Pub Date : 2023-05-18DOI: 10.1177/10848223231174226
S. Ross, Nadja Ziegert, F. Rodriguez
Non-pharmacological interventions show promising positive effects on dementia symptoms. Since the majority of dementia care activities are performed by family caregivers, it is important to know how they perceive and implement such approaches. We aimed to investigate the extent to which non-pharmacological interventions are considered by family caregivers in dementia care and the barriers they encounter in implementing them. A total of 30 family caregivers (mean age: 63.07 years, female: 70%) living inside (30%) and outside the homes (70%) of people with dementia participated. Descriptive data analysis was used to determine the frequency of non-pharmacological interventions implemented, perceived effects, lacking resources, and barriers, while inferential statistics were used to examine whether funding source varied between interventions with high versus low frequency. The most frequently implemented non-pharmacological interventions were initiating/maintaining social contact, cognitively stimulating and rehabilitative activities, and time in nature. In general, enjoyment was the most commonly perceived effect of non-pharmacological interventions. Additional effects were reported with respect to well-being, cognitive decline, autobiographical memory, perception of competence, and other symptoms. Major barriers were organizational burden, accessibility, and a lack of funding. Further, lacking resources included a lack of services (e.g., therapies, transport, group activities) and information on possible interventions. This study highlighted that family caregivers frequently implement non-pharmacological interventions in dementia care. Given the perceived positive effects on dementia symptoms, health care interventions are needed that address barriers and provide resources to foster the implementation of non-pharmacological interventions by family caregivers.
{"title":"Implementation of Non-pharmacological Interventions in Dementia Care: Family Caregiver Perspective","authors":"S. Ross, Nadja Ziegert, F. Rodriguez","doi":"10.1177/10848223231174226","DOIUrl":"https://doi.org/10.1177/10848223231174226","url":null,"abstract":"Non-pharmacological interventions show promising positive effects on dementia symptoms. Since the majority of dementia care activities are performed by family caregivers, it is important to know how they perceive and implement such approaches. We aimed to investigate the extent to which non-pharmacological interventions are considered by family caregivers in dementia care and the barriers they encounter in implementing them. A total of 30 family caregivers (mean age: 63.07 years, female: 70%) living inside (30%) and outside the homes (70%) of people with dementia participated. Descriptive data analysis was used to determine the frequency of non-pharmacological interventions implemented, perceived effects, lacking resources, and barriers, while inferential statistics were used to examine whether funding source varied between interventions with high versus low frequency. The most frequently implemented non-pharmacological interventions were initiating/maintaining social contact, cognitively stimulating and rehabilitative activities, and time in nature. In general, enjoyment was the most commonly perceived effect of non-pharmacological interventions. Additional effects were reported with respect to well-being, cognitive decline, autobiographical memory, perception of competence, and other symptoms. Major barriers were organizational burden, accessibility, and a lack of funding. Further, lacking resources included a lack of services (e.g., therapies, transport, group activities) and information on possible interventions. This study highlighted that family caregivers frequently implement non-pharmacological interventions in dementia care. Given the perceived positive effects on dementia symptoms, health care interventions are needed that address barriers and provide resources to foster the implementation of non-pharmacological interventions by family caregivers.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88239327","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 : 2023-05-08DOI: 10.1177/10848223231170019
Max Jajszczok, C. Eastwood, H. Quan, Laurel D. Scott, Abram Gutscher, R. Zhao
A systematic scoping review of health system Performance and Quality Indicators (PQI) related literature for evaluating publicly funded home care programming was conducted. Through the scoping review we identify PQIs, map these based on quadrants of the Institute for Healthcare Improvement’s (IHI) Quadruple Aim, classify these PQIs under general “areas of focus” categories, and present recommendations for use. We selected all articles that identified, referenced, proposed, and/or described at least 1 PQI to measure home care service programming. Minimum inclusion criteria were a description of 1 or more PQIs designed to evaluate and/or measure home care programming, outcomes of home care clients and/or caregivers, or overall system impacts of home care service provision. The review identified 3,475 citations. A review of the abstracts led to the retrieval of 510 full-text articles for assessment of which 105 articles were selected for detailed review and extraction of identified PQIs. Of the 105 identified articles a total of 829 unique PQIs were gathered. Based on the IHI Quadruple Aim, 661 unique measures were identified as Clinical Outcome, 35 as Healthcare Provider Satisfaction, 99 Patient Experience, and 34 in the Financial/Sustainability quadrants. Many patient outcome specific PQIs exist, followed by patient experience measures. Very few PQIs exist in the financial or healthcare provider experience quadrants. The lack of indicators across all the IHI Quadruple Aim quadrants is an opportunity for further development supporting home care quality oversight.
