Pub Date : 2021-03-19DOI: 10.1177/10848223211002849
A. Gerolamo, M. Pogorzelska-Maziarz, A. Gentsch, A. Traczuk, TingAnn Hsiao, G. Amadio, T. Haddad, K. Rising
Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.
{"title":"Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers","authors":"A. Gerolamo, M. Pogorzelska-Maziarz, A. Gentsch, A. Traczuk, TingAnn Hsiao, G. Amadio, T. Haddad, K. Rising","doi":"10.1177/10848223211002849","DOIUrl":"https://doi.org/10.1177/10848223211002849","url":null,"abstract":"Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"258 - 263"},"PeriodicalIF":1.1,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211002849","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45879772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-14DOI: 10.1177/10848223211000048
R. Amini, N. Kalvandi, Masoud Khodaveisi, Leili Tapak
Home injuries are among the causes of death and disability in toddlers. Preventing home injuries is an essential part of the child health care program. Using education-based models interventions can promote mothers’ practices regarding home injuries. This study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on the mothers’ preventive practices regarding toddler home injuries. A quasi-experimental study was conducted on 116 mothers referred to comprehensive health centers (58 mothers in each experimental and control group), who were selected using the cluster sampling method. Data were collected using a researcher-developed TPB questionnaire, which was validated by I-CVI (≥0.78), and CVR (≥0.79). Its reliability also confirmed by Cronbach’s alpha coefficients (.52-.93). Afterward, educational intervention was implemented in the experimental group based on TPB in four 45 to 60 minute sessions. After 2 months, the data were recollected from the two groups and analyzed using SPSS software version 16. Comparing the scores of TPB constructs (i.e., perceived behavioral control, behavioral intention, and subjective norms), and mothers’ preventive practices regarding toddler home injuries revealed no statistically significant difference between the 2 groups pre-intervention. However, after the intervention, significant differences were observed between the 2 groups in terms of awareness, the TPB constructs (except for subjective norms), and preventive practices of the mothers (p < .001). Mothers’ preventive practices regarding toddler home injuries were improved after applying TPB; hence, it is suggested a larger study be completed to confirm the results of this theory-based education.
{"title":"Investigation of the Effect of Education Based on the Theory of Planned Behavior on the Mothers’ Preventive Practices Regarding Toddler Home Injuries","authors":"R. Amini, N. Kalvandi, Masoud Khodaveisi, Leili Tapak","doi":"10.1177/10848223211000048","DOIUrl":"https://doi.org/10.1177/10848223211000048","url":null,"abstract":"Home injuries are among the causes of death and disability in toddlers. Preventing home injuries is an essential part of the child health care program. Using education-based models interventions can promote mothers’ practices regarding home injuries. This study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on the mothers’ preventive practices regarding toddler home injuries. A quasi-experimental study was conducted on 116 mothers referred to comprehensive health centers (58 mothers in each experimental and control group), who were selected using the cluster sampling method. Data were collected using a researcher-developed TPB questionnaire, which was validated by I-CVI (≥0.78), and CVR (≥0.79). Its reliability also confirmed by Cronbach’s alpha coefficients (.52-.93). Afterward, educational intervention was implemented in the experimental group based on TPB in four 45 to 60 minute sessions. After 2 months, the data were recollected from the two groups and analyzed using SPSS software version 16. Comparing the scores of TPB constructs (i.e., perceived behavioral control, behavioral intention, and subjective norms), and mothers’ preventive practices regarding toddler home injuries revealed no statistically significant difference between the 2 groups pre-intervention. However, after the intervention, significant differences were observed between the 2 groups in terms of awareness, the TPB constructs (except for subjective norms), and preventive practices of the mothers (p < .001). Mothers’ preventive practices regarding toddler home injuries were improved after applying TPB; hence, it is suggested a larger study be completed to confirm the results of this theory-based education.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"250 - 257"},"PeriodicalIF":1.1,"publicationDate":"2021-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211000048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42124886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-14DOI: 10.1177/10848223211002166
Alireza Nikbakht Nasrabadi, L. Mardanian Dehkordi, F. Taleghani
Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.
