Pub Date : 2022-06-03DOI: 10.1177/10848223221099603
Hana Lee, Aeri Kim, Hyun-Hee Heo, Jisoo Lee, Kyungmi Woo
This study aimed to identify the characteristics of home health care (HHC) patients, main diagnoses, service type, home visit patterns, and primary caregiver type from a major tertiary hospital in South Korea to provide basic data for tailored nursing care. We used Electronic Health Records (EHRs) data of 1776 patients, from 2011 to 2020, from a premier tertiary hospital in South Korea and conducted secondary data analysis using descriptive statistics, a chi-squared test, and an independent samples t-test. Patients’ mean age (i.e., 50.9% men and 49.1% women) was 74.50 ± 15.48 years. Further, admission to HHC via the outpatient and inpatient department comprised 1047 (59.0%) and 729 patients (41.0%), respectively. Based on the Korean Standard Classification of Diseases, neoplasms (49.9%) were identified as the most common main diagnosis, followed by diseases of the nervous system (10.3%) and musculoskeletal system and connective tissue disease (6.2%). An average of 2.2 homecare nursing services were provided per visit, with lab sampling (43.9%), other intravenous injections (31.0%), and ventilator care (23.0%) being the most frequent services. The total HHC service period for patients via the outpatient department was 76.88 days longer (292.24 vs 215.36 days) than those from the inpatient department. Younger patients were cared for by parents and siblings and older patients by spouses, offspring, and formal caregivers. It is pivotal to identify general characteristics of HHC patients through long-term monitoring and retrospective analysis to provide high-quality and tailored interventions to them.
{"title":"Examining Characteristics and Service Utilization of South Korean Home Health Care Patients: Secondary Analysis of 10-Year Data From a Tertiary Hospital","authors":"Hana Lee, Aeri Kim, Hyun-Hee Heo, Jisoo Lee, Kyungmi Woo","doi":"10.1177/10848223221099603","DOIUrl":"https://doi.org/10.1177/10848223221099603","url":null,"abstract":"This study aimed to identify the characteristics of home health care (HHC) patients, main diagnoses, service type, home visit patterns, and primary caregiver type from a major tertiary hospital in South Korea to provide basic data for tailored nursing care. We used Electronic Health Records (EHRs) data of 1776 patients, from 2011 to 2020, from a premier tertiary hospital in South Korea and conducted secondary data analysis using descriptive statistics, a chi-squared test, and an independent samples t-test. Patients’ mean age (i.e., 50.9% men and 49.1% women) was 74.50 ± 15.48 years. Further, admission to HHC via the outpatient and inpatient department comprised 1047 (59.0%) and 729 patients (41.0%), respectively. Based on the Korean Standard Classification of Diseases, neoplasms (49.9%) were identified as the most common main diagnosis, followed by diseases of the nervous system (10.3%) and musculoskeletal system and connective tissue disease (6.2%). An average of 2.2 homecare nursing services were provided per visit, with lab sampling (43.9%), other intravenous injections (31.0%), and ventilator care (23.0%) being the most frequent services. The total HHC service period for patients via the outpatient department was 76.88 days longer (292.24 vs 215.36 days) than those from the inpatient department. Younger patients were cared for by parents and siblings and older patients by spouses, offspring, and formal caregivers. It is pivotal to identify general characteristics of HHC patients through long-term monitoring and retrospective analysis to provide high-quality and tailored interventions to them.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48074314","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 : 2022-06-03DOI: 10.1177/10848223221101194
S. Frye, Alison Bell
Heart failure is a chronic medical condition that requires lifelong self-management to optimize health. Self-management strategies include self-monitoring symptoms, managing medications, modifying the diet, and maintaining healthy activity levels. However, knowledge of self-management skills is insufficient; people with heart failure must develop self-efficacy in order to take action to improve their health. Self-management programs rely on group interaction to build self-efficacy, but specialized group interventions are inaccessible to individuals who are homebound. The purpose of this pilot study was to examine the feasibility of Heart Smart, a 5-week, virtual program to increase self-efficacy for heart failure self-management. Three participants were enrolled from a large academic home health system in the greater Philadelphia area. All 3 participants demonstrated improved scores on the Self-Efficacy for Managing Chronic Diseases 6-Item Scale. Two out of the 3 participants had clinically important gains on the Kansas City Cardiomyopathy Questionnaire. All 3 participants made gains on the Atlanta Heart Failure Knowledge Test. Participants were able to log in and access the virtual meeting platform effectively with minimal training. Participant satisfaction within the group was high. These pilot study results indicate the potential for positive self-management gains, and larger scale trials of the Heart Smart intervention are recommended.
