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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 134 Research Studies Displayed
Squires A, Engel P, Ma C
Continuity of care versus language concordance as an intervention to reduce hospital readmissions from home health care.
The purpose of this study was to examine the relative effectiveness of continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. Participants included over 22,000 non-English-speaking patients from the New York City area who were admitted to their home health site following hospital discharge. Findings revealed that high continuity of care and high language concordance significantly decreased readmissions, along with high continuity of care and low language concordance; low continuity of care and high language concordance did not significantly impact readmissions. The authors concluded that enhancing continuity of care for those with language barriers the US home health system may help to address disparities and reduce hospital readmission rates.
Citation: Squires A, Engel P, Ma C . Continuity of care versus language concordance as an intervention to reduce hospital readmissions from home health care. Med Care 2023 Sep; 61(9):605-10. doi: 10.1097/mlr.0000000000001884..
Keywords: Hospital Readmissions, Transitions of Care, Home Healthcare
Oladapo-Shittu O, Hannum SM, Salinas AB
The need to expand the infection prevention workforce in home infusion therapy.
This study looked at the prevalence of formal surveillance and infection prevention training for home infusion staff. The authors interviewed home infusion staff who perform surveillance activities about barriers to and facilitators for central line-associated bloodstream infection (CLABSI) surveillance and identified barriers to training in CLABSI surveillance. Their findings showed a lack of formal surveillance training which can be addressed by by adapting existing training resources to the home infusion setting.
Citation: Oladapo-Shittu O, Hannum SM, Salinas AB . The need to expand the infection prevention workforce in home infusion therapy. Am J Infect Control 2023 May; 51(5):594-96. doi: 10.1016/j.ajic.2022.11.008.AHRQ-funded; HS027819..
Keywords: Healthcare-Associated Infections (HAIs), Prevention, Home Healthcare, Central Line-Associated Bloodstream Infections (CLABSI)
Hobensack M, Song J, Chae S
Capturing concerns about patient deterioration in narrative documentation in home healthcare.
This study aimed to build machine learning algorithms to identify “concerning” narrative notes of home healthcare (HHC) patients and identify emergency themes to support early identification of patients at risk for deterioration. Six algorithms were applied to 4000 narrative notes from a HHC agency to classify notes as either "concerning" or "not concerning." Emerging themes were identified using Latent Dirichlet Allocation bag of words topic modeling. Emerging themes of concern included patient-clinician communication, HHC services provided, gait challenges, mobility concerns, wounds, and caregivers. Most of these themes had already been identified in previous literature as increasing risk for adverse events.
Citation: Hobensack M, Song J, Chae S . Capturing concerns about patient deterioration in narrative documentation in home healthcare. AMIA Annu Symp Proc 2023 Apr 29; 2022:552-59..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Hobensack M, Song J, Scharp D
Machine learning applied to electronic health record data in home healthcare: a scoping review.
This literature review aimed to synthesize and appraise the literature describing the application of machine learning to predict adverse outcomes (e.g., hospitalization, mortality) using electronic health record (EHR) data in the home healthcare (HHC) setting. The secondary aim was to evaluate the comprehensiveness of predictors used in the machine learning algorithms guided by the Biopsychosocial Model. Studies were included if they 1) described services provided in the HHC setting, 2) applied machine learning algorithms to predict adverse outcomes, defined as outcomes related to patient deterioration, 3) used EHR data and, 4) focused on the adult population. Predictors were mapped to the Biopsychosocial Model. The final sample included 20 studies, of which 18 used predictors from standardized assessments integrated in the EHR. The most common outcome was hospitalization (55%), followed by mortality (25%). About 35% of studies excluded psychological predictors. Most studies (75%) demonstrated high or unclear risk of bias with tree based algorithms most frequently applied (75%).
Citation: Hobensack M, Song J, Scharp D . Machine learning applied to electronic health record data in home healthcare: a scoping review. Int J Med Inform 2023 Feb; 170:104978. doi: 10.1016/j.ijmedinf.2022.104978..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Song J, Chae S, Bowles KH
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
The purpose of this retrospective cohort study was to identify risk factor clusters in home health care and assess whether the clusters are related with hospitalizations or emergency department visits. The researchers included 61,454 patients associated with 79,079 episodes receiving home health care from one of the largest home health care organizations in the U.S. The study found that a total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Three clusters were formed by the risk factors: 1) Cluster 1- a combination of risk factors related to situations where patients may experience increased pain ("impaired physical comfort with pain"). 2) Cluster 2 - characterized by multiple comorbidities or other risks for hospitalization (e.g., prior falls, called "high comorbidity burden"). 3) Cluster 3 - "impaired cognitive/psychological and skin integrity" which includes dementia or skin ulcer. The risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 when compared to cluster 1. The study concluded that Varying combinations of risk factors affected the likelihood of negative outcomes.