{"title":"Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions","authors":"Alireza Nikbakht Nasrabadi, L. Mardanian Dehkordi, F. Taleghani","doi":"10.1177/10848223211002166","DOIUrl":"https://doi.org/10.1177/10848223211002166","url":null,"abstract":"Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"239 - 244"},"PeriodicalIF":1.1,"publicationDate":"2021-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211002166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41485347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-06DOI: 10.1177/1084822321996623
J. Lord, N. Borkowski, R. Weech-Maldonado
Health literacy has been identified as a barrier to patient engagement among older adults, especially within the home health care setting. This systematic literature review explores patient engagement; the relationship between patient engagement and health literacy; and finally, best practices for improving patient engagement through health literacy. Various interventions were explored but the “Ask Me Three®” tool created by the Institute for Healthcare Improvement and the National Patient Safety Foundation, was a best practice for improving patient engagement through increased health literacy. This educational intervention is a high-touch, low-cost, process designed to engage patients, and their informal caregivers in their own care through increased communication by asking three important questions: (1) What is my main problem?, (2) What do I need to do?, and (3) Why is it important for me to do this? These questions make the patient engage with their provider to identify their main health problem; what actions need to be taken to improve their health, and why those actions are important. Providers can potentially influence patient’s behavior through engagement and increased health literacy. The “Ask Me Three®” intervention is an example of how increased patient engagement and health literacy can lead to better health outcomes. The “Ask Me Three®” intervention may improve the quality of home health care.
健康知识已被确定为老年人参与患者活动的障碍，尤其是在家庭医疗环境中。这篇系统的文献综述探讨了患者参与；患者参与度与健康素养之间的关系；最后，通过健康知识提高患者参与度的最佳实践。我们探索了各种干预措施，但由医疗保健改善研究所和国家患者安全基金会创建的“Ask Me Three®”工具是通过提高健康素养来提高患者参与度的最佳实践。这种教育干预是一种高接触、低成本的过程，旨在通过提出三个重要问题，通过加强沟通，让患者及其非正式护理人员参与到自己的护理中：（1）我的主要问题是什么？，（2） 我需要做什么？，以及（3）为什么这样做对我来说很重要？这些问题使患者与他们的提供者接触，以确定他们的主要健康问题；需要采取哪些行动来改善他们的健康，以及为什么这些行动很重要。提供者可以通过参与和提高健康素养来潜在地影响患者的行为。“Ask Me Three®”干预是一个例子，说明了提高患者参与度和健康素养可以带来更好的健康结果。“Ask Me Three®”干预措施可以提高家庭医疗保健的质量。
{"title":"Patient Engagement in Home Health: The Role of Health Literacy and “Ask Me Three®”","authors":"J. Lord, N. Borkowski, R. Weech-Maldonado","doi":"10.1177/1084822321996623","DOIUrl":"https://doi.org/10.1177/1084822321996623","url":null,"abstract":"Health literacy has been identified as a barrier to patient engagement among older adults, especially within the home health care setting. This systematic literature review explores patient engagement; the relationship between patient engagement and health literacy; and finally, best practices for improving patient engagement through health literacy. Various interventions were explored but the “Ask Me Three®” tool created by the Institute for Healthcare Improvement and the National Patient Safety Foundation, was a best practice for improving patient engagement through increased health literacy. This educational intervention is a high-touch, low-cost, process designed to engage patients, and their informal caregivers in their own care through increased communication by asking three important questions: (1) What is my main problem?, (2) What do I need to do?, and (3) Why is it important for me to do this? These questions make the patient engage with their provider to identify their main health problem; what actions need to be taken to improve their health, and why those actions are important. Providers can potentially influence patient’s behavior through engagement and increased health literacy. The “Ask Me Three®” intervention is an example of how increased patient engagement and health literacy can lead to better health outcomes. The “Ask Me Three®” intervention may improve the quality of home health care.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"202 - 209"},"PeriodicalIF":1.1,"publicationDate":"2021-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822321996623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47608547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-11DOI: 10.1177/1084822321994779
Tracy Chippendale, Patricia A Gentile
