35663115 PMCID: PMC9154272 DOI: 10.1093/jamiaopen/ooac034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the overlap of information between electronic health record (EHR) and patient–nurse verbal communication in home healthcare (HHC). Methods Patient–nurse verbal communications during home visits were recorded between February 16, 2021 and September 2, 2021 with patients being served in an organization located in the Northeast United States. Twenty-two audio recordings for 15 patients were transcribed. To compare overlap of information, manual annotations of problems and interventions were made on transcriptions as well as information from EHR including structured data and clinical notes corresponding to HHC visits. Results About 30% (1534/5118) of utterances (ie, spoken language preceding/following silence or a change of speaker) were identified as including problems or interventions. A total of 216 problems and 492 interventions were identified through verbal communication among all the patients in the study. Approximately 50.5% of the problems and 20.8% of the interventions discussed during the verbal communication were not documented in the EHR. Preliminary results showed that statistical differences between racial groups were observed in a comparison of problems and interventions. Discussion This study was the first to investigate the extent that problems and interventions were mentioned in patient–nurse verbal communication during HHC visits and whether this information was documented in EHR. Our analysis identified gaps in information overlap and possible racial disparities. Conclusion Our results highlight the value of analyzing communications between HHC patients and nurses. Future studies should explore ways to capture information in verbal communication using automated speech recognition.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York, New York, USA
| | - Maryam Zolnoori
- Columbia University School of Nursing, New York, New York, USA
| | - Danielle Scharp
- Columbia University School of Nursing, New York, New York, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Zoran Kostic
- Fu Foundation School of Engineering and Applied Science, Department of Electrical Engineering, Columbia University, New York, New York, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, New York, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
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Nathu VD, Virkutyte J, Rao MB, Nieto-Caballero M, Hernandez M, Reponen T. Direct-Read Fluorescence-Based Measurements of Bioaerosol Exposure in Home Healthcare. Int J Environ Res Public Health 2022; 19:ijerph19063613. [PMID: 35329300 PMCID: PMC8951687 DOI: 10.3390/ijerph19063613] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Home healthcare workers (HHCWs) are subjected to variable working environments which increase their risk of being exposed to numerous occupational hazards. One of the potential occupational hazards within the industry includes exposure to bioaerosols. This study aimed to characterize concentrations of three types of bioaerosols utilizing a novel fluorescence-based direct-reading instrument during seven activities that HHCWs typically encounter in patients’ homes. Bioaerosols were measured in an indoor residence throughout all seasons in Cincinnati, OH, USA. A fluorescence-based direct-reading instrument (InstaScope, DetectionTek, Boulder, CO, USA) was utilized for all data collection. Total particle counts and concentrations for each particle type, including fluorescent and non-fluorescent particles, were utilized to form the response variable, a normalized concentration calculated as a ratio of concentration during activity to the background concentration. Walking experiments produced a median concentration ratio of 52.45 and 2.77 for pollen and fungi, respectively. Fungi and bacteria produced the highest and lowest median concentration ratios of 17.81 and 1.90 for showering, respectively. Lastly, our current study showed that sleeping activity did not increase bioaerosol concentrations. We further conclude that utilizing direct-reading methods may save time and effort in bioaerosol-exposure assessment.
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Affiliation(s)
- Vishal D. Nathu
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
| | - Jurate Virkutyte
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
| | - Marepalli B. Rao
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
| | - Marina Nieto-Caballero
- Department of Environmental Engineering, College of Engineering & Applied Science, University of Colorado Boulder, Boulder, CO 80309-0428, USA; (M.N.-C.); (M.H.)
| | - Mark Hernandez
- Department of Environmental Engineering, College of Engineering & Applied Science, University of Colorado Boulder, Boulder, CO 80309-0428, USA; (M.N.-C.); (M.H.)
| | - Tiina Reponen
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
- Correspondence:
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30
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Siconolfi D, Edelen MO, McMullen TL, Martino S, Ahluwalia SC, Chen EK, Dalton SE, Paddock S, Rodriguez A, Saliba D, Mandl S, Mota T. Standardized assessment of depression symptoms in post-acute care: A screening threshold approach. J Am Geriatr Soc 2022; 70:1023-1034. [PMID: 35235215 DOI: 10.1111/jgs.17646] [Citation(s) in RCA: 2] [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: 06/14/2021] [Revised: 10/09/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression symptoms have impacts on quality of life, rehabilitation and treatment adherence, and resource utilization among patients in post-acute care (PAC) settings. The PHQ-2 and PHQ-9 are instruments for the assessment of depression, previously used in PAC settings, that have tradeoffs in terms of measurement depth versus respondent/assessor burden. Therefore, the present study tested a gateway version of the protocol (PHQ-2 to 9). METHODS In 143 PAC settings in 14 U.S. markets across 10 states from November 2017 to August 2018, facility and research nurses administered the PHQ-2 to communicative patients (n = 3010). Nurses administered the full PHQ-9 if the patient screened positive for either of the two cardinal symptoms assessed by the PHQ-2 (depressed mood and anhedonia). We assessed the prevalence and frequency of depression symptoms using the PHQ-2 to 9, associations between depression screening results and patient characteristics and clinical conditions, and feasibility indicators. RESULTS More than 1 in 4 patients (28%) screened positive on the PHQ-2. Only 6% of those completing the full PHQ-9 had a score indicating "minimal" severity. The average score (M = 11.9) met the threshold for moderate depression. Positive PHQ-2 screening was associated with age, female gender, disposition at discharge, septicemia/severe sepsis, and dependence for ADLs of toileting and lying to sitting mobility. Age was also associated with full PHQ-9 scores; patients ages 45-64 had the highest mean score. Length of stay was not associated with PHQ-2 screening results or full PHQ-2 to 9 scores. Missing data were minimal (<2.4%). The average time to complete was 2.3 min. Interrater reliability and percent agreement were excellent. CONCLUSIONS These findings suggest the feasibility of a gateway scoring approach to standardized assessment of depression symptoms among PAC patients, and that depression symptoms are relatively common among this inpatient population.