Citation: Song J, Chae S, Bowles KH . The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care. J Adv Nurs 2023 Feb; 79(2):593-604. doi: 10.1111/jan.15498..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Duan KI, Wong ES, Liao JM
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
The purpose of this study was to explore how respiratory durable medical equipment (DME) supply has changed since Medicare implemented the Competitive Bidding Program (CBP) in 2011and increased the scale of the program nationally in 2013 and 2016. The researchers analyzed all publicly available nationwide Medicare DME data from 2013 to 2019 and analyzed all respiratory DME included in the CBP (excluding accessories such as masks, tubing, and filters). The researchers found that the three highest-volume respiratory DME products were stationary oxygen concentrators, continuous positive airway pressure (CPAP) devices, and gaseous portable oxygen. Decreases in suppliers across all items and increases in claims per supplier for the majority of items suggest greater market concentration of respiratory DME suppliers for Medicare beneficiaries. Even as the Medicare population expanded by 2.6% between 2013 and 2019, the number of patients receiving home oxygen decreased, results that could represent reduced access to home oxygen DME. Finally, in contrast to declines in use for most home oxygen items, the percentage of Medicare beneficiaries using portable oxygen concentrators and CPAP devices increased significantly. The researchers conclude that this analysis addresses a critical knowledge gap and highlights the need for future work evaluating how policies such as the CBP affect respiratory DME access and outcomes.
Citation: Duan KI, Wong ES, Liao JM . Long-term trends in home respiratory medical equipment among U.S. Medicare patients. Am J Respir Crit Care Med 2022 Aug 15;206(4):509-11. doi: 10.1164/rccm.202202-0238LE..
Keywords: Home Healthcare, Medicare, Respiratory Conditions
Lee JL, Gustavson AM, Kian L
Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
This research letter discusses the development process for cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations. These collaborations are proposed between health, social, and academic research systems. The authors collaborated with their local Houston Meals on Wheels (MOW) program, the University of Texas Health Science Center at Houston, and the Harris County Health System. These organizations formed a Healthy Aging Committee with several healthcare professionals from different healthcare systems participating as volunteers. The goal of the Committee was to identify ways to highlight the potential benefits of nutritious meal delivery. The three institutions worked together through all stages of research, from grant writing to recruiting participants, establishing trust in their relationships, and leveraging their connections and expertise in different areas. In their first research project, they investigated the addition of a home-based exercise program with enhanced meal deliveries to improve frailty status in older adults who were frail and homebound. This pilot study had been stopped during the pandemic. The restarted study was revised so that the MOW drivers delivering frozen and shelf-stable meals in person once a week would now also provide exercise handouts for those in the treatment group to minimize face-to-face contact. Their current second research project is evaluating whether the combination of a virtual assistant device such as Amazon Alexa with meal delivery can improve mental health for homebound older adults with cognitive impairment.
Citation: Lee JL, Gustavson AM, Kian L . Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations. J Am Geriatr Soc 2022 Jul; 70(7):1939-41. doi: 10.1111/jgs.17813..
Keywords: Elderly, Home Healthcare, Vulnerable Populations, Public Health
Hobensack M, Ojo M, Barrón Y
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
The objectives of this study were to identify risk factors that home healthcare clinicians associate with patient deterioration and to understand clinicians’ response to and documentation of these risk factors. The authors interviewed multidisciplinary home healthcare clinicians and used directed content analysis to identify risk factors for deterioration. A total of 79 risk factors were identified by the clinicians, who responded most often by communicating with the prescribing provider or following up with patients and caregivers. Clinicians also acknowledged that social factors played a role in deterioration risk. The authors noted that, since most risk factors were documented in clinical notes, methods such as natural language processing are needed to extract them. They concluded that by providing a comprehensive list of risk factors grounded in clinician expertise and mapped to standardized terminologies, the results of their study supported the development of an early warning system for patient deterioration.