Most people prefer to age in place. However, there is a growing body of literature to suggest a reluctance to accept supportive services in the home due to concerns about trust, privacy, cost, and fear of being a burden. The purpose of this study was to examine potential facilitators and barriers to accepting home care services in the website content of Licensed Home Care Service Agencies (LHSCA). In this linguistic analysis study, the written content from 88 randomly selected LHCSA websites was examined. We used LIWC2015 and Microsoft® Word software to analyze websites for relevant word categories that reflect older adult identified facilitators and barriers to the acceptance of home care services. Results revealed that the summary score for clout (i.e., confidence and leadership reflected in the writing) was high. Some of the most commonly used word categories were positive emotions, present focused, and affiliation. The word category money was included, but to a lesser degree. However, Burden and related words were highly prevalent in the writing sample. In summary, LHCSA website content contains both facilitators and barriers to the acceptance of home care services. Given the importance of home care services in promoting the ability of older adults to age in place, greater attention may be needed regarding the way services are presented and advertised to consumers.
{"title":"Facilitators and Barriers to Accepting Long Term Care at Home: An Analysis of Licensed Home Care Service Agency Websites","authors":"Tracy Chippendale, Patricia A Gentile","doi":"10.1177/1084822321994779","DOIUrl":"https://doi.org/10.1177/1084822321994779","url":null,"abstract":"Most people prefer to age in place. However, there is a growing body of literature to suggest a reluctance to accept supportive services in the home due to concerns about trust, privacy, cost, and fear of being a burden. The purpose of this study was to examine potential facilitators and barriers to accepting home care services in the website content of Licensed Home Care Service Agencies (LHSCA). In this linguistic analysis study, the written content from 88 randomly selected LHCSA websites was examined. We used LIWC2015 and Microsoft® Word software to analyze websites for relevant word categories that reflect older adult identified facilitators and barriers to the acceptance of home care services. Results revealed that the summary score for clout (i.e., confidence and leadership reflected in the writing) was high. Some of the most commonly used word categories were positive emotions, present focused, and affiliation. The word category money was included, but to a lesser degree. However, Burden and related words were highly prevalent in the writing sample. In summary, LHCSA website content contains both facilitators and barriers to the acceptance of home care services. Given the importance of home care services in promoting the ability of older adults to age in place, greater attention may be needed regarding the way services are presented and advertised to consumers.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"245 - 249"},"PeriodicalIF":1.1,"publicationDate":"2021-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822321994779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42732321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1177/1084822321990376
D. Pinto, L. Spencer, S. Pereira, P. Machado, P. Sousa, M. Padilha
To systematize strategies that may support patients with Chronic Obstructive Pulmonary Disease to maintain the effects of pulmonary rehabilitation over time. This systematic literature review was conducted, and the evidence was electronically searched in the Web of Science, Scopus, and EBSCO databases. This review included randomized controlled clinical trials, published until September 2019, that addressed components of an unsupervised home-based pulmonary rehabilitation program, maintenance strategies following outpatient pulmonary rehabilitation programs, as well as data on outcomes for quality of life, exercise performance, and dyspnea. A final sample of 5 articles was obtained from a total of 1693 studies. Data for final synthesis were grouped into 2 categories: components of unsupervised home-based pulmonary rehabilitation programs and maintenance strategies. An unsupervised home-based pulmonary rehabilitation program should consist of an educational component, an endurance training component, and a strength training component. When patients are transferred to the home environment, it is important to include more functional exercises specifically adapted to the patient’s condition, goals, and needs.