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Affiliation(s)
| | - Maria O Edelen
- RAND Corporation, Boston, Massachusetts, USA.,Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tara L McMullen
- Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA
| | | | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Susan Paddock
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,UCLA Borun Center, Los Angeles, California, USA.,Los Angeles VA GRECC, Los Angeles, California, USA
| | - Stella Mandl
- Division of Health Care Financing, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Teresa Mota
- Abt Associates, Cambridge, Massachusetts, USA
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Osakwe ZT, Oni-Eseleh O, Bianco G, Saint Fleur-Calixte R. Symptom Burden and Activity of Daily Living (ADL) Dependency Among Home Health care Patients Discharged to Home Hospice. Am J Hosp Palliat Care 2022; 39:966-976. [PMID: 35037476 DOI: 10.1177/10499091211063808] [Citation(s) in RCA: 2] [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] [Indexed: 11/17/2022] Open
Abstract
Background: We sought to examine sociodemographic and clinical characteristics present on admission to HHC associated with discharge to hospice. Methods: We used a 5% random sample of 2017 national Outcome and Assessment Information Set (OASIS) data. A Cox proportional hazards regression model was estimated for the primary outcome (discharge to hospice) to examine the associations with sociodemographic and clinical characteristics of HHC patients. Results: Among 489, 230 HHC patients, 4268 were discharged to hospice. The median (interquartile range) length of HHC stay for patients discharged to hospice care was 33 (14-78) days. Compared to White patients, Black, Hispanic, and other race, (hazard ratio [HR] = .50 [95% confidence interval, CI = .44-.57]), (HR = .53 [95% CI = .46-.62]), and (HR = .49 [95% CI = .40-.61], respectively) was associated with shorter time to discharge to hospice care. Clinical characteristics including severe dependence in activities of daily (ADL) (HR = 1.68 [95% CI = 1.01-2.78]), cognitive impairment (HR = 1.10 [95% CI = 1.01-1.20]), disruptive behavior daily (HR = 1.11 [95% CI = 1.02-1.22]), and inability to feed oneself (HR = 4.78, 95% CI = 4.30, 5.31) was associated with shorter time to discharge to hospice. Symptoms of anxiety daily (HR = 1.55 [95% CI = 1.43-1.68]), and pain daily or all the time (HR = 1.54 [95% CI = 1.43-1.64]) were associated with shorter time to discharge to hospice. Conclusions: High symptom burden, ADL dependency, and cognitive impairment on admission to HHC services was associated with greater likelihood of discharge to hospice.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, 15670Adelphi University, Garden City, NY, USA
| | - Ohiro Oni-Eseleh
- School of Social Work, 382510Adelphi University - Hudson Valley Center, Poughkeepsie, NY, USA
| | - Gabriella Bianco
- College of Nursing and Public Health, 15670Adelphi University, Garden City, NY, USA
| | - Rose Saint Fleur-Calixte
- Epidemiology and Biostatistics, School of Public Health State University of New York, Downstate Health Sciences University, NY, USA
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Zhou J, Ho V, Javadi B. New Internet of Medical Things for Home-Based Treatment of Anorectal Disorders. Sensors (Basel) 2022; 22:s22020625. [PMID: 35062585 PMCID: PMC8780207 DOI: 10.3390/s22020625] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
Home-based healthcare provides a viable and cost-effective method of delivery for resource- and labour-intensive therapies, such as rehabilitation therapies, including anorectal biofeedback. However, existing systems for home anorectal biofeedback are not able to monitor patient compliance or assess the quality of exercises performed, and as a result have yet to see wide spread clinical adoption. In this paper, we propose a new Internet of Medical Things (IoMT) system to provide home-based biofeedback therapy, facilitating remote monitoring by the physician. We discuss our user-centric design process and the proposed architecture, including a new sensing probe, mobile app, and cloud-based web application. A case study involving biofeedback training exercises was performed. Data from the IoMT was compared against the clinical standard, high-definition anorectal manometry. We demonstrated the feasibility of our proposed IoMT in providing anorectal pressure profiles equivalent to clinical manometry and its application for home-based anorectal biofeedback therapy.