{"title":"Health System Quality and Performance Indicators for Evaluating Home Care Programming: A Scoping Review","authors":"Max Jajszczok, C. Eastwood, H. Quan, Laurel D. Scott, Abram Gutscher, R. Zhao","doi":"10.1177/10848223231170019","DOIUrl":"https://doi.org/10.1177/10848223231170019","url":null,"abstract":"A systematic scoping review of health system Performance and Quality Indicators (PQI) related literature for evaluating publicly funded home care programming was conducted. Through the scoping review we identify PQIs, map these based on quadrants of the Institute for Healthcare Improvement’s (IHI) Quadruple Aim, classify these PQIs under general “areas of focus” categories, and present recommendations for use. We selected all articles that identified, referenced, proposed, and/or described at least 1 PQI to measure home care service programming. Minimum inclusion criteria were a description of 1 or more PQIs designed to evaluate and/or measure home care programming, outcomes of home care clients and/or caregivers, or overall system impacts of home care service provision. The review identified 3,475 citations. A review of the abstracts led to the retrieval of 510 full-text articles for assessment of which 105 articles were selected for detailed review and extraction of identified PQIs. Of the 105 identified articles a total of 829 unique PQIs were gathered. Based on the IHI Quadruple Aim, 661 unique measures were identified as Clinical Outcome, 35 as Healthcare Provider Satisfaction, 99 Patient Experience, and 34 in the Financial/Sustainability quadrants. Many patient outcome specific PQIs exist, followed by patient experience measures. Very few PQIs exist in the financial or healthcare provider experience quadrants. The lack of indicators across all the IHI Quadruple Aim quadrants is an opportunity for further development supporting home care quality oversight.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73192385","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 : 2023-05-01DOI: 10.1177/10848223221102544
W. Cabin
There is extensive literature on the significance of financial incentives in the Hospice Medicare Benefit (HMB) and the growth of proprietary ownership of hospices in the United States. A literature review indicates a paucity of information on hospice nurses’ and hospice social workers’ perceptions of the impact of the HMB’s financial structure on care planning and delivery decisions. In a previous issue of this journal, the author addressed the literature gap by presenting a study on hospice nurses’ perceptions of the impact of financial factors on their decision-making regarding care for Medicare hospice beneficiaries. The study presented in this article is a companion qualitative study to the nurses’ study. This article presents background on the topic and an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 hospice social workers from 6 different hospices between December 1, 2018 and January 31, 2020, in the New York City metropolitan area. Six themes emerged from the interviews: finances are the guiding principle in care planning and service delivery decisions; balancing patient care needs, cost, and finance-related length of stay (LOS) is a challenge; the emphasis on finance diminishes the social workers’ ability to address hospice patient needs; the emphasis on finance diminishes the social workers’ ability to address hospice caregiver needs; the social work role is diminished because of the role of nurses in developing and implementing the plan of treatment, which influences finances; and the Interdisciplinary Team (IDT) is the crucial clinical and financial decision-making setting, but gives limited weight to social work input.