系统化策略，以支持慢性阻塞性肺病患者在一段时间内保持肺部康复的效果。进行了这项系统的文献综述，并在Web of Science、Scopus和EBSCO数据库中以电子方式搜索证据。这篇综述包括截至2019年9月发表的随机对照临床试验，涉及无监督的家庭肺部康复计划的组成部分、门诊肺部康复计划后的维持策略，以及生活质量、运动表现和呼吸困难的结果数据。从总共1693项研究中获得了5篇文章的最终样本。用于最终综合的数据分为两类：无监督家庭肺部康复计划的组成部分和维持策略。无监督的家庭肺部康复计划应包括教育部分、耐力训练部分和力量训练部分。当患者被转移到家庭环境中时，重要的是要包括更多专门适应患者病情、目标和需求的功能锻炼。
{"title":"Maintaining Effects of Pulmonary Rehabilitation at Home in Chronic Obstructive Pulmonary Disease: A Systematic Literature Review","authors":"D. Pinto, L. Spencer, S. Pereira, P. Machado, P. Sousa, M. Padilha","doi":"10.1177/1084822321990376","DOIUrl":"https://doi.org/10.1177/1084822321990376","url":null,"abstract":"To systematize strategies that may support patients with Chronic Obstructive Pulmonary Disease to maintain the effects of pulmonary rehabilitation over time. This systematic literature review was conducted, and the evidence was electronically searched in the Web of Science, Scopus, and EBSCO databases. This review included randomized controlled clinical trials, published until September 2019, that addressed components of an unsupervised home-based pulmonary rehabilitation program, maintenance strategies following outpatient pulmonary rehabilitation programs, as well as data on outcomes for quality of life, exercise performance, and dyspnea. A final sample of 5 articles was obtained from a total of 1693 studies. Data for final synthesis were grouped into 2 categories: components of unsupervised home-based pulmonary rehabilitation programs and maintenance strategies. An unsupervised home-based pulmonary rehabilitation program should consist of an educational component, an endurance training component, and a strength training component. When patients are transferred to the home environment, it is important to include more functional exercises specifically adapted to the patient’s condition, goals, and needs.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"226 - 233"},"PeriodicalIF":1.1,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822321990376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47009423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1177/1084822320959319
Emin Rençber, O. Terzi
Advanced age, restrictions on daily life activities, increased disability, and chronic diseases negatively affect the quality of life of older individuals. The aim of the present study was to investigate the quality of life of older patients receiving home health care services (HHCS) in Samsun province, Turkey. The population of this cross-sectional study comprised 489 individuals aged 65 years and older. Patient selection was performed using the stratified randomized sampling method. A total of 183 patients were included in the study. Data were collected using a questionnaire and face-to-face interviews. The Mann-Whitney U and Kruskal–Wallis tests were used in the statistical evaluation of data, and significance was regarded as p < .05 for all tests. Some 75.4% of the patients were women, and the average age was 82 years. Eighty-three percent of the participants were semi-dependent or completely dependent in the activities of daily living (ADL); however, in the instrumental activities of daily living (IADL), 96.0% were semi-dependent or completely dependent. The quality of life of the older people receiving HHCS was identified as low both in the physical and mental health components. However, physical quality of life was statistically higher in men, in graduates of primary school or above, and in patients with no decubitus ulcers compared with the others. We found that the older individuals receiving HHCS had a lower quality of life due to their chronic diseases and high dependency compared with the general population and their contemporaries.