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Affiliation(s)
- Jerry Zhou
- Translational Gastroenterology Laboratory, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (J.Z.); (V.H.)
| | - Vincent Ho
- Translational Gastroenterology Laboratory, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (J.Z.); (V.H.)
- Department of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia
| | - Bahman Javadi
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Correspondence: ; Tel.: +61-2-9685-9181
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Alabbasi KH, Kruger E, Tennant M. Long Term Implications of Home Healthcare Management on Mortality in Older Adults with Functional Difficulties in the Saudi Community. Geriatrics (Basel) 2021; 6:115. [PMID: 34940340 DOI: 10.3390/geriatrics6040115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background: This study aims to investigate whether certain demographic factors of patients receiving home healthcare (HHC) interventions have any positive impact on mortality. Methods: the study included all patients who were enrolled in the HHC program in a referred medical complex, Jeddah, Saudi Arabia between the years 2017 and 2020 (593 patients). Results: A total of 6548 HHC visits were received during the study period. From the total number of visits, 3592 (54.9%) HHC visits were scheduled in the year 2020 compared to 157 (2.4%) scheduled HHC visits in 2017 (p < 0.001). The most successful HHC visits were provided in 2020 compared with the year 2017 (2193 vs. 132; p < 0.001). The cancelled HHC visits were observed to be the lowest (194) in 2019. Three explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] made a statistically significant contribution to the logistic regression model after controlling for other variables. Suffering from cerebrovascular diseases and/or bedridden were the strongest predictor of death in patients receiving HHC. Conclusions: During the 2020 pandemic, there was a sharp increase in HHC compared to previous years. Three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were reported.
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Coulourides Kogan A, Li O, Fields T, Mosqueda L, Lorenz K. Frontline provider perceptions of implementing home-based palliative care covered by an insurer. Health Serv Res 2021; 57:872-880. [PMID: 34806185 PMCID: PMC9264462 DOI: 10.1111/1475-6773.13913] [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: 05/10/2021] [Revised: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine frontline providers' experiences implementing home-based palliative care (HBPC) covered by a private health insurer in partnership with community-based hospice, home health, and Accountable Care Organizations. STUDY SETTING Primary data collection at three community-based hospice and home health organizations in Northern and Southern California at the outset of the new private payer-contracted HBPC. STUDY DESIGN Qualitative focus groups with frontline HBPC providers. DATA COLLECTION Focus groups were guided by a nine-item, semi-structured research protocol, audio-recorded, transcribed verbatim, and analyzed by two independent coders using a grounded theory approach. PRINCIPAL FINDINGS Participants (n = 24) were mostly White (79.2%) female (91.7%) aged 39 years or less (62.5%), and from diverse disciplines. Three major themes were identified: (1) patient referrals, (2) organizational factors, and (3) HBPC reimbursement. Findings highlight barriers and facilitators to implementing HBPC covered by an insurer including the organization's community reputation, the dynamic/"teaminess" of the HBPC team, having a site champion/"quarterback," and issues from a siloed medical system. Participants also discussed challenges with patient referrals, specifically, lack of palliative care knowledge (both providers and patients/families) and poor communication with patients referred to HBPC. CONCLUSIONS This study found that despite a favorable perception of payer-contracted HBPC by frontline providers, barriers and facilitators persist, with patient accrual/referral paramount.
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Affiliation(s)
- Alexis Coulourides Kogan
- Keck School of Medicine of USC, Department of Family Medicine and Geriatrics, University of Southern California, Alhambra, California, USA
| | - Oscar Li
- Keck School of Medicine of USC, Department of Family Medicine and Geriatrics, University of Southern California, Alhambra, California, USA
| | - Torrie Fields
- Healthcare Quality & Affordability, Palliative Care, Blue Shield of California, San Francisco, California, USA.,VotiveHealth, San Luis Obispo, California, USA
| | - Laura Mosqueda
- Keck School of Medicine of USC, Department of Family Medicine and Geriatrics, University of Southern California, Alhambra, California, USA
| | - Karl Lorenz
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Henderson CM, Raisanen JC, Shipman KJ, Jabre NA, Wilfond BS, Boss RD. Life with pediatric home ventilation: Expectations versus experience. Pediatr Pulmonol 2021; 56:3366-3373. [PMID: 34310864 DOI: 10.1002/ppul.25577] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 04/06/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore the family experience of home ventilation through a comparison of anticipated home life changes with subsequent experiences. STUDY DESIGN Guided interviews with parents across three states who chose home ventilation for their child within the last 5 years. PATIENT-SUBJECT SELECTION Purposive sampling of parents who chose home ventilation for their child within the last 5 years. METHODS Interviews were transcribed for qualitative analysis and analyzed for thematic saturation and prevalence of codes. RESULTS Twenty families were interviewed. Families generally reported not considering potential home life changes when facing the decision about home ventilation; instead, they worried most about medical management. These concerns reversed in importance later. Families learned medical management quickly but felt largely unprepared for the extensive changes to their home life, including isolation, altered relationships with extended family and community, effects on siblings, financial strain, and need for physical changes to their house. Families had not anticipated how much they would be affected by home healthcare as a new part of their life. CONCLUSIONS The priorities that families consider during decisions about pediatric home ventilation may not be aligned with the actual home experience of this technology. Given that the success of home ventilation largely rests with the family's care, family expectations for home life adaptations must be augmented, as should postdischarge supports for families with complex home care experiences.