Citation: Hobensack M, Ojo M, Barrón Y . Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians. J Am Med Inform Assoc 2022 Apr 13;29(5):805-12. doi: 10.1093/jamia/ocac023..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Home Healthcare, Risk, Hospitalization
Wang J, Ying M, Li Y
Home health agencies with more socially vulnerable patients have poorer experience of care ratings.
The purpose of this study was to evaluate the relationship between Medicare dual eligibility and race/ ethnicity when exploring Medicare-certified Home Health Agencies (CHHAs) and experience of care ratings. The researchers analyzed the 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs and found that CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings. In addition, CHHAs with higher proportions of racial/ ethnic minorities were less likely to have high experience of care ratings in the domains of care delivery, communication, and specific care issues.
Citation: Wang J, Ying M, Li Y . Home health agencies with more socially vulnerable patients have poorer experience of care ratings. J Appl Gerontol 2022 Mar;41(3):661-70. doi: 10.1177/07334648211053859..
Keywords: Elderly, Home Healthcare, Vulnerable Populations, Provider Performance
Schwartz ML, Rahman M, Thomas KS
Consumer selection and home health agency quality and patient experience stars.
The objective of this study was to compare the impact of the introduction of two distinct sets of star ratings, quality of care, and patient experience, on home health agency (HHA) selection. The investigators concluded that the introduction of quality of care and patient experience stars were associated with changes in HHA selection; however, the strength of these relationships was weaker than observed in other health care settings where a single star rating was reported.
Citation: Schwartz ML, Rahman M, Thomas KS . Consumer selection and home health agency quality and patient experience stars. Health Serv Res 2022 Feb;57(1):113-24. doi: 10.1111/1475-6773.13867..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Home Healthcare, Patient Experience, Quality Measures, Quality of Care, Provider Performance, Quality Indicators (QIs)
Bryant KB, Green MB, Shimbo D
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
This analysis examined how historical use of home blood pressure monitoring (HBPM) aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis and how HBPM use varies by patient characteristics. A cohort of 7185 adults aged 20 years or older without a diagnosis of hypertension or antihypertensive medication use and a high office BP (≥130/80 mm Hg) who participated in the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014 cycle were included. Participants who answered as having self-initiated or physician recommended HBPM were categorized as having used or having been told to use HBPM. The authors estimate that 31.4 million US adults did not have diagnosed hypertension, were not taking antihypertensive medications, and had an office BP ≥130/80 mm Hg. Out of that population, 95.3% would have met criteria to undergo out-of-office BP monitoring by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Only 3.6% (1.1 million) were told to use HBPM, and 15.7% had used HPBM. There were no differences in use by race/ethnicity, sex, health insurance status, or source of routine healthcare. The authors suggest the use of a telemonitoring system to improve ease of HBPM.
Citation: Bryant KB, Green MB, Shimbo D . Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go. Hypertension 2022 Feb;79(2):e15-e17. doi: 10.1161/hypertensionaha.121.18463..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Home Healthcare, Guidelines, Evidence-Based Practice
Squires A, Ma C, Miner S
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. The objective of this retrospective cross-sectional study was to determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.
Citation: Squires A, Ma C, Miner S . Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis. Int J Nurs Stud 2022 Jan;125:104093. doi: 10.1016/j.ijnurstu.2021.104093..
Keywords: Cultural Competence, Home Healthcare, Hospital Readmissions, Risk, Communication
Ma C, McDonald MV, Feldman PH
Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia.
The objective of this retrospective cohort study was to examine the association between continuity of nursing care in home health care (HHC) and rehospitalization among persons with dementia (PWD). Multiple years of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency was used. Findings showed that wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
Citation: Ma C, McDonald MV, Feldman PH . Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia. Med Care 2021 Oct;59(10):913-20. doi: 10.1097/mlr.0000000000001599..
Keywords: Elderly, Home Healthcare, Dementia, Neurological Disorders, Hospital Readmissions
Song J, Woo K, Shang J
Predictive risk models for wound infection-related hospitalization or ED visits in home health care using machine-learning algorithms.
Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, in this paper, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC.
Citation: Song J, Woo K, Shang J . Predictive risk models for wound infection-related hospitalization or ED visits in home health care using machine-learning algorithms. Adv Skin Wound Care 2021 Aug;34(8):1-12. doi: 10.1097/01.Asw.0000755928.30524.22..
Keywords: Home Healthcare, Injuries and Wounds, Risk, Hospitalization
Russell D, Burgdorf JG, Kramer C
Family caregivers' conceptions of trust in home health care providers.