{"title":"“It’s Just Too Much”: The Financial Calculus in Medicare Hospice","authors":"W. Cabin","doi":"10.1177/10848223221102544","DOIUrl":"https://doi.org/10.1177/10848223221102544","url":null,"abstract":"There is extensive literature on the significance of financial incentives in the Hospice Medicare Benefit (HMB) and the growth of proprietary ownership of hospices in the United States. A literature review indicates a paucity of information on hospice nurses’ and hospice social workers’ perceptions of the impact of the HMB’s financial structure on care planning and delivery decisions. In a previous issue of this journal, the author addressed the literature gap by presenting a study on hospice nurses’ perceptions of the impact of financial factors on their decision-making regarding care for Medicare hospice beneficiaries. The study presented in this article is a companion qualitative study to the nurses’ study. This article presents background on the topic and an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 hospice social workers from 6 different hospices between December 1, 2018 and January 31, 2020, in the New York City metropolitan area. Six themes emerged from the interviews: finances are the guiding principle in care planning and service delivery decisions; balancing patient care needs, cost, and finance-related length of stay (LOS) is a challenge; the emphasis on finance diminishes the social workers’ ability to address hospice patient needs; the emphasis on finance diminishes the social workers’ ability to address hospice caregiver needs; the social work role is diminished because of the role of nurses in developing and implementing the plan of treatment, which influences finances; and the Interdisciplinary Team (IDT) is the crucial clinical and financial decision-making setting, but gives limited weight to social work input.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45438760","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 : 2023-05-01Epub Date: 2022-12-24DOI: 10.1177/10848223221141902
Monika Pogorzelska-Maziarz, Ashley M Chastain, Uduwanage Gayani E Perera, Catherine C Cohen, Patricia W Stone, Kyungmi Woo, Jingjing Shang
Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR; (2) Benefits of EHR; (3) Benefits of other HIT; (4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR; an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.
{"title":"Health Information Technology Adoption at U.S. Home Health Care Agencies: Results from a Multi-Methods Study.","authors":"Monika Pogorzelska-Maziarz, Ashley M Chastain, Uduwanage Gayani E Perera, Catherine C Cohen, Patricia W Stone, Kyungmi Woo, Jingjing Shang","doi":"10.1177/10848223221141902","DOIUrl":"10.1177/10848223221141902","url":null,"abstract":"<p><p>Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR; (2) Benefits of EHR; (3) Benefits of other HIT; (4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR; an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.</p>","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47765198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-27DOI: 10.1177/10848223231170599
Gro Næss, T. Wyller, E. Gjevjon
Early identification and follow-up of sub-acute and acute functional decline in older persons living with multimorbidity at home require integrated and proactive care by interdisciplinary health personnel. Yet, in the context of the task-oriented and fragmented home healthcare services, early identification is challenging. Therefore, the aim of this study was to identify preconditions for the success of a proactive and interdisciplinary follow-up of older recipients of home healthcare. We conducted a qualitative secondary analysis of data from 6 focus group interviews with registered nurses and nurse leaders. In addition, we performed and analyzed data from 2 new focus group interviews with general practitioners and RNs who had a role as super users in a developmental project which introduced a clinical instrument for early identification of sub-acute and acute functional decline (sub-acute functional decline in the elderly—SAFE). Their experiences with using SAFE constituted the backdrop for the study. In total, 41 representatives of the interprofessional primary care staff of 3 city districts participated. Having a common goal, sharing tasks and having reciprocal understanding of each health profession’s contribution, systems and tools and clinical leadership were all seen as important factors for succeeding in the proactive and interdisciplinary follow-up of older recipients of home healthcare. Clinical leadership was deemed the strongest precondition, and clear leadership which promotes integrative and proactive care by facilitating interdisciplinary collaboration appears to be the main key for success.