{"title":"Heart Smart: A Virtual Self-Management Intervention for Homebound People With Heart Failure: A Pilot Study","authors":"S. Frye, Alison Bell","doi":"10.1177/10848223221101194","DOIUrl":"https://doi.org/10.1177/10848223221101194","url":null,"abstract":"Heart failure is a chronic medical condition that requires lifelong self-management to optimize health. Self-management strategies include self-monitoring symptoms, managing medications, modifying the diet, and maintaining healthy activity levels. However, knowledge of self-management skills is insufficient; people with heart failure must develop self-efficacy in order to take action to improve their health. Self-management programs rely on group interaction to build self-efficacy, but specialized group interventions are inaccessible to individuals who are homebound. The purpose of this pilot study was to examine the feasibility of Heart Smart, a 5-week, virtual program to increase self-efficacy for heart failure self-management. Three participants were enrolled from a large academic home health system in the greater Philadelphia area. All 3 participants demonstrated improved scores on the Self-Efficacy for Managing Chronic Diseases 6-Item Scale. Two out of the 3 participants had clinically important gains on the Kansas City Cardiomyopathy Questionnaire. All 3 participants made gains on the Atlanta Heart Failure Knowledge Test. Participants were able to log in and access the virtual meeting platform effectively with minimal training. Participant satisfaction within the group was high. These pilot study results indicate the potential for positive self-management gains, and larger scale trials of the Heart Smart intervention are recommended.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42927348","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 : 2022-05-04DOI: 10.1177/10848223221096344
H. Kim, Gwang Suk Kim, Hyangkyu Lee, Jiyeon Choi, Y. S. Kim, E. Oh
Patients on home ventilators rely on mechanical ventilation until their death; hence, family caregivers should perform additional caregiving, including tracheostomy, equipment management, and positive pressure ventilation by ambu-bag in emergencies. Therefore, a systematic discharge education program and evaluation of actual caregiver performance are necessary for safe home management. The program consists of suction and tracheostomy management, home ventilator management, emergency management, fundamental caregiving, and video material. To test clinical validity, family caregivers of patients about to be discharged to their homes from S hospital in Seoul, Korea, were selected by convenience sampling with a non-equivalent control group design. Of 18 participants, one refused, one died, and two became unstable after their agreement; therefore, 14 participants were finally included. To compare caregiving performance scores between the groups, we ran repeated measures ANOVA. Intergroup and period interaction of suction (F = 6.08, p = .001) and tracheostomy management (F = 3.00, p = .038) crucial for airway management, showed significant statistical differences. In short, the intervention group showed a faster increase in suction and tracheostomy management than the control group. Home ventilator management (F = 22.53, p < .001), emergency management (F = 12.01, p < .001), and fundamental caregiving (F = 7.88, p < .001) showed significant differences within the group regarding the period. According to the results of the clinical validity test, the discharge education program increased the family caregiver’s suction and tracheostomy management performance scores. Further research is needed to demonstrate long-term effects of the program with a larger sample.
{"title":"Effects of the Discharge Education Program on Family Caregivers Caring for Patients on Mechanical Home Ventilation in Korea: A Pilot Test","authors":"H. Kim, Gwang Suk Kim, Hyangkyu Lee, Jiyeon Choi, Y. S. Kim, E. Oh","doi":"10.1177/10848223221096344","DOIUrl":"https://doi.org/10.1177/10848223221096344","url":null,"abstract":"Patients on home ventilators rely on mechanical ventilation until their death; hence, family caregivers should perform additional caregiving, including tracheostomy, equipment management, and positive pressure ventilation by ambu-bag in emergencies. Therefore, a systematic discharge education program and evaluation of actual caregiver performance are necessary for safe home management. The program consists of suction and tracheostomy management, home ventilator management, emergency management, fundamental caregiving, and video material. To test clinical validity, family caregivers of patients about to be discharged to their homes from S hospital in Seoul, Korea, were selected by convenience sampling with a non-equivalent control group design. Of 18 participants, one refused, one died, and two became unstable after their agreement; therefore, 14 participants were finally included. To compare caregiving performance scores between the groups, we ran repeated measures ANOVA. Intergroup and period interaction of suction (F = 6.08, p = .001) and tracheostomy management (F = 3.00, p = .038) crucial for airway management, showed significant statistical differences. In short, the intervention group showed a faster increase in suction and tracheostomy management than the control group. Home ventilator management (F = 22.53, p < .001), emergency management (F = 12.01, p < .001), and fundamental caregiving (F = 7.88, p < .001) showed significant differences within the group regarding the period. According to the results of the clinical validity test, the discharge education program increased the family caregiver’s suction and tracheostomy management performance scores. Further research is needed to demonstrate long-term effects of the program with a larger sample.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41869987","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}
Covid 19 has made a huge difference in all aspects of life, especially in care and treatment. Hospitalization is limited because of infected family members and fear of getting Covid 19 has limited. The purpose of this study is to analyze the existing conditions based on the SWOT analysis for the home care program for children in Coronavirus crisis. This study is a qualitative study with a conventional content analysis approach. Participants were 18 nurses, physicians, and faculty members, selected based on their willingness to participate in the study and through purposeful sampling. Two specialized panels and 10 presence and in-presence interview sessions were held to collect data. Then, the data were analyzed using SWOT analysis. Four main categories were emerged of the study including: (a) need for a legal protocol, (b) mutual fear of Covid-19, (c) self-responsibility in Corona, and (d) team working approach in the program development. In addition, solutions based on the SWOT analytical were suggested. The results of the study showed that it is necessary to develop a formal protocol, along with self-responsibility, and a program based on the needs of the community and the Covid crisis incorporating the team opinion.