Trust is important to family caregivers of older adults receiving home health care (HHC). Caregivers rely extensively on nurses, home health aides, and other providers to manage complex care tasks. The current study examined how family caregivers conceived of trust in HHC providers. The investigators found that caregivers' conceptions of trust in providers were affected by interpersonal aspects of their interactions with providers as well as the broader systems of care within which they participate.
Citation: Russell D, Burgdorf JG, Kramer C . Family caregivers' conceptions of trust in home health care providers. Res Gerontol Nurs 2021 Jul-Aug;14(4):200-10. doi: 10.3928/19404921-20210526-01..
Keywords: Elderly, Home Healthcare, Caregiving
Burgdorf JG, Arbaje AI, Stuart EA
Unmet family caregiver training needs associated with acute care utilization during home health care.
This study estimated the proportion of family caregivers assisting Medicare home health patients who have unmet training needs and its’ potential impact on older adults’ risk of acute care utilization. Linked data from the National Health and Aging Trends Study, Outcome and Assessment Information Set (OASIS), Medicare Provider of Services file, and Medicare claims data from 2011 to 2016 were used. Rates of unmet training needs varied from 8.2% of family caregivers assisting with household chores and 16% assisting with self-care tasks. After controlling for older adult and home health provider characteristics, older adults with family caregivers who had unmet training needs were twice as likely to incur acute care utilization during their home health episode.
Citation: Burgdorf JG, Arbaje AI, Stuart EA . Unmet family caregiver training needs associated with acute care utilization during home health care. J Am Geriatr Soc 2021 Jul;69(7):1887-95. doi: 10.1111/jgs.17138..
Keywords: Caregiving, Home Healthcare, Elderly, Healthcare Utilization, Training
Adams V, Song J, Shang J
Infection prevention and control practices in the home environment: examining enablers and barriers to adherence among home health care nurses.
This study’s aim was to examine the impact of individual, home environment, and organization factors on Infection Prevention and Control (IPC) practices in home health care. A survey of 350 nurses across two large home care agencies was conducted to examine the relationship between IPC adherence and these factors. Multiple barriers to IPC practices in patients’ homes were reported including clutter (74.5%), and a dirty environment (70.3%). They also reported limited availability of some IPC supplies including personal protective equipment.
Citation: Adams V, Song J, Shang J . Infection prevention and control practices in the home environment: examining enablers and barriers to adherence among home health care nurses. Am J Infect Control 2021 Jun;49(6):721-26. doi: 10.1016/j.ajic.2020.10.021..
Keywords: Home Healthcare, Community-Acquired Infections, Infectious Diseases, Prevention, Provider: Nurse, Provider
Smith JM, Lin H, Thomas-Hawkins C
Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity.
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015.
Citation: Smith JM, Lin H, Thomas-Hawkins C . Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity. Int J Environ Res Public Health 2021 May 25;18(11). doi: 10.3390/ijerph18115623..
Keywords: Elderly, Home Healthcare, Hospital Readmissions, Medicare, Diabetes, Chronic Conditions, Racial and Ethnic Minorities
Wang J, Ying M, Temkin-Greener H
Care-partner support and hospitalization in assisted living during transitional home health care.
This study examined the impact of care-partner support on outcomes among assisted living (AL) residents. Variation in care-partner and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services was investigated. Analysis of national data from various databases was used and a total of 741,926 participants were identified with Medicare HH admissions in 2017. Care-partner support during the HH admission was measured in seven domains: activity of daily living (ADLs), instrumental activities of ADLs), medication administration, treatment, medical equipment, home safety, and transportation. Care-partner support was categorized as assistance not needed, care-partner currently providing assistance, care-partner needs additional training/support to provide assistance, and care-partner is unavailable/unlikely to provide assistance. Among the cohort, inadequate care-partner support was identified for all seven domains ranging from 13.1% for transportation to 49.8% for treatment and was unavailable for 0.9% for transportation to 11.0% for treatment. Having inadequate or unavailable care-partner support was related to increased risk of hospitalization by 8.9% for treatment to 41.3% for medication administration.
Citation: Wang J, Ying M, Temkin-Greener H . Care-partner support and hospitalization in assisted living during transitional home health care. J Am Geriatr Soc 2021 May;69(5):1231-39. doi: 10.1111/jgs.17005..
Keywords: Elderly, Transitions of Care, Caregiving, Hospitalization, Home Healthcare, Long-Term Care
Champion C, Sockolow PS, Bowles KH
Getting to complete and accurate medication lists during the transition to home health care.