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Affiliation(s)
- Carrie M Henderson
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Center for Bioethics and Medical Humanities, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Nicholas A Jabre
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Lindberg JE, Quinn MM, Gore RJ, Galligan CJ, Sama SR, Sheikh NN, Markkanen PK, Parker-Vega A, Karlsson ND, LeBouf RF, Virji MA. Assessment of home care aides' respiratory exposure to total volatile organic compounds and chlorine during simulated bathroom cleaning: An experimental design with conventional and "green" products. J Occup Environ Hyg 2021; 18:276-287. [PMID: 34004120 PMCID: PMC8898565 DOI: 10.1080/15459624.2021.1910280] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Home care (HC) aide visits to clients' homes often involve cleaning and disinfecting (C&D) bathrooms. Some ingredients in C&D household products are associated with respiratory illness, including sodium hypochlorite (bleach) and quaternary ammonium compounds (quats). "Green" products may be safer for the environment, however there are limited quantitative evaluations of their respiratory risks. This study assessed airborne concentrations and time profiles of total volatile organic compounds (TVOC) and chlorine generated during typical bathroom cleaning performed by aides using conventional and green products. Aides performed cleaning tasks in a simulated residential bathroom constructed in an environmental air sampling laboratory. A balanced experimental design involved each aide coming to the lab for four visits during which she performed two 20-min cleaning sessions using one of three C&D products (bleach-based, 1-5% sodium hypochlorite by weight; quats-based, 0.1-1% by weight quaternary ammonium compounds; and "green," 0.05% by weight thymol, a component of botanical thyme oil) or distilled water as a control. TVOC and chlorine direct reading instruments were attached to aides with sample inlets located in the breathing zone. Ten-second averages of TVOC and chlorine gas concentrations and instantaneous peak concentrations were recorded for the sessions' duration. TVOC concentrations by methods of C&D application (spraying, streaming, wiping) also were evaluated. The study completed 169 air sampling sessions with 22 aides. The quats-based product generated more than twice the average TVOC concentrations (mean = 1,210 ppb) than the bleach-based (mean = 593 ppb) or green (mean = 498 ppb) products. Each product generated TVOC concentrations that rose rapidly within the first few minutes of application. Spraying produced the highest TVOC exposures, wiping the lowest. Thirteen aides (65%) experienced peak chlorine exposures above the OSHA PEL ceiling limit (1 ppm) when using the bleach-based product. HC aides may experience respiratory hazards from use of conventional or green C&D products formulated with bleach or other respiratory irritants and sprayed in small, poorly ventilated spaces typical of bathrooms. Spraying should be avoided.
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Affiliation(s)
- J. E. Lindberg
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - M. M. Quinn
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - R. J. Gore
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts
| | - C. J. Galligan
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - S. R. Sama
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - N. N. Sheikh
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - P. K. Markkanen
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - A. Parker-Vega
- Office of Environment, Health and Safety, University of California, San Francisco, San Francisco, California
| | - N. D. Karlsson
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - R. F. LeBouf
- Division of Respiratory Health, National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia
| | - M. A. Virji
- Division of Respiratory Health, National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia
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Russell D, Dowding D, Trifilio M, McDonald MV, Song J, Adams V, Ojo MI, Perry EK, Shang J. Individual, social, and environmental factors for infection risk among home healthcare patients: A multi-method study. Health Soc Care Community 2021; 29:780-788. [PMID: 33606903 PMCID: PMC8084932 DOI: 10.1111/hsc.13321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
There has been limited research into the individual, social, and environmental factors for infection risk among patients in the home healthcare (HHC) setting, where the infection is a leading cause of hospitalisation. The aims of this study were to (1) explore nurse perceptions of individual, social, and environmental factors for infection risk among HHC patients; and (2) identify the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 and included qualitative interviews with HHC nurses (n = 50) and structured observations of nurse visits to patients' homes (n = 400). Thematic analyses of interviews with nurses suggested they perceived infection risk among patients as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Statistical analyses of observation checklists revealed nurses encountered an average of 1.7 environmental barriers upon each home visit. Frequent environmental barriers observed during visits to HHC patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%). Additional research is needed to clarify inter-relationships among these factors and identify strategies for addressing each as part of a comprehensive infection control program in HHC.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Marygrace Trifilio
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Margaret V. McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | | | - Marietta I. Ojo
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Eun K. Perry
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Jingjing Shang
- Columbia University School of Nursing, New York, NY, USA
