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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 34 Research Studies DisplayedJones CD, Falvey J, Hess E
Predicting hospital readmissions from home healthcare in Medicare beneficiaries.
The authors used patient-level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee-for-service beneficiaries. They found that variables available to HHC clinicians at the first post-discharge HHC visit can predict readmission risk and inform care plans in HHC. They recommend that future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome.
AHRQ-funded; HS024569.
Citation: Jones CD, Falvey J, Hess E .
Predicting hospital readmissions from home healthcare in Medicare beneficiaries.
J Am Geriatr Soc 2019 Dec;67(12):2505-10. doi: 10.1111/jgs.16153..
Keywords: Home Healthcare, Hospital Readmissions, Medicare, Elderly, Transitions of Care
Kang Y, Taylor JO, Osterhage K
Home care nurses' perspectives regarding health information management among older adults.
The purpose of this qualitative study was to determine how home healthcare nurses (HCNs) obtain and provide health information, to describe the perspective of HCNs regarding older adult personal health information (PHI), and to identify the potential role of technology in older adult health information transfer. Researchers conducted and analyzed phone interviews with 17 HCNs from two home healthcare agencies. Results showed these five themes: 1) common practices of obtaining health information; 2) barriers to obtaining health information; 3) ideal ways to obtain and provide health information; 4) use of patient portals; and 5) HCNs' use of technology for health information exchange. Most HCNs reported that it would be difficult for older adult patients to update their PHI without assistance, but HCNs lack the time and resources to assist older adults in PHI management activities.
AHRQ-funded; HS022106.
Citation: Kang Y, Taylor JO, Osterhage K .
Home care nurses' perspectives regarding health information management among older adults.
Home Healthc Now 2019 Nov/Dec;37(6):319-27. doi: 10.1097/nhh.0000000000000796..
Keywords: Home Healthcare, Elderly, Health Information Technology (HIT), Provider: Nurse, Provider
Squires A, Miner S, Liang E
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. The objective of this study was to explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care.
AHRQ-funded; HS023593.
Citation: Squires A, Miner S, Liang E .
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Int J Nurs Stud 2019 Nov;99:103394. doi: 10.1016/j.ijnurstu.2019.103394..
Keywords: Home Healthcare, Cultural Competence, Communication, Provider, Healthcare Delivery
Popescu I, Sood N, Joshi S
Trends in the use of skilled nursing facility and home health care under the Hospital Readmissions Reduction Program: an interrupted time-series analysis.
Medicare's Hospital Readmission Reduction Program penalizes hospitals with elevated 30-day readmission rates for acute myocardial infarction, heart failure, or pneumonia. The authors investigated if, in order to reduce readmissions, hospitals may have increased referrals to skilled nursing facilities and home health care. They found that hospitals might be shifting to more intensive postacute care to avoid readmissions among seniors with pneumonia. At the same time, penalized hospitals' efforts to prevent readmissions may be keeping higher proportions of their patients in the community.
AHRQ-funded; HS024284; HS025394.
Citation: Popescu I, Sood N, Joshi S .
Trends in the use of skilled nursing facility and home health care under the Hospital Readmissions Reduction Program: an interrupted time-series analysis.
Med Care 2019 Oct;57(10):757-65. doi: 10.1097/mlr.0000000000001184..
Keywords: Home Healthcare, Nursing Homes, Chronic Conditions, Hospital Readmissions, Long-Term Care, Hospitals, Heart Disease and Health, Pneumonia, Cardiovascular Conditions
Sobotka SA, Lynch E, Quinn MT
Unmet respite needs of children with medical technology dependence.
Children with medical technology dependency (MTD) require a medical device to compensate for a vital body function and substantial nursing care. As such, they require constant high-level supervision. Respite care provides caregivers with a temporary break, and is associated with reduced stress; however, there are often barriers. The study utilizes mixed methodology with the National Survey of Children with Special Health Care Needs (NS-CSHCN) and semistructured interviews with state-wide care coordinators to understand the gap for respite care services.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Lynch E, Quinn MT .