{"title":"Clinical Leadership – An Important Precondition for the Success of Proactive and Interdisciplinary Follow-up of Frail Older Recipients of Home Healthcare","authors":"Gro Næss, T. Wyller, E. Gjevjon","doi":"10.1177/10848223231170599","DOIUrl":"https://doi.org/10.1177/10848223231170599","url":null,"abstract":"Early identification and follow-up of sub-acute and acute functional decline in older persons living with multimorbidity at home require integrated and proactive care by interdisciplinary health personnel. Yet, in the context of the task-oriented and fragmented home healthcare services, early identification is challenging. Therefore, the aim of this study was to identify preconditions for the success of a proactive and interdisciplinary follow-up of older recipients of home healthcare. We conducted a qualitative secondary analysis of data from 6 focus group interviews with registered nurses and nurse leaders. In addition, we performed and analyzed data from 2 new focus group interviews with general practitioners and RNs who had a role as super users in a developmental project which introduced a clinical instrument for early identification of sub-acute and acute functional decline (sub-acute functional decline in the elderly—SAFE). Their experiences with using SAFE constituted the backdrop for the study. In total, 41 representatives of the interprofessional primary care staff of 3 city districts participated. Having a common goal, sharing tasks and having reciprocal understanding of each health profession’s contribution, systems and tools and clinical leadership were all seen as important factors for succeeding in the proactive and interdisciplinary follow-up of older recipients of home healthcare. Clinical leadership was deemed the strongest precondition, and clear leadership which promotes integrative and proactive care by facilitating interdisciplinary collaboration appears to be the main key for success.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80538343","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 : 2023-04-25DOI: 10.1177/10848223231169038
W. Cabin
There is significant literature about the Medicare Outcome and Information Assessment (OASIS). A new OASIS Version E, effective January 2023, makes significant changes in assessing patient mental health. However, a literature review indicates no studies of the anticipated effectiveness of the OASIS-E on improving psychosocial care of Medicare home health beneficiaries. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 36 home care social workers from 5 different home health agencies in the New York City metropolitan area between August 1, 2022, and November 30, 2022. Four themes emerged from the study, namely that social workers believe the OASIS-E revisions: are an improvement over prior OASIS versions; are cumbersome and do not require administration by a social worker; do not impose specific guidance requirements on using new measures scoring results in making care decisions; and do not address coverage of specific interventions that address patients with significant mental health issues. Policymakers are urged to modify the OASIS-E guidance manual to require use of new mental health assessment scores in care planning and to expand coverage of evidence-based treatment interventions for patients with significant assessed mental health conditions.
{"title":"“They Are Measures Without Impact”: Home Care Social Workers Criticize OASIS-E","authors":"W. Cabin","doi":"10.1177/10848223231169038","DOIUrl":"https://doi.org/10.1177/10848223231169038","url":null,"abstract":"There is significant literature about the Medicare Outcome and Information Assessment (OASIS). A new OASIS Version E, effective January 2023, makes significant changes in assessing patient mental health. However, a literature review indicates no studies of the anticipated effectiveness of the OASIS-E on improving psychosocial care of Medicare home health beneficiaries. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 36 home care social workers from 5 different home health agencies in the New York City metropolitan area between August 1, 2022, and November 30, 2022. Four themes emerged from the study, namely that social workers believe the OASIS-E revisions: are an improvement over prior OASIS versions; are cumbersome and do not require administration by a social worker; do not impose specific guidance requirements on using new measures scoring results in making care decisions; and do not address coverage of specific interventions that address patients with significant mental health issues. Policymakers are urged to modify the OASIS-E guidance manual to require use of new mental health assessment scores in care planning and to expand coverage of evidence-based treatment interventions for patients with significant assessed mental health conditions.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90833144","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 : 2023-04-21DOI: 10.1177/10848223231169504
H. Marani, Allie Peckham
As utilization of home care increases across Canada, questions are emerging concerning the extent to which home care expenses, many of which are not publicly covered, are borne by unpaid caregivers of home care recipients. In this systematic review, we review English-language literature published between 2001 and 2022 exploring the magnitude and sources of home care costs incurred by unpaid caregivers in Canada. Of particular interest were empirical, cost-of-illness studies that describe the implications of these costs across domains of financial risk, including caregivers’ income level, employment status, and personal health. Following the screening of 492 studies derived across 6 databases (OVID Medline, CINAHL, PsycINFO, AMED, EconLit, and EMBASE), 24 studies were included in this review. Overall, few studies describe how home care expenses incurred by unpaid caregivers contribute to their financial risk. While some studies characterize the direct costs of caregiving incurred by caregivers, including out-of-pocket expenditure on transportation to medical appointments, respite care, home renovations, supplemental housekeeping, and prescription medications, limited studies attempt to estimate the magnitude of these expenses. Concerning financial risk, the literature is chiefly concerned with indirect costs of caregiving, including consequences on caregivers’ employment (foregone wages). Findings from this literature review suggest further work is needed in Canadian context to document costs associated with unpaid home care provision.