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Tomita S, Kuga T, Osugi Y, Kobayashi D. Factors associated with the accomplishment of home death among patients receiving physician-led home healthcare. Geriatr Gerontol Int 2021; 21:525-531. [PMID: 33904229 DOI: 10.1111/ggi.14173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate unique factors associated with home death in older Asian individuals who received physician-led home healthcare. METHODS We carried out a case-control study at a single hospital in Japan from February 2018 to December 2019. We included patients who had started receiving physician-led home healthcare and died at home as cases, and those receiving the same type of care but died in the hospital as controls. Multivariable logistic regression was used to evaluate factors associated with home death. RESULTS A total of 152 patients (mean age 70.3 years [SD 11.2 years]; 86 [56.6%] men) were included, of whom 89 (58.6%) died at home and 63 (41.4%) died in the hospital. Comparing the two groups, the presence of family psychological problems related to care was significantly more common in the hospital death group (home death 49.4%; hospital death 32.3%, P = 0.036). Home death was related to patients aged >85 years compared with patients aged <75 years (adjusted odds ratio 6.47, 95% CI 1.52-27.48) and patients who were in the highest quartile of the number of symptoms (adjusted odds ratio 5.45, 95% CI 1.15-25.95) compared with the lowest. Family members' willingness for the patient to die at home was associated with home death (adjusted odds ratio 7.47, 95% CI 2.13-26.19). CONCLUSIONS Older age and multiple symptoms were related to accomplishing home death. Patient preference was not associated with the place of death, but family member preference was. These results might reflect family concepts particular to Asia. Geriatr Gerontol Int 2021; 21: 525-531.
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Affiliation(s)
- Shiori Tomita
- General Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takao Kuga
- General Medicine, Toyota Regional Medical Center, Toyota, Japan
| | - Yasuhiro Osugi
- Community Based Medicine, Fujita Health University, Toyoake, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
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Morioka N, Kashiwagi M. Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan. Int J Environ Res Public Health 2021; 18:2546. [PMID: 33806436 DOI: 10.3390/ijerph18052546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.
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Chastain J, Kumar AR, Nathan-Roberts D. Healthcare handoffs among lay caregivers. Int J Qual Health Care 2021; 33:6103808. [PMID: 33459787 DOI: 10.1093/intqhc/mzab012] [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: 10/08/2020] [Revised: 12/23/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Much of home healthcare is also performed by informal caregivers. This paper seeks to add understanding to the home healthcare field, specifically studying care handoffs between informal caregivers. This study included 16 trained and 20 lay participants to determine differences due to expertise. This comparison is useful because there is a lot of published research on healthcare handoff happenings involving healthcare professionals, and the results indicate how much of the published research can be applied to care handoffs between informal caregivers. OBJECTIVE The primary objective of this study is to identify differences between lay and professional caregivers when there is uncertainty in a caregiving handoff from their fellow caregiver. METHODS The study design included between-group analysis of Expertise (layman and expert) and within-group analysis of Task Difficulty and Communication Modality. Dependent variables included willingness to ask for help, confidence in handoff instructions, confidence in the ability to complete tasks and task accuracy. Both Expertise groups were given the same four scenarios in a repeated measures study design. RESULTS The findings suggest statistically significant differences in how informal caregivers respond to unclear handoff instructions, where lay participants were more confident in understanding instructions, more confident in executing the tasks, less willing to ask for help and also less able to spot and resolve conflicting information compared to trained participants. Lower performance in resolving conflicting information was exhibited by the lay participants. However, when comparing with the syringes that were prepared correctly, it was observed that the accuracy of those prepared syringes was higher for lay participants than for trained participants. CONCLUSION It was anticipated that lay participants would be more willing to ask for help due to lack of subject matter expertise and trained participants would be more confident in completing tasks due to their superior subject matter expertise, but the opposite was true in both cases. It was also anticipated that lay and trained participants would be equally confident of the instructions given by their fellow caregiver, yet trained participants were less confident. The results from this study have impacts on the design of instructions (often by formal caregivers) for informal caregivers.
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Affiliation(s)
- Janet Chastain
- Department of Industrial and Systems Engineering, San Jose State University, San Jose, CA 95192, USA
| | - Anil R Kumar
- Department of Industrial and Systems Engineering, San Jose State University, San Jose, CA 95192, USA
| | - Dan Nathan-Roberts
- Department of Industrial and Systems Engineering, San Jose State University, San Jose, CA 95192, USA
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Abstract
IntroductionThe number of patients and clinical conditions treated in home healthcare (HHC) is increasing. Care in home settings presents many challenges, including healthcare-associated infections (HAI). Currently, in Belgium, data and guidelines on the topic are lacking.AimTo develop a definition of HAI in HHC and investigate associated risk factors and recommendations for infection prevention and control (IPC).MethodsThe study included three components: a scoping literature review, in-depth interviews with individuals involved in HHC and a two-round Delphi survey to reach consensus among key informants on the previous steps' results.ResultsThe literature review included 47 publications. We conducted 21 in-depth interviews. The Delphi survey's two rounds had 21 and 23 participants, respectively. No standard definition was broadly accepted or known. Evidence on associated risk factors was impacted by methodological limitations and recommendations were inconsistent. Agreement was reached on defining HAI in HHC as any infection specifically linked with providing care that develops in a patient receiving HHC from a professional healthcare worker and occurs ≥ 48 hours after starting HHC. Risk factors were hand hygiene, untrained patients and caregivers, patients' hygiene and presence and management of invasive devices. Agreed recommendations were to adapt and standardise existing IPC guidelines to HHC and to perform a national point prevalence study to measure the burden of HAI in HHC.ConclusionsThis study offers an overview of available evidence and field knowledge of HAI in HHC. It provides a framework for a prevalence study, future monitoring policies and guidelines on IPC in Belgium.