Unmet respite needs of children with medical technology dependence.
Clin Pediatr 2019 Oct;58(11-12):1175-86. doi: 10.1177/0009922819870251..
Keywords: Children/Adolescents, Medical Devices, Disabilities, Caregiving, Home Healthcare, Care Coordination
Sobotka SA, Foster C, Lynch E
Attributable delay of discharge for children with long-term mechanical ventilation.
The purpose of this study was to assess the reasons for discharge delays for children with long-term mechanical ventilation. The investigators found that over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Foster C, Lynch E .
Attributable delay of discharge for children with long-term mechanical ventilation.
J Pediatr 2019 Sep;212:166-71. doi: 10.1016/j.jpeds.2019.04.034..
Keywords: Children/Adolescents, Respiratory Conditions, Hospital Discharge, Home Healthcare
Sockolow PS, Bass EJ, Ynag Y
Availability and quality of information used by nurses while admitting patients to a rural home health care agency.
This study investigated the availability and quality of information used by nurses in a rural home health care agency during patient admission. Twelve in-home admissions were observed and the nurses were interviewed before and after the admissions process. Content and quality of documents available to the nurses was analyzed and needed documents were not uniformly present. They rarely received visit pattern or medication management information. These results show the need for a high quality electronic health record system.
AHRQ-funded; HS024537.
Citation: Sockolow PS, Bass EJ, Ynag Y .
Availability and quality of information used by nurses while admitting patients to a rural home health care agency.
Stud Health Technol Inform 2019 Aug 21;264:798-802. doi: 10.3233/shti190333..
Keywords: Rural Health, Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Provider
Hale K, Ostbye T, Perera B
A novel adaptation of the HOME Inventory for Elders: the importance of the home environment across the life course.
This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Results indicated that elders are active household contributors who strive to achieve harmonious relations with co-resident kin. These findings reveal notable synergies between early- and late-life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.
AHRQ-funded; HS000032.
Citation: Hale K, Ostbye T, Perera B .
A novel adaptation of the HOME Inventory for Elders: the importance of the home environment across the life course.
Int J Environ Res Public Health 2019 Aug 8;16(16). doi: 10.3390/ijerph16162826..
Keywords: Elderly, Home Healthcare
Gorges RJ, Sanghavi P, Konetzka RT
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
The authors investigated the outcomes of expanding Medicaid funding for long-term care home and community-based services (HCBS). Using national Medicaid claims data on older adults enrolled in both Medicare and Medicaid, they found that overall hospitalization rates were similar for HCBS and nursing facility users. They concluded that home and community-based services need to be carefully targeted to avoid adverse outcomes and that the racial/ethnic disparities in access to high-quality institutional long-term care are also present in HCBS.
AHRQ-funded; HS000084.
Citation: Gorges RJ, Sanghavi P, Konetzka RT .
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
Health Aff 2019 Jul;38(7):1110-18. doi: 10.1377/hlthaff.2018.05409..
Keywords: Elderly, Medicaid, Medicare, Long-Term Care, Home Healthcare, Disparities, Racial and Ethnic Minorities
Chase JD, Russell D, Rice M
Caregivers' perceptions managing functional needs among older adults receiving post-acute home health care.
The researchers conducted telephone interviews to explore caregivers’ experiences managing physical functioning (PF) needs of older adults in the post-acute home health care setting. Caregivers depicted the enormity of caregiving tasks needed to manage older patients' PF needs and described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. The researchers conclude that their findings can guide nursing efforts to target caregiver training and support during the critical care transition period.
AHRQ-funded; HS022140.
Citation: Chase JD, Russell D, Rice M .
Caregivers' perceptions managing functional needs among older adults receiving post-acute home health care.
Res Gerontol Nurs 2019 Jul 1;12(4):174-83. doi: 10.3928/19404921-20190319-01..
