National Healthcare Quality and Disparities Report
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Topics
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Care Coordination (2)
- Caregiving (1)
- Care Management (1)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Clinician-Patient Communication (1)
- Comparative Effectiveness (2)
- Critical Care (1)
- Cultural Competence (1)
- Diagnostic Safety and Quality (1)
- Disparities (1)
- Elderly (8)
- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (1)
- Falls (1)
- Healthcare Costs (3)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (2)
- Health Services Research (HSR) (1)
- Heart Disease and Health (2)
- (-) Home Healthcare (22)
- Hospital Discharge (3)
- Hospitalization (1)
- Hospital Readmissions (1)
- Implementation (1)
- Long-Term Care (2)
- Medical Devices (2)
- Medicare (3)
- Medication (2)
- Neurological Disorders (1)
- Nursing Homes (1)
- Nutrition (1)
- Pain (2)
- Palliative Care (3)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient Experience (1)
- Patient Safety (2)
- Patient Self-Management (3)
- Payment (1)
- Policy (1)
- Practice Patterns (1)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Transitions of Care (2)
- Urban Health (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedWang Y, Spatz ES, Tariq M
Home health agency performance in the United States: 2011-15.
This review’s evaluation of home health agency quality performance included 11,462 Medicare-certified home health agencies that served 92.4 percent of all ZIP codes nationwide, accounting for 315.2 million people. It found that home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance.
AHRQ-funded; HS023000.
Citation: Wang Y, Spatz ES, Tariq M .
Home health agency performance in the United States: 2011-15.
J Am Geriatr Soc 2017 Dec;65(12):2572-79. doi: 10.1111/jgs.14987.
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Keywords: Quality of Care, Home Healthcare, Quality Indicators (QIs), Quality Measures
Werner NE, Malkana S, Gurses AP
Toward a process-level view of distributed healthcare tasks: medication management as a case study.
Researchers aimed to highlight the importance of using a process-level view in analyzing distributed healthcare tasks through a case study analysis of medication management (MM). Their findings identified key cross-system characteristics not observable at the task-level: (1) identification of emergent properties (e.g., role ambiguity, loosely-coupled teams performing MM) and associated barriers; and (2) examination of barrier propagation across system boundaries.
AHRQ-funded; HS022916.
Citation: Werner NE, Malkana S, Gurses AP .
Toward a process-level view of distributed healthcare tasks: medication management as a case study.
Appl Ergon 2017 Nov;65:255-68. doi: 10.1016/j.apergo.2017.06.020.
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Keywords: Care Management, Elderly, Home Healthcare, Medication, Transitions of Care
Jones CD, Jones J, RIchard A
"Connecting the Dots": a qualitative study of home health nurse perspectives on coordinating care for recently discharged patients.
This study described home health care (HHC) nurse perspectives about challenges and solutions to coordinating care for recently discharged patients. HHC nurses described challenges and solutions within domains of Accountability, Communication, Assessing Needs & Goals, and Medication Management. One additional domain of Safety, for both patients and HHC nurses, emerged from the analysis.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, RIchard A .
"Connecting the Dots": a qualitative study of home health nurse perspectives on coordinating care for recently discharged patients.
J Gen Intern Med 2017 Oct;32(10):1114-21. doi: 10.1007/s11606-017-4104-0.
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Keywords: Care Coordination, Elderly, Home Healthcare, Health Services Research (HSR), Hospital Discharge
Sobotka SA, Agarwal RK, Msall ME
Prolonged hospital discharge for children with technology dependency: a source of health care disparities.
As the population of children who use medical technology such as long-term ventilation increases, it is important to critically evaluate the systems for preparing families for home life. The authors discuss the complication of hospital discharge and how it contributes to health and developmental disparities. They also describe a hospital-to-home transitional care model, which presents a home-like environment to provide developmental support while focusing on parental training, home nursing, and public-funding arrangements.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Agarwal RK, Msall ME .
Prolonged hospital discharge for children with technology dependency: a source of health care disparities.
Pediatr Ann 2017 Oct;46(10):e365-e70. doi: 10.3928/19382359-20170919-01.
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Keywords: Children/Adolescents, Disparities, Home Healthcare, Hospital Discharge, Medical Devices
Wang SY, Dang W, Aldridge MD
Associations of hospice disenrollment and hospitalization with continuous home care provision.
The researchers examined rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). They concluded that CHC hospices had significantly lower rates of hospice disenrollment and posthospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.
AHRQ-funded; HS023900.
Citation: Wang SY, Dang W, Aldridge MD .
Associations of hospice disenrollment and hospitalization with continuous home care provision.
Med Care 2017 Sep;55(9):848-55. doi: 10.1097/mlr.0000000000000776.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care
Jorgensen SM, Carnahan RM, Weckmann MT
Validity of the delirium observation screening scale in identifying delirium in home hospice patients.
The Delirium Observation Screening Scale (DOS) was developed to improve delirium recognition but has yet to be validated in the home hospice setting. This pilot study aimed to explore the accuracy of the DOS for identifying delirium in home hospice patients. It concluded that the DOS appears to be an accurate way to screen for delirium in home hospice patients.
AHRQ-funded; HS022666.
Citation: Jorgensen SM, Carnahan RM, Weckmann MT .
Validity of the delirium observation screening scale in identifying delirium in home hospice patients.
Am J Hosp Palliat Care 2017 Sep;34(8):744-47. doi: 10.1177/1049909116658468.
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Keywords: Diagnostic Safety and Quality, Elderly, Home Healthcare, Neurological Disorders, Palliative Care
Squires A, Peng TR, Barrón-Vaya Y
An exploratory analysis of patient-provider language-concordant home health care visit patterns.