{"title":"Quality of Life of Older People Receiving Home Health Care Services: An Example From Turkey","authors":"Emin Rençber, O. Terzi","doi":"10.1177/1084822320959319","DOIUrl":"https://doi.org/10.1177/1084822320959319","url":null,"abstract":"Advanced age, restrictions on daily life activities, increased disability, and chronic diseases negatively affect the quality of life of older individuals. The aim of the present study was to investigate the quality of life of older patients receiving home health care services (HHCS) in Samsun province, Turkey. The population of this cross-sectional study comprised 489 individuals aged 65 years and older. Patient selection was performed using the stratified randomized sampling method. A total of 183 patients were included in the study. Data were collected using a questionnaire and face-to-face interviews. The Mann-Whitney U and Kruskal–Wallis tests were used in the statistical evaluation of data, and significance was regarded as p < .05 for all tests. Some 75.4% of the patients were women, and the average age was 82 years. Eighty-three percent of the participants were semi-dependent or completely dependent in the activities of daily living (ADL); however, in the instrumental activities of daily living (IADL), 96.0% were semi-dependent or completely dependent. The quality of life of the older people receiving HHCS was identified as low both in the physical and mental health components. However, physical quality of life was statistically higher in men, in graduates of primary school or above, and in patients with no decubitus ulcers compared with the others. We found that the older individuals receiving HHCS had a lower quality of life due to their chronic diseases and high dependency compared with the general population and their contemporaries.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"3 - 7"},"PeriodicalIF":1.1,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822320959319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44704608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1177/1084822321990382
Elizabeth Plummer, William F. Wempe
Beginning January 1, 2020, Medicare’s Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies’ (HHAs’) reimbursements. Instead, PDGM advances Medicare’s shift toward value-based payment models by directly linking HHAs’ reimbursements to patients’ medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs’ pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM’s likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs’ expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.
{"title":"Home Health Agencies: Empirical Evidence on the Patient-Driven Groupings Model’s Expected Effects on Agency Reimbursements","authors":"Elizabeth Plummer, William F. Wempe","doi":"10.1177/1084822321990382","DOIUrl":"https://doi.org/10.1177/1084822321990382","url":null,"abstract":"Beginning January 1, 2020, Medicare’s Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies’ (HHAs’) reimbursements. Instead, PDGM advances Medicare’s shift toward value-based payment models by directly linking HHAs’ reimbursements to patients’ medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs’ pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM’s likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs’ expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"183 - 192"},"PeriodicalIF":1.1,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822321990382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48257861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-20DOI: 10.1177/1084822320988513
R. García-Carretero, Óscar Vázquez-Gómez, Belen Rodriguez-Maya, Gema Naranjo-Mansilla, Esther Luna-Heredia
Infective endocarditis (IE) is a severe condition with high morbidity and mortality, and it requires long-term suppressive antibiotic therapy. Outpatient parenteral antimicrobial therapy (OPAT) has been used for a range of infectious diseases for more than 30 years, and in Spain it is used in hospital-at-home (HaH) settings. Our objectives were to describe and characterize the demographic, clinical, and microbiological features of patients admitted to an HaH setting and to assess the safety and effectiveness of OPAT. We conducted a retrospective study that included patients diagnosed with IE over a period of 8 years (2011-2018). We collected demographic and clinical features, length of hospital stay, antimicrobial treatment, microbiological profiles, and outcomes. We included 26 patients during the observation period. Their mean age was 66.5 years, and 88.5% were male. The mean hospital stay was 10.5 days, and the mean stay in the HaH setting was 31 days. A total of 6 patients required readmission due to deterioration, of whom 3 had severe mitral insufficiency. The 8 patients had symptoms of heart failure, but they were treated at home and did not require readmission. Ultimately, 12 patients recovered and were referred to a surgical unit for valvular repair and replacement on a scheduled basis. OPAT is a useful and effective tool for the management of patients diagnosed with IE in HaH settings.