{"title":"Strengths, Weaknesses, Threats, and Opportunities a Pediatric Home Care Program in Covid 19 Virus Pandemic: A Qualitative Study","authors":"faramarz kalhor, Marzieh Adel Mehraban, Majied Keyvanfar, Zobeideh Behjeh, Mahboobeh Namnabati","doi":"10.1177/10848223221090674","DOIUrl":"https://doi.org/10.1177/10848223221090674","url":null,"abstract":"Covid 19 has made a huge difference in all aspects of life, especially in care and treatment. Hospitalization is limited because of infected family members and fear of getting Covid 19 has limited. The purpose of this study is to analyze the existing conditions based on the SWOT analysis for the home care program for children in Coronavirus crisis. This study is a qualitative study with a conventional content analysis approach. Participants were 18 nurses, physicians, and faculty members, selected based on their willingness to participate in the study and through purposeful sampling. Two specialized panels and 10 presence and in-presence interview sessions were held to collect data. Then, the data were analyzed using SWOT analysis. Four main categories were emerged of the study including: (a) need for a legal protocol, (b) mutual fear of Covid-19, (c) self-responsibility in Corona, and (d) team working approach in the program development. In addition, solutions based on the SWOT analytical were suggested. The results of the study showed that it is necessary to develop a formal protocol, along with self-responsibility, and a program based on the needs of the community and the Covid crisis incorporating the team opinion.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49468221","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 : 2022-03-18DOI: 10.1177/10848223221085992
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’ perceptions of the impact of the HMB’s financial structure on care planning and delivery decisions. 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 48 hospice nurses 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; appropriate patient selection allows hospices to maximize profit by maximizing length of stay (LOS) and minimizing service utilization; balancing patient care needs, cost, and LOS is a challenge; live discharge decisions save money, but can compromise care; the Interdisciplinary Team (IDT) is where most major decisions are made regarding patient care and finances; and money drives patient care decisions, regardless of ownership type.
{"title":"The Hospice Algorithm: Capitalizing on Death and Dying","authors":"W. Cabin","doi":"10.1177/10848223221085992","DOIUrl":"https://doi.org/10.1177/10848223221085992","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’ perceptions of the impact of the HMB’s financial structure on care planning and delivery decisions. 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 48 hospice nurses 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; appropriate patient selection allows hospices to maximize profit by maximizing length of stay (LOS) and minimizing service utilization; balancing patient care needs, cost, and LOS is a challenge; live discharge decisions save money, but can compromise care; the Interdisciplinary Team (IDT) is where most major decisions are made regarding patient care and finances; and money drives patient care decisions, regardless of ownership type.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45867351","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 : 2022-03-14DOI: 10.1177/10848223221085684
Halah Almulla, Dena S. Hassouneh
Aging populations and a rising disease burden have increased the need for palliative care (PC). Despite the growing demand for PC, only 14% of patients worldwide receive this service. Home-based PC is necessary because many people prefer to receive care and die at home. Nurses are well equipped to address diverse health care needs in the community and are critical to successful delivery of home-based PC. The purpose of this review is to synthesize and analyze literature relevant to home-based PC in Saudi Arabia with an emphasis on nursing. This purpose required us to examine literature in two areas: PC and home health care (HHC). We identified studies through database searches. We found 24 studies published between 2005 and 2021 that met quality and inclusion criteria. Although PC and HHC are associated with positive outcomes, lack of nurses’ knowledge and awareness of PC and the underdevelopment of HHC in Saudi Arabia have contributed to underuse of these services. Nurses are vital to the functioning of interdisciplinary teams and effective interfacing with patients, caregivers, and families. Education and training of nurses in Saudi Arabia is essential to promoting access to PC and HHC and the development of home-based PC in the kingdom.