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Affiliation(s)
- Ana Hoxha
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laure Mortgat
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Park YJ, Jung SY, Son TY, Kang SJ. Self-Organizing IoT Device-Based Smart Diagnosing Assistance System for Activities of Daily Living. Sensors (Basel) 2021; 21:785. [PMID: 33503949 DOI: 10.3390/s21030785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
Activity of daily living (ADL) is a criterion for evaluating the performance ability of daily life by recognizing various activity events occurring in real life. However, most of the data necessary for ADL evaluation are collected only through observation and questionnaire by the patient or the patient’s caregiver. Recently, Internet of Things (IoT) device studies using various environmental sensors are being used for ADL collection and analysis. In this paper, we propose an IoT Device Platform for ADL capability measurement. Wearable devices and stationary devices recognize activity events in real environments and perform user identification through various sensors. The user’s ADL data are sent to the network hub for analysis. The proposed IoT platform devices support many sensor devices such as acceleration, flame, temperature, and humidity in order to recognize various activities in real life. In addition, in this paper, using the implemented platform, ADL measurement test was performed on hospital patients. Through this test, the accuracy and reliability of the platform are analyzed.
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Kang Y, Mondesir FL, Young D, Norris E, Hernandez JM, Nativi-Nicolau J, Stehlik J. Home Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge: A Quality-Improvement Pilot Project. Home Healthc Now 2021; 39:25-31. [PMID: 33417359 PMCID: PMC9910483 DOI: 10.1097/nhh.0000000000000925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/14/2023]
Abstract
Frequent rehospitalizations among patients with heart failure (HF) result in patient burden and high cost. Homebound patients with HF qualify for home healthcare after hospital discharge. It is not known if nonhomebound patients with HF could also benefit from home healthcare nursing (HHN) visits to improve the transition from hospital to home. The purpose of this quality-improvement pilot study was to assess the impact of HHN visits provided to nonhomebound HF patients after hospital discharge on 30-day rehospitalization rates. We included patients with HF who were ineligible for home healthcare services due to their nonhomebound status. Home healthcare nurses followed a modified version of the discharge checklist from the American Heart Association's Rise Above Heart Failure materials, and provided education as appropriate based on patients' responses. We enrolled 68 patients in the study. The mean age was 60.2 years; 61.8% were male and 77.9% were White. Based on patient responses to the checklist, key areas addressed during HHN visits were medication management and HF self-care. In the HHN visit group, 15% of the patients experienced rehospitalization within 30 days, compared with 23% in the non-HHN visit group among 540 patients discharged in the same time frame who met the inclusion criteria but were not enrolled in the study (p = .12). Our pilot data show that HHN visits for nonhomebound patients are feasible and result in a numerically lower 30-day rehospitalization rate after discharge. Further study is needed to confirm the clinical efficacy of this approach.
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Chen PJ, Ho CH, Liao JY, Smits L, Hsiung CA, Yu SJ, Zhang KP, Petersen I, Sampson EL. The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study. Int J Environ Res Public Health 2020; 17:E9255. [PMID: 33322024 DOI: 10.3390/ijerph17249255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND For people with dementia, burdensome transitions may indicate poorer-quality end-of-life care. Little is known regarding the association between home healthcare (HHC) and these burdensome transitions. We aimed to investigate the impact of HHC on transitions and hospital/intensive care unit (ICU) utilisation nearing the end-of-life for people with dementia at a national level. METHODS A nested case-control analysis was applied in a retrospective cohort study using a nationwide electronic records database. We included people with new dementia diagnoses who died during 2002-2013 in whole population data from the universal healthcare system in Taiwan. Burdensome transitions were defined as multiple hospitalisations in the last 90 days (early transitions, ET) or any hospitalisation or emergency room visit in the last three days of life (late transitions, LT). People with (cases) and without (controls) burdensome transitions were matched on a ratio of 1:2. We performed conditional logistic regression with stratified analyses to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) of the risks of transitions. RESULTS Among 150,125 people with new dementia diagnoses, 61,399 died during follow-up, and 31.1% had burdensome transitions (50% were early and 50% late). People with ET had the highest frequency of admissions and longer stays in hospital/ICU during their last year of life, while people with LT had fewer hospital/ICU utilisation than people without end-of-life transitions. Receiving HHC was associated with an increased risk of ET (OR = 1.14, 95 % CI: 1.08-1.21) but a decreased risk of LT (OR = 0.89, 95 % CI 0.83-0.94). In the people receiving HHC, however, those who received longer duration (e.g., OR = 0.50, 95 % CI: 0.42-0.60, >365 versus ≤30 days) or more frequent HHC or HHC delivered closer to the time of death were associated with a remarkably lower risk of ET. CONCLUSIONS HHC has differential effects on early and late transitions. Characteristics of HHC such as better continuity or interdisciplinary coordination may reduce the risk of transitions at the end-of-life. We need further studies to understand the longitudinal effects of HHC and its synergy with palliative care, as well as the key components of HHC that achieve better end-of-life outcomes.