{"title":"Infective Endocarditis in a Hospital-at-Home Setting: A Retrospective Analysis in a Peripheral Spanish Hospital","authors":"R. García-Carretero, Óscar Vázquez-Gómez, Belen Rodriguez-Maya, Gema Naranjo-Mansilla, Esther Luna-Heredia","doi":"10.1177/1084822320988513","DOIUrl":"https://doi.org/10.1177/1084822320988513","url":null,"abstract":"Infective endocarditis (IE) is a severe condition with high morbidity and mortality, and it requires long-term suppressive antibiotic therapy. Outpatient parenteral antimicrobial therapy (OPAT) has been used for a range of infectious diseases for more than 30 years, and in Spain it is used in hospital-at-home (HaH) settings. Our objectives were to describe and characterize the demographic, clinical, and microbiological features of patients admitted to an HaH setting and to assess the safety and effectiveness of OPAT. We conducted a retrospective study that included patients diagnosed with IE over a period of 8 years (2011-2018). We collected demographic and clinical features, length of hospital stay, antimicrobial treatment, microbiological profiles, and outcomes. We included 26 patients during the observation period. Their mean age was 66.5 years, and 88.5% were male. The mean hospital stay was 10.5 days, and the mean stay in the HaH setting was 31 days. A total of 6 patients required readmission due to deterioration, of whom 3 had severe mitral insufficiency. The 8 patients had symptoms of heart failure, but they were treated at home and did not require readmission. Ultimately, 12 patients recovered and were referred to a surgical unit for valvular repair and replacement on a scheduled basis. OPAT is a useful and effective tool for the management of patients diagnosed with IE in HaH settings.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"177 - 182"},"PeriodicalIF":1.1,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822320988513","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45858998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-19DOI: 10.1177/1084822320986965
Wanich Suksatan, T. Tankumpuan
Patients with heart failure are known to be particularly vulnerable to depression resulting in adverse health outcomes. However, there has been no literature review on current evidence regarding the relationship between depression and rehospitalization. This review aims to explore the relationship between depression and rehospitalization in patients with heart failure. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included articles published between 2001 and 2019 taken from Scopus, PubMed, CINAHL, and PsycINFO databases. We identified 12 relevant studies with participants ranging from 115 to 160,169 patients. Heart failure patients with depression were more likely to be rehospitalized than those without. To explain this, few reasons have been proposed. First, depression could disrupt the regulation of autonomic nervous system, neurohormonal activation, and body’s natural rhythm. Second, depressed patients tend to have poor adherence to medication. Healthcare providers should not only focus on drug and dietary management but also on implementing effective interventions to manage depression, in order to reduce the risk of rehospitalization. Moreover, palliative care should start at the stage of heart failure diagnosis to improve quality of life, better outcomes, and lower cost of care for the patients.
{"title":"Depression and Rehospitalization in Patients With Heart Failure After Discharge From Hospital to Home: An Integrative Review","authors":"Wanich Suksatan, T. Tankumpuan","doi":"10.1177/1084822320986965","DOIUrl":"https://doi.org/10.1177/1084822320986965","url":null,"abstract":"Patients with heart failure are known to be particularly vulnerable to depression resulting in adverse health outcomes. However, there has been no literature review on current evidence regarding the relationship between depression and rehospitalization. This review aims to explore the relationship between depression and rehospitalization in patients with heart failure. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included articles published between 2001 and 2019 taken from Scopus, PubMed, CINAHL, and PsycINFO databases. We identified 12 relevant studies with participants ranging from 115 to 160,169 patients. Heart failure patients with depression were more likely to be rehospitalized than those without. To explain this, few reasons have been proposed. First, depression could disrupt the regulation of autonomic nervous system, neurohormonal activation, and body’s natural rhythm. Second, depressed patients tend to have poor adherence to medication. Healthcare providers should not only focus on drug and dietary management but also on implementing effective interventions to manage depression, in order to reduce the risk of rehospitalization. Moreover, palliative care should start at the stage of heart failure diagnosis to improve quality of life, better outcomes, and lower cost of care for the patients.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"217 - 225"},"PeriodicalIF":1.1,"publicationDate":"2021-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1084822320986965","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41942223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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