{"title":"Unpaid Caregiver Costs in Canada: A Systematic Review","authors":"H. Marani, Allie Peckham","doi":"10.1177/10848223231169504","DOIUrl":"https://doi.org/10.1177/10848223231169504","url":null,"abstract":"As utilization of home care increases across Canada, questions are emerging concerning the extent to which home care expenses, many of which are not publicly covered, are borne by unpaid caregivers of home care recipients. In this systematic review, we review English-language literature published between 2001 and 2022 exploring the magnitude and sources of home care costs incurred by unpaid caregivers in Canada. Of particular interest were empirical, cost-of-illness studies that describe the implications of these costs across domains of financial risk, including caregivers’ income level, employment status, and personal health. Following the screening of 492 studies derived across 6 databases (OVID Medline, CINAHL, PsycINFO, AMED, EconLit, and EMBASE), 24 studies were included in this review. Overall, few studies describe how home care expenses incurred by unpaid caregivers contribute to their financial risk. While some studies characterize the direct costs of caregiving incurred by caregivers, including out-of-pocket expenditure on transportation to medical appointments, respite care, home renovations, supplemental housekeeping, and prescription medications, limited studies attempt to estimate the magnitude of these expenses. Concerning financial risk, the literature is chiefly concerned with indirect costs of caregiving, including consequences on caregivers’ employment (foregone wages). Findings from this literature review suggest further work is needed in Canadian context to document costs associated with unpaid home care provision.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78508184","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 : 2023-04-17DOI: 10.1177/10848223231167878
C. Foster, L. Morales, Andrea J. Fawcett, Cara Coleman
Despite the rising prevalence of children with medical complexity who need extensive medical care at home, the literature evaluating pediatric home healthcare has not been well summarized. Our objective was to systematically review the evidence-base of pediatric home healthcare to understand what is currently know about access and quality of home healthcare for children. Pubmed, Ovid Medline, Embase, CINAHL, Cochrane Library, Proquest Dissertations and Theses Global were searched for studies in the United States, United Kingdom, Canada, and Australia English publications (1980-2020) regarding children (≤18 years) using shift-based home healthcare services. Blinded independent review was conducted followed by extraction of study characteristics including how each study examined access and/or quality, which was categorized using the National Academy of Medicine quality dimensions. Of 9533 abstracts, 101 were included. Most were US (82%) and regional (72%) studies. Half (54%) focused on home nursing followed by home services generally (43%). The majority (77%) evaluated access and patient-family centeredness (62%); their results identified consistent limitations in access and quality resulting in negative impacts on patients and families. Less than 20% of publications addressed safety, effectiveness or equity. Bias scoring found that quantitative studies were universally weak, but qualitative studies were mostly moderate or strong. Results are limited by design heterogeneity and exclusion of training research. While research in pediatric home healthcare has increased, studies remain observational and rarely evaluate quality in reproducible ways. More rigorous measures and interventional research are needed to improve this healthcare sector for children.