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Sobotka SA, Lynch E, Peek ME, Graham RJ. Readmission drivers for children with medical complexity: Home nursing shortages cause health crises. Pediatr Pulmonol 2020; 55:1474-1480. [PMID: 32212321 PMCID: PMC7290239 DOI: 10.1002/ppul.24744] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Received: 12/20/2019] [Accepted: 03/15/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Children with medical technology dependence (MTD) are frequently readmitted to the hospital. However, due to their medical fragility, it is often difficult to untangle the root causes for readmissions to identify the most effective preventive approaches. We sought to explore environmental and family factors driving hospital readmissions for children with MTD. DESIGN Semi-structured, in-person interviews were conducted with state-wide care coordinators for children with MTD in Illinois with at least 1 year of experience. Interview topics related to children with MTD transitioning from hospital-to-home, essential supports for living in the community, and factors which influenced and prevented hospital readmission. The interview guide served as an initial codebook which was iteratively modified as themes emerged. RESULTS Fifteen care coordinators with on average 6.6 years of experience were interviewed. They described that lack of home nursing was one of the primary drivers of readmissions due to parental exhaustion and lack of medical expertize in the home. Unavoidable medical admissions, a lack of a plan for emergencies, and home environmental factors also contributed to readmissions. CONCLUSION Hospital readmission is an expected occurrence for children with MTD, yet still may be substantially reduced through consistent, quality home health nursing to bolster family capacity and allow for respite from constant caregiving. Improved incentives for the home health workforce to increase manpower would be ultimately offset by reduced hospitalizations for children with MTD. Additionally, more research is needed to understand which home nursing structures and skills optimally support families in the reality of manpower scarcity.
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Affiliation(s)
- Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Monica E Peek
- Section of General Internal Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Robert J Graham
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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Bowles KH, Murtaugh CM, Jordan L, Barrón Y, Mikkelsen ME, Whitehouse CR, Chase JAD, Ryvicker M, Feldman PH. Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors. J Am Med Dir Assoc 2019; 21:84-90.e2. [PMID: 31837933 DOI: 10.1016/j.jamda.2019.11.001] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission. DESIGN Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data. SETTING AND PARTICIPANTS National sample of Medicare beneficiaries hospitalized for sepsis who were discharged to HHC between July 1, 2013 and June 30, 2014 (N = 165,228). METHODS We used an indicator distinguishing among 3 types of sepsis: explicitly coded sepsis diagnosis without organ dysfunction; severe sepsis with organ dysfunction; and septic shock. We compared these subgroups' demographic, clinical and functional characteristics, comorbidities, risk factors for rehospitalization, characteristics of the index hospital stay, and predicted 7-day hospital readmission. RESULTS The majority (80.7%) had severe sepsis, 5.7% had septic shock, and 13.6% had sepsis without acute organ system dysfunction. The medical diagnoses recorded at HHC admission identified sepsis or blood infection only 7% of the time, potentially creating difficulty identifying the sepsis survivor in HHC. Among sepsis types, septic shock survivors had the greatest illness burden profile. This study describes 12 key variables, each of which individually raises the relative 7-day readmission risk by as much as 60%. Increased risk of 7-day rehospitalization was found among those with septic shock, 3 or more previous inpatient stays, index hospital length of stay of >8 days, dyspnea, >6 functional dependencies, and other risk factors. CONCLUSIONS AND IMPLICATIONS Implications for practice include using our findings to identify sepsis survivors who are at risk for early readmission. Assessment for these factors may profile the at-risk patient, thereby triggering the call for additional acute care intervention such as delayed discharge, or post-acute intervention such as early home visit and outpatient follow-up.
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Affiliation(s)
- Kathryn H Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA; Center for Home Care Policy & Research Visiting Nurse Service of New York, New York, NY.
| | | | - Lizeyka Jordan
- Center for Home Care Policy & Research Visiting Nurse Service of New York, New York, NY
| | - Yolanda Barrón
- Center for Home Care Policy & Research Visiting Nurse Service of New York, New York, NY
| | - Mark E Mikkelsen
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | | | - Jo-Ana D Chase
- University of Missouri, Sinclair School of Nursing, Columbia, MO
| | - Miriam Ryvicker
- Center for Home Care Policy & Research Visiting Nurse Service of New York, New York, NY
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Keller SC, Cosgrove SE, Arbaje AI, Chang RHE, Krosche A, Williams D, Gurses AP. Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy. Jt Comm J Qual Patient Saf 2019; 45:763-771. [PMID: 31447376 PMCID: PMC6823133 DOI: 10.1016/j.jcjq.2019.07.003] [Citation(s) in RCA: 5] [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: 04/30/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. METHODS A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. RESULTS Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing "high-skilled tasks." Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. CONCLUSION Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.