Keywords: Caregiving, Elderly, Home Healthcare, Transitions of Care
Coe NB, Guo J, Konetzka RT
What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.
Research on home-based long-term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploited the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery. The investigators found that some family involvement in home-based care significantly decreased health-care utilization: lower likelihood of emergency room use, Medicaid-financed inpatient days, any Medicaid hospital expenditures, and fewer months with Medicaid-paid inpatient use.
AHRQ-authored.
Citation: Coe NB, Guo J, Konetzka RT .
What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.
Health Econ 2019 May;28(5):678-92. doi: 10.1002/hec.3873..
Keywords: Home Healthcare, Long-Term Care, Medicaid
Fraze TK, Beidler LB, Briggs ADM
'Eyes in the home': ACOs use home visits to improve care management, identify needs, and reduce hospital use.
Researchers used national survey data from physician practices and accountable care organizations (ACOs), paired with qualitative interviews, to learn about home visiting programs. They found that interviewed ACOs reported using home visits as part of care management and care transitions programs as well as to evaluate patients' home environments and identify needs, most often using nonphysician staff. Further, home visit implementation for some types of patients can be challenging because of barriers related to reimbursement, staffing, and resources.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
'Eyes in the home': ACOs use home visits to improve care management, identify needs, and reduce hospital use.
Health Aff 2019 Jun;38(6):1021-27. doi: 10.1377/hlthaff.2019.00003..
Keywords: Transitions of Care, Home Healthcare, Healthcare Delivery, Care Management
Burgdorf J, Roth DL, Riffin C
Factors associated with receipt of training among caregivers of older adults.
Emerging evidence suggests that support of family caregivers, including education and training, can improve health outcomes for caregivers and care recipients. In this paper, the authors examine whether caregiver characteristics are associated with receipt of training. The investigators found that 93% of older adults’ family caregivers did not report receiving role-related training.
AHRQ-funded; HS000029.
Citation: Burgdorf J, Roth DL, Riffin C .
Factors associated with receipt of training among caregivers of older adults.
JAMA Intern Med 2019 Jun;179(6):833-35. doi: 10.1001/jamainternmed.2018.8694.
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Keywords: Caregiving, Training, Education: Patient and Caregiver, Home Healthcare, Quality of Life, Elderly
Keller SC, Alexander M, Williams D
Perspectives on central-line-associated bloodstream infection surveillance in home infusion therapy.
This study examined in the differences between 3 professional society members who provide home infusion services in diagnosing and defining central-line-associated bloodstream infections (CLABSIs). The three societies surveyed were members of the Infusion Nurses Society (INS), the National Home Infusion Association (NHIA), and the Society for Healthcare Epidemiology of America Research Network (SRN). The INS is a 6000-member global organization of main nurses who work in all practice settings including home infusion. The NHIA is a 400-member trade organization focused on providing infusion products and services in the home, and SRN is a network of 111 healthcare institutions that collaborate on research to prevent healthcare-associated infections and antibiotic resistance. There was a difference in the criteria used for defining a CLABSI with home testing, and their use of the Association for Professionals in Infection Control/Healthcare Infection Control Practices Advisory Committee (APIC-HICPAC) criteria. Although some perspective was gained from a wide variety of professionals, there was a low response rate, which suggests the possibility of response bias.
AHRQ-funded; HS025782.
Citation: Keller SC, Alexander M, Williams D .
Perspectives on central-line-associated bloodstream infection surveillance in home infusion therapy.
Infect Control Hosp Epidemiol 2019 Jun;40(6):729-31. doi: 10.1017/ice.2019.90..
Keywords: Home Healthcare, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety
Fabius CD, Robison J
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examined the influence of these factors on living arrangements for 659 program participants age 65 or older.
AHRQ-funded; HS000011.
Citation: Fabius CD, Robison J .
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
J Appl Gerontol 2019 Apr;38(4):454-78. doi: 10.1177/0733464816687496..