{"title":"Home-Based Palliative Care and Home Health Care in Saudi Arabia: An Integrative Literature Review","authors":"Halah Almulla, Dena S. Hassouneh","doi":"10.1177/10848223221085684","DOIUrl":"https://doi.org/10.1177/10848223221085684","url":null,"abstract":"Aging populations and a rising disease burden have increased the need for palliative care (PC). Despite the growing demand for PC, only 14% of patients worldwide receive this service. Home-based PC is necessary because many people prefer to receive care and die at home. Nurses are well equipped to address diverse health care needs in the community and are critical to successful delivery of home-based PC. The purpose of this review is to synthesize and analyze literature relevant to home-based PC in Saudi Arabia with an emphasis on nursing. This purpose required us to examine literature in two areas: PC and home health care (HHC). We identified studies through database searches. We found 24 studies published between 2005 and 2021 that met quality and inclusion criteria. Although PC and HHC are associated with positive outcomes, lack of nurses’ knowledge and awareness of PC and the underdevelopment of HHC in Saudi Arabia have contributed to underuse of these services. Nurses are vital to the functioning of interdisciplinary teams and effective interfacing with patients, caregivers, and families. Education and training of nurses in Saudi Arabia is essential to promoting access to PC and HHC and the development of home-based PC in the kingdom.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48540027","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 : 2022-03-10DOI: 10.1177/10848223221082661
Chutima Phuaksaman, Watit Niyomkarn, Prapasri Somboon, W. Boonjindasup, S. Hantragool, S. Sritippayawan
Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.
{"title":"Long-term Outcomes of Pediatric Tracheostomy Home Care in a Limited Resource Setting of Professional Home Nurse","authors":"Chutima Phuaksaman, Watit Niyomkarn, Prapasri Somboon, W. Boonjindasup, S. Hantragool, S. Sritippayawan","doi":"10.1177/10848223221082661","DOIUrl":"https://doi.org/10.1177/10848223221082661","url":null,"abstract":"Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46044372","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 : 2022-03-10DOI: 10.1177/10848223221079630
Morris Hamilton, Mary Juergens, Qing Zheng, Elizabeth Campbell, M. Plotzke
The Bipartisan Budget Act (BBA) of 20181 created a temporary transitional payment (TTP) through Medicare Part B, which establishes fee-for-service (FFS) payment for eligible home infusion suppliers when they furnish home infusion therapy (HIT) service visits by skilled professionals in a beneficiary’s home on the day of HIT drug administration. Payment varies by 3 condition-specific payment categories. The Centers for Medicare & Medicaid Services (CMS) implemented the TTP on January 1, 2019. The TTP ended when the permanent HIT benefit began on January 1, 2021. To better understand how beneficiaries utilized this benefit during the TTP period, we examine trends in HIT services utilization between January 2019 and December 2020. Despite being new, the HIT benefit showed only a slight ramp-up phase, with a stable level of visits evolving over the remainder of 2019 and early 2020. Utilization decreased during the COVID-19 public health emergency, especially for infusion drugs related to heart failure and cancer. Additionally, relative to the geographic distribution of the Medicare FFS population, HIT service visit users are concentrated in the mid-Atlantic states. HIT service visit users are more likely to be young, white or black, and urban dwelling, compared to the general Medicare FFS beneficiaries.