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Affiliation(s)
- Sara C. Keller
- Division of Infectious Diseases, Department of Medicine; Associate Faculty, Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine; Johns Hopkins University School of Medicine, Baltimore
| | - Sara E. Cosgrove
- Division of Infectious Diseases, Department of Medicine; Faculty, Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Alicia I. Arbaje
- Medicine, Director of Transitional Care Research, Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology, Department of Medicine; Johns Hopkins University School of Medicine, and Faculty, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Amanda Krosche
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine
| | - Deborah Williams
- Division of Quality Management, Johns Hopkins Home Care Group, Baltimore
| | - Ayse P. Gurses
- Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Associate Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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48
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Sundler AJ, Hjertberg F, Keri H, Holmström IK. Attributes of person-centred communication: A qualitative exploration of communication with older persons in home health care. Int J Older People Nurs 2019; 15:e12284. [PMID: 31642182 DOI: 10.1111/opn.12284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/05/2019] [Revised: 08/18/2019] [Accepted: 09/27/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous research points to challenges related to the home healthcare of older persons and to the complexity of communication. Although person-centred care has been advocated widely, there remains a need for in-depth knowledge on how to enable person-centred and supportive communication in the care of older persons. AIM The aim of this study was to explore attributes of person-centred communication between nurses and older persons being cared for in their home. METHODS A descriptive study with a qualitative approach was conducted. A data set from the COMHOME-study consisting of 77 audio-recorded home healthcare visits between registered nurses and older persons was analysed with a method for qualitative thematic analysis. RESULTS The findings indicate that the attributes of person-centred communication comprise recognising, inviting and involving older persons. To facilitate this form of communication, attentiveness and responsiveness on the part of RNs seemed significant. Person-centred communication was facilitated when the RNs used verbal expressions to emphasise and acknowledge the older persons' views and were attentive to their emotions and expressions. CONCLUSION The nurses' attentiveness and responsiveness seems important for person-centred communication with older persons. Communication skills are needed to recognise, invite and involve older persons in their care and to support their health and well-being. Implication for practice The importance of communication which facilitate a person-centred approach by nurses should be acknowledged when caring for older persons and included in education and training.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | | | - Helena Keri
- Home healthcare, Jönköping municipality, Jönköping, Sweden
| | - Inger K Holmström
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Weerahandi H, Bao H, Herrin J, Dharmarajan K, Ross JS, Jones S, Horwitz LI. Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization. J Am Geriatr Soc 2019; 68:96-102. [PMID: 31603248 DOI: 10.1111/jgs.16179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/13/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVE Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. Here, we examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization. DESIGN Retrospective cohort study. SETTING Fee-for-service Medicare data, 2012 to 2015. PARTICIPANTS Beneficiaries, aged 65 years and older, hospitalized with HF who were subsequently discharged to SNF and then discharged home. MEASUREMENTS The primary outcome was unplanned readmission within 30 days of discharge to home from SNF. We compared time to readmission between those with and without HHC services using a Cox model. RESULTS Of 67 585 HF hospitalizations discharged to SNFs and subsequently discharged home, 13 257 (19.6%) were discharged with HHC, and 54 328 (80.4%) were discharged without HHC. Patients discharged home from SNFs with HHC had lower 30-day readmission rates than patients discharged without HHC (22.8% vs 24.5%; P < .0001) and a longer time to readmission. In an adjusted model, the hazard for readmission was 0.91 (0.86-0.95) with receipt of HHC. CONCLUSIONS Recipients of HHC were less likely to be readmitted within 30 days vs those discharged home without HHC. This is unexpected, as patients discharged with HHC likely have more functional impairments. Since patients requiring a SNF stay after hospital discharge may have additional needs, they may particularly benefit from restorative therapy through HHC; however, only approximately 20% received such services. J Am Geriatr Soc 68:96-102, 2019.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.,Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
| | - Haikun Bao
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Simon Jones
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
| | - Leora I Horwitz
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.,Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
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50
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Sobotka SA, Foster C, Lynch E, Hird-McCorry L, Goodman DM. Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation. J Pediatr 2019; 212:166-171. [PMID: 31153586 PMCID: PMC7290238 DOI: 10.1016/j.jpeds.2019.04.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Received: 11/01/2018] [Revised: 03/10/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the reasons for discharge delays for children with long-term mechanical ventilation. STUDY DESIGN Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ2 tests were used to compare nursing hours and demographics. RESULTS Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient. CONCLUSIONS Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago
| | - Carolyn Foster
- Division of Academic General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine;,Mary Ann and J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago
| | - Lindsey Hird-McCorry
- Pulmonary Habilitation Program/Transitional Care Unit, Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Denise M. Goodman
- Division of Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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