Keywords: Elderly, Transitions of Care, Racial and Ethnic Minorities, Medicaid, Nursing Homes, Home Healthcare, Healthcare Delivery
Krah NM, Bardsley T, Nelson R
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. The objective of this study was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL). The investigators concluded that the overall burden of OPAT was substantially higher than that of oral therapy, including higher direct and indirect costs and greater impact on caregiver QoL.
AHRQ-funded; HS023320.
Citation: Krah NM, Bardsley T, Nelson R .
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
Hosp Pediatr 2019 Apr;9(4):234-40. doi: 10.1542/hpeds.201-0193.
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Keywords: Healthcare Costs, Children/Adolescents, Caregiving, Home Healthcare, Antimicrobial Stewardship, Antibiotics, Medication
Jones CD, Jones J, Bowles KH
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
The purpose of this study was to evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. The authors concluded that communication between hospitals and HHC was suboptimal, and patients were often not prepared to receive HHC. They suggest that providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
J Am Med Dir Assoc 2019 Apr;20(4):487-91. doi: 10.1016/j.jamda.2019.01.004..
Keywords: Transitions of Care, Home Healthcare, Hospital Discharge, Hospitals, Communication
Berry JG, Goodman DM, Coller RJ
Association of home respiratory equipment and supply use with health care resource utilization in children.
The purpose of this cohort study was to compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES). The investigators found that the use of RMES was associated with high health care spending, especially with hospital and home health care. They suggest that population health initiatives in children may benefit from consideration of RMES in comprehensive risk assessment for health care spending.
AHRQ-funded; HS02513.
Citation: Berry JG, Goodman DM, Coller RJ .
Association of home respiratory equipment and supply use with health care resource utilization in children.
J Pediatr 2019 Apr;207:169-75.e2. doi: 10.1016/j.jpeds.2018.11.046..
Keywords: Children/Adolescents, Healthcare Costs, Healthcare Utilization, Home Healthcare, Respiratory Conditions
Keller SC, Cosgrove SE, Kohut M
Hazards from physical attributes of the home environment among patients on outpatient parenteral antimicrobial therapy.
This study looked at hazards that patients undergoing outpatient parenteral antimicrobial therapy (OPAT) have to avoid while undergoing the treatment at home with a venous catheter. A qualitative study was conducted with patients discharged from 2 academic medical centers in Baltimore, Maryland. Hazards identified included bathing, pets, temperature extremes, household clutter, food and soil exposures and travel. Patients that were interviewed developed strategies to avoid these hazards.
AHRQ-funded; HS025782.
Citation: Keller SC, Cosgrove SE, Kohut M .
Hazards from physical attributes of the home environment among patients on outpatient parenteral antimicrobial therapy.
Am J Infect Control 2019 Apr;47(4):425-30. doi: 10.1016/j.ajic.2018.09.020..
Keywords: Home Healthcare, Infectious Diseases, Patient Safety, Prevention
Leeman H, Cosgrove SE, Williams D
Assessing burden of central line-associated bloodstream infections present on hospital admission.
Investigators described patients presenting to an academic medical center with central line-associated bloodstream infection present on hospital admission over 1 year. Of the 130 admissions, they found that about half presented from home infusion, followed by oncology clinic, hemodialysis, and skilled nursing facility. They concluded that efforts to reduce such infections should address patients across the entire health care system.
AHRQ-funded; HS025782.
Citation: Leeman H, Cosgrove SE, Williams D .
Assessing burden of central line-associated bloodstream infections present on hospital admission.
Am J Infect Control 2020 Feb;48(2):216-18. doi: 10.1016/j.ajic.2019.08.010..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitalization, Home Healthcare, Hospitals, Infectious Diseases
Jones CD, Jones J, Bowles KH
Patient, caregiver, and clinician perspectives on expectations for home healthcare after discharge: a qualitative case study.