{"title":"Home Infusion Therapy: Utilization Under the Medicare Part B Temporary Transitional Payment","authors":"Morris Hamilton, Mary Juergens, Qing Zheng, Elizabeth Campbell, M. Plotzke","doi":"10.1177/10848223221079630","DOIUrl":"https://doi.org/10.1177/10848223221079630","url":null,"abstract":"The Bipartisan Budget Act (BBA) of 20181 created a temporary transitional payment (TTP) through Medicare Part B, which establishes fee-for-service (FFS) payment for eligible home infusion suppliers when they furnish home infusion therapy (HIT) service visits by skilled professionals in a beneficiary’s home on the day of HIT drug administration. Payment varies by 3 condition-specific payment categories. The Centers for Medicare & Medicaid Services (CMS) implemented the TTP on January 1, 2019. The TTP ended when the permanent HIT benefit began on January 1, 2021. To better understand how beneficiaries utilized this benefit during the TTP period, we examine trends in HIT services utilization between January 2019 and December 2020. Despite being new, the HIT benefit showed only a slight ramp-up phase, with a stable level of visits evolving over the remainder of 2019 and early 2020. Utilization decreased during the COVID-19 public health emergency, especially for infusion drugs related to heart failure and cancer. Additionally, relative to the geographic distribution of the Medicare FFS population, HIT service visit users are concentrated in the mid-Atlantic states. HIT service visit users are more likely to be young, white or black, and urban dwelling, compared to the general Medicare FFS beneficiaries.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47926615","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 : 2022-03-03DOI: 10.1177/10848223221082660
Sharon E. Bigger, L. Glenn
Advance care planning (ACP) is a conversation about values, future treatment choices, and designation of a surrogate decision-maker, held in advance of a health crisis. ACP protocols are established by home health agencies (HHAs) to support the staff in talking about patients’ future treatment choices, which can include opting against acute care use. In 2016, Medicare implemented an experimental incentive program called Home Health Value-Based Purchasing (HHVBP) in 9 regionally representative states. These agencies were required to compete on value, where reimbursement rates were tied to outcomes in a Total Performance Score (TPS). With home health’s aim of avoiding unplanned acute care use, in-patient hospitalization was weighted the heaviest as a poor outcome, followed by emergency department (ED) use. The purpose of this quasi-interventional study was to determine the relationship between advance care planning protocols and ED use among HHAs in the U. S. by the status of participation HHVBP intervention group. The Advance Care Planning Protocol (ACPP) score was measured by scoring survey questions. Our findings show (1) ACPP score intensity was higher in states that participated in the HHVBP program; (2) high measurement reliability for the ACPP scores; (3) no significant relationship between ACPP and ED use overall; but (4) the relationship between ACPP intensity and ED use was equal-and-opposite for the HHVBP and non-HHVBP groups. These findings suggest that the HHVBP intervention altered the influence of ACPP intensity on ED use. Recommendations are made for the HHVBP program regarding ACP’s role in goal-concordant care.
{"title":"Emergency Department Use and Advance Care Planning in Home Health Value-Based Purchasing","authors":"Sharon E. Bigger, L. Glenn","doi":"10.1177/10848223221082660","DOIUrl":"https://doi.org/10.1177/10848223221082660","url":null,"abstract":"Advance care planning (ACP) is a conversation about values, future treatment choices, and designation of a surrogate decision-maker, held in advance of a health crisis. ACP protocols are established by home health agencies (HHAs) to support the staff in talking about patients’ future treatment choices, which can include opting against acute care use. In 2016, Medicare implemented an experimental incentive program called Home Health Value-Based Purchasing (HHVBP) in 9 regionally representative states. These agencies were required to compete on value, where reimbursement rates were tied to outcomes in a Total Performance Score (TPS). With home health’s aim of avoiding unplanned acute care use, in-patient hospitalization was weighted the heaviest as a poor outcome, followed by emergency department (ED) use. The purpose of this quasi-interventional study was to determine the relationship between advance care planning protocols and ED use among HHAs in the U. S. by the status of participation HHVBP intervention group. The Advance Care Planning Protocol (ACPP) score was measured by scoring survey questions. Our findings show (1) ACPP score intensity was higher in states that participated in the HHVBP program; (2) high measurement reliability for the ACPP scores; (3) no significant relationship between ACPP and ED use overall; but (4) the relationship between ACPP intensity and ED use was equal-and-opposite for the HHVBP and non-HHVBP groups. These findings suggest that the HHVBP intervention altered the influence of ACPP intensity on ED use. Recommendations are made for the HHVBP program regarding ACP’s role in goal-concordant care.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48416551","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 : 2022-02-08DOI: 10.1177/10848223221078581
J. Daniel, K. Little
To conduct a home-visit program for nursing students, to improve student confidence and comfort completing home visits in the underserved region of Southside, Virginia. The project was conducted in a rural community, where 24 nursing students and 1 family nurse practitioner made home visits once a week from September to December 2020. Students were evaluated on both their understanding of community health nursing and home-visit comfort levels via an anonymous pre- and post-home-visit assessment. Thirteen of the twenty-four students (54%) completed both the pre- and post-surveys. Results of the paired sample t-tests showed a significant increase in students’ comfort level from before the visit (3.0769) to after the visit (3.3077, p = .005). Students’ confidence levels also increased from before the visit (2.6923) to after the visit (3.3846, p = .006). Nursing educators are challenged to provide nursing students with the knowledge and skills needed to provide competent and compassionate evidence-based care in the field. Nursing student reported confidence in their nursing skills in the field after completing the home visit. Future research is needed on the benefit of completing home visits in nursing education programs.
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