{"title":"Access and Quality of Pediatric Home Healthcare: A Systematic Review","authors":"C. Foster, L. Morales, Andrea J. Fawcett, Cara Coleman","doi":"10.1177/10848223231167878","DOIUrl":"https://doi.org/10.1177/10848223231167878","url":null,"abstract":"Despite the rising prevalence of children with medical complexity who need extensive medical care at home, the literature evaluating pediatric home healthcare has not been well summarized. Our objective was to systematically review the evidence-base of pediatric home healthcare to understand what is currently know about access and quality of home healthcare for children. Pubmed, Ovid Medline, Embase, CINAHL, Cochrane Library, Proquest Dissertations and Theses Global were searched for studies in the United States, United Kingdom, Canada, and Australia English publications (1980-2020) regarding children (≤18 years) using shift-based home healthcare services. Blinded independent review was conducted followed by extraction of study characteristics including how each study examined access and/or quality, which was categorized using the National Academy of Medicine quality dimensions. Of 9533 abstracts, 101 were included. Most were US (82%) and regional (72%) studies. Half (54%) focused on home nursing followed by home services generally (43%). The majority (77%) evaluated access and patient-family centeredness (62%); their results identified consistent limitations in access and quality resulting in negative impacts on patients and families. Less than 20% of publications addressed safety, effectiveness or equity. Bias scoring found that quantitative studies were universally weak, but qualitative studies were mostly moderate or strong. Results are limited by design heterogeneity and exclusion of training research. While research in pediatric home healthcare has increased, studies remain observational and rarely evaluate quality in reproducible ways. More rigorous measures and interventional research are needed to improve this healthcare sector for children.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88718908","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 : 2023-04-07DOI: 10.1177/10848223231166372
Brigitte Belanger, Olivia Weeks, Ashli Suiters, Paul Arthur
An emerging crisis of care exists in the United States in the treatment of aging adults with neurocognitive disorders (NCD). Families face great obstacles locating resources and finding appropriate caregiving options for their needs. Occupational therapy practitioners are well suited to assist both persons with NCD and their care partners through training and support services to promote safety and independence and maximize participation in activities of daily living. Occupational therapy practitioners increasingly employ Animal Assisted Therapy (AAT) programs with tailored activities to foster problem-solving skills to enhance performance and behavior, improving quality of life. This feasibility study employed mixed-methodology to establish a proof of concept by offering a series of six 90-minute AAT group intervention sessions with persons with NCD and care partners at an Alzheimer’s Resource Center in Florida. While quantitative results were not significant, many promising qualitative themes emerged to direct future inquiry in AAT interventions with this population.
{"title":"The Role of Animal-Assisted Therapy (AAT) in Neurocognitive Disorder Group Interventions: Benefits for Participants and Care Partners","authors":"Brigitte Belanger, Olivia Weeks, Ashli Suiters, Paul Arthur","doi":"10.1177/10848223231166372","DOIUrl":"https://doi.org/10.1177/10848223231166372","url":null,"abstract":"An emerging crisis of care exists in the United States in the treatment of aging adults with neurocognitive disorders (NCD). Families face great obstacles locating resources and finding appropriate caregiving options for their needs. Occupational therapy practitioners are well suited to assist both persons with NCD and their care partners through training and support services to promote safety and independence and maximize participation in activities of daily living. Occupational therapy practitioners increasingly employ Animal Assisted Therapy (AAT) programs with tailored activities to foster problem-solving skills to enhance performance and behavior, improving quality of life. This feasibility study employed mixed-methodology to establish a proof of concept by offering a series of six 90-minute AAT group intervention sessions with persons with NCD and care partners at an Alzheimer’s Resource Center in Florida. While quantitative results were not significant, many promising qualitative themes emerged to direct future inquiry in AAT interventions with this population.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42242815","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 : 2023-04-07DOI: 10.1177/10848223231165754
R. Saglam Aksut, Busra Yavuz, Mehmet Aksut, Deniz Gunay, M. Kırali
Heart transplantation is the most important treatment option in end-stage heart failure, and heart transplant recipients should be monitored at home by healthcare professionals in terms of symptoms and self-care requisites. The aim of this study is to examine symptoms and self-care requisites of patients with heart transplantation after discharge. Symptoms and self-care requisites of 81 patients who had heart transplantation between 2015 and 2020 were evaluated retrospectively in this study. Survey data were collected using the telephone interview method. It was determined that 77.8% of the patients were male and their mean age was 41.87 ± 2.51 years. Fatigue (91.4%), pain in the back, neck, and joints (86.4%), restlessness/agitation (81.5%), weight gain (71.6%), and edema in the lower extremities (71.6%) were the first 5 common symptoms experienced at home after heart transplantation. It was also found that the vast majority of patients (80.2%) answered negatively to the question of eliminating the lack of knowledge about the disease, and some of the patients were found not to pay attention to some important issues (e.g., regular blood pressure check, quitting smoking, etc.). Findings revealed that patients with heart transplantation experience a series of symptoms, and their self-care requisites were mostly focused on education and information specific to the disease after discharge. As a part of public health nursing practices, home care concentrating on symptoms and learning needs of patients should be planned and organized with a multidisciplinary approach to decrease rehospitalization and contribute to cost-effectiveness after heart transplantation.
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