In a 2-year period, this study showed that among the 238,513 visits with 18,132 limited English proficiency patients, only 20 percent of visits were language concordant. The study suggests that home health care services may not be meeting the demand for language services, but more research is needed to determine the right “dose” of bilingual home care visits to optimize home care outcomes and establish a standard for care.
AHRQ-funded; HS023593.
Citation: Squires A, Peng TR, Barrón-Vaya Y .
An exploratory analysis of patient-provider language-concordant home health care visit patterns.
Home Health Care Management & Practice 2017 Aug 1;29(3):161-67. doi: 10.1177/1084822317696706.
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Keywords: Cultural Competence, Home Healthcare, Clinician-Patient Communication, Racial and Ethnic Minorities, Urban Health
Reid MC, Henderson CR, Jr., Trachtenberg MA
Implementing a pain self-management protocol in home care: a cluster-randomized pragmatic trial.
The researchers sought to determine the effectiveness of a cognitive-behavioral pain self-management protocol delivered by physical therapists for use by older adults with activity-limiting pain receiving home care. Their real-world pragmatic trial found no effect of implementation of a pain self-management intervention in a home care setting.
AHRQ-funded; HS020648.
Citation: Reid MC, Henderson CR, Jr., Trachtenberg MA .
Implementing a pain self-management protocol in home care: a cluster-randomized pragmatic trial.
J Am Geriatr Soc 2017 Aug;65(8):1667-75. doi: 10.1111/jgs.14836.
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Keywords: Home Healthcare, Patient Self-Management, Pain, Elderly, Comparative Effectiveness
Keller SC, Gurses AP, Werner N
Older adults and management of medical devices in the home: five requirements for appropriate use.
This study concerns a qualitative evaluation of barriers and facilitators of appropriate use, and outcomes of inappropriate use, among older adults at the transition from hospital to home with skilled home health care (SHHC). Five requirements for the appropriate use of home medical devices were identified. A systems approach integrating the hospital with the SHHC agency is needed to make the use of home medical devices safer.
AHRQ-funded; HS022916.
Citation: Keller SC, Gurses AP, Werner N .
Older adults and management of medical devices in the home: five requirements for appropriate use.
Popul Health Manag 2017 Aug;20(4):278-86. doi: 10.1089/pop.2016.0070.
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Keywords: Elderly, Caregiving, Home Healthcare, Medical Devices, Patient Safety
Murtaugh CM, Deb P, Zhu C
Reducing readmissions among heart failure patients discharged to home health care: effectiveness of early and intensive nursing services and early physician follow-up.
This study compared the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure patients discharged to home health care. Neither treatment by itself had a statistically significant effect on hospital readmission. In combination, however, they reduced the probability of readmission by roughly 8 percentage points.
AHRQ-funded; HS020257.
Citation: Murtaugh CM, Deb P, Zhu C .
Reducing readmissions among heart failure patients discharged to home health care: effectiveness of early and intensive nursing services and early physician follow-up.
Health Serv Res 2017 Aug;52(4):1445-72. doi: 10.1111/1475-6773.12537.
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Keywords: Comparative Effectiveness, Heart Disease and Health, Home Healthcare, Hospital Readmissions, Patient-Centered Outcomes Research
Jones CD, Bowles KH, Richard A
High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home.
Providing home health nursing and therapy could promote recovery in vulnerable HF patients with post-hospital syndrome and potentially reduce readmissions. The authors argue that understanding the characteristics of effective post-acute HHC for patients with HF will inform best practices, optimal outcomes for cost, and ultimately high-value care.
AHRQ-funded; HS024569.
Citation: Jones CD, Bowles KH, Richard A .
High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home.
Circ Cardiovasc Qual Outcomes 2017 May;10(5). doi: 10.1161/circoutcomes.117.003676.
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Keywords: Home Healthcare, Heart Disease and Health, Transitions of Care, Care Coordination, Medicare
Buys DR, Campbell AD, Godfryd A
Meals enhancing nutrition after discharge: findings from a pilot randomized controlled trial.
This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program. It found that participants were overwhelmingly satisfied (82 percent to 100 percent satisfied or very satisfied) with staff performance, meal quality, and delivery processes.
AHRQ-funded; HS013852.
Citation: Buys DR, Campbell AD, Godfryd A .
Meals enhancing nutrition after discharge: findings from a pilot randomized controlled trial.
J Acad Nutr Diet 2017 Apr;117(4):599-608. doi: 10.1016/j.jand.2016.11.005.
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Keywords: Nutrition, Patient Experience, Elderly, Home Healthcare, Hospital Discharge
Beissner KL, Bach E, Murtaugh CM, Trifilio M, Hend KL, Bach E, Murtaugh CM
Translating evidence-based protocols into the home healthcare setting.
A comparative effectiveness study was undertaken at a large urban home care agency to examine an evidence-based pain self-management program delivered by physical therapists (PTs). This article focuses on PT training, methods implemented to reinforce content after training and to encourage uptake of the program with appropriate patients, and therapists' fidelity to the program.
AHRQ-funded; HS020648.
Citation: Beissner KL, Bach E, Murtaugh CM, Trifilio M, Hend KL, Bach E, Murtaugh CM .
Translating evidence-based protocols into the home healthcare setting.
Home Healthc Now 2017 Feb;35(2):105-12. doi: 10.1097/nhh.0000000000000486..
Keywords: Evidence-Based Practice, Home Healthcare, Pain, Patient Self-Management, Implementation
Sood N, Alpert A, Barnes K
Effects of payment reform in more versus less competitive markets.
In this paper, the authors exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, they find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets..
AHRQ-funded; HS018541.
Citation: Sood N, Alpert A, Barnes K .
Effects of payment reform in more versus less competitive