The objective of this study was to evaluate and compare expectations for skilled home health care (HHC) from the patient, caregiver, and HHC perspectives after hospital discharge. Results showed that unclear expectations occurred when the patient and/or caregiver expectations were uncertain or misaligned with the services received; in most such cases, the patient and caregiver did not have prior experience with HHC. Recommendations to improve HHC transitions included actively engaging both patients and caregivers in the hospital and HHC settings to provide education about HHC services and assess and address additional care needs.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Patient, caregiver, and clinician perspectives on expectations for home healthcare after discharge: a qualitative case study.
J Hosp Med 2019 Feb;14(2):90-95. doi: 10.12788/jhm.3140..
Keywords: Caregiving, Health Services Research (HSR), Home Healthcare, Patient Experience, Provider, Provider: Clinician, Transitions of Care
Arbaje AI, Hughes A, Werner N
Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study.
The goal of this study was to identify information management (IM) process failures made during home health visits to middle-aged and older adults after hospital discharge. Communication risks included information overload, information underload, information scatter, information conflict, and erroneous information.
AHRQ-funded; HS022916.
Citation: Arbaje AI, Hughes A, Werner N .
Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study.
BMJ Qual Saf 2019 Feb;28(2):111-20. doi: 10.1136/bmjqs-2018-008163..
Keywords: Elderly, Home Healthcare, Hospital Discharge, Patient Safety, Transitions of Care
Jarrin OF, Pouladi FA, Madigan EA
International priorities for home care education, research, practice, and management: qualitative content analysis.
The purpose of this study was to articulate an international vision for the future of home care education, research, practice, and management shared by experienced home care nurses working in leadership roles. Four major themes emerged, in this qualitative study, reflecting international priorities for the future of home care education, research, practice, and management: 1) Build the evidence base for home care; 2) Design better systems of care; 3) Develop leaders at all levels; and 4) Address payment and policy issues.
AHRQ-funded; HS022406.
Citation: Jarrin OF, Pouladi FA, Madigan EA .
International priorities for home care education, research, practice, and management: qualitative content analysis.
Nurse Educ Today 2019 Feb;73:83-87. doi: 10.1016/j.nedt.2018.11.020..
Keywords: Education: Continuing Medical Education, Healthcare Delivery, Home Healthcare, Nursing, Provider
Knierim SD, Moore SL, Raghunath SG
Home visitations for delivering an early childhood obesity intervention in Denver: parent and patient navigator perspectives.
This qualitative study explored parent and patient navigator perspectives of home visitation as part of a childhood obesity program in a low-income, largely Latino population. The investigators concluded that a home visitation program delivering a pediatric obesity prevention curriculum in Denver was convenient and held families accountable, but posed scheduling difficulties and raised safety concerns.
AHRQ-funded; HS021138; HS022143.
Citation: Knierim SD, Moore SL, Raghunath SG .
Home visitations for delivering an early childhood obesity intervention in Denver: parent and patient navigator perspectives.
Matern Child Health J 2018 Nov;22(11):1589-97. doi: 10.1007/s10995-018-2553-7..
Keywords: Children/Adolescents, Home Healthcare, Low-Income, Obesity, Children/Adolescents, Racial and Ethnic Minorities
Yang Y, Bass EJ, Bowles KH
Impact of home care admission nurses' goals on electronic health record documentation strategies at the point of care.
The article reports on a study designed to investigate documentation strategies used by home care nurses with respect to entering electronic data during admission as well as the effect of nursing goals on the process. This was done to characterize admission nurses' practices at the point of care and to establish a basis for design recommendations for electronic health records (EHRs). Five nurses in rural Pennsylvania home care agencies were observed during the admission process. The results of the study lead the authors to recommend that EHR design and training should support the manner in which home care nurses document patient encounters.
AHRQ-funded; HS024537.
Citation: Yang Y, Bass EJ, Bowles KH .
Impact of home care admission nurses' goals on electronic health record documentation strategies at the point of care.
Comput Inform Nurs 2019 Jan;37(1):39-46. doi: 10.1097/cin.0000000000000468..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Home Healthcare, Nursing