This observational field study looked at the work that home health care (HHC) admissions nurses complete related to medication reconciliation tasks, explored the impact of shared electronic medication data (interoperability), and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies. Three diverse Pennsylvania HHC agencies participated, with each using different electronic health record systems. Six nurses per site admitted 2 patients each (36 patients total) and their tasks were examined in depth. Medication reconciliation tasks included changes in number of medications and change types and calls to the health provider (doctor or pharmacy) to resolve medication-related issues. A high percentage of patients used multiple medications (more than 12 medications on average), and were high-risk (on average more than 8 medications per patient). Medication reconciliation decreased the number of prescriptions between pre- and post-reconciliation for 91% of patients with 41% of the medications requiring changes. Two-thirds of the nurses called a provider to facilitate medication changes. Interoperability reduced the number of changes required but did not eliminate changes or calls to providers.
AHRQ-funded; R01 HS024537.
Citation: Champion C, Sockolow PS, Bowles KH . Getting to complete and accurate medication lists during the transition to home health care. J Am Med Dir Assoc 2021 May;22(5):1003-08. doi: 10.1016/j.jamda.2020.06.024..
Keywords: Medication, Medication: Safety, Transitions of Care, Home Healthcare, Patient Safety
Woo K, Adams V, Wilson P
Identifying urinary tract infection-related information in home care nursing notes.
Urinary tract infection (UTI) is common in home care but not easily captured with standard assessment. This study aimed to examine the value of nursing notes in detecting UTI signs and symptoms in home care. The investigators found that information in nursing notes was often overlooked by stakeholders and not integrated into predictive modeling for decision-making support. They indicate that their findings highlighted the value of nursing notes in early risk identification and care guidance.
AHRQ-funded; R01 HS024723.
Citation: Woo K, Adams V, Wilson P . Identifying urinary tract infection-related information in home care nursing notes. J Am Med Dir Assoc 2021 May;22(5):1015-21.e2. doi: 10.1016/j.jamda.2020.12.010..
Keywords: Urinary Tract Infection (UTI), Home Healthcare, Diagnostic Safety and Quality
Russell D, Dowding D, Trifilio M
Individual, social, and environmental factors for infection risk among home healthcare patients: a multi-method study.
This paper is a study of nurse perceptions of individual, social, and environmental factors for infection risk among home healthcare (HHC) patients and also identifies the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 from qualitative interviews with 50 HHC nurses and structured observations of nurse visits to patients’ homes (n = 400). Perceived infection risk among patients was characterized as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Frequent environmental barriers observed during visits to patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%).
Citation: Russell D, Dowding D, Trifilio M . Individual, social, and environmental factors for infection risk among home healthcare patients: a multi-method study. Health Soc Care Community 2021 May;29(3):780-88. doi: 10.1111/hsc.13321..
Keywords: Home Healthcare, Community-Acquired Infections, Risk, Provider: Nurse, Provider
McDonald MV, Brickner C, Russell D
Observation of hand hygiene practices in home health care.
The purpose of this observational study was to describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits. The investigators concluded that hand hygiene adherence in HHC was suboptimal, with rates mirroring those reported in hospital and outpatient settings.
Citation: McDonald MV, Brickner C, Russell D . Observation of hand hygiene practices in home health care. J Am Med Dir Assoc 2021 May;22(5):1029-34. doi: 10.1016/j.jamda.2020.07.031..
Keywords: Home Healthcare, Nursing, Provider: Nurse, Provider, Prevention, Healthcare-Associated Infections (HAIs), Guidelines
Sockolow PS, Bowles KH, Le NB
There's a problem with the problem list: incongruence of patient problem information across the home care admission.
The purpose of this observational field study was to illustrate patterns of patient problem information received and documented across the home health care (HHC) admission process and offer practice, policy, and health information technology recommendations to improve information transfer. The investigators concluded that diagnosis or problem information transferred from the referral source or gathered during an in-home assessment did not appear in the plan of care. Because of the EHR structure, clinicians could not identify inactive problem or problem priority.
Citation: Sockolow PS, Bowles KH, Le NB . There's a problem with the problem list: incongruence of patient problem information across the home care admission. J Am Med Dir Assoc 2021 May;22(5):1009-14. doi: 10.1016/j.jamda.2020.06.032..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
Citation: Reistetter TA, Eschbach K K, Prochaska J . Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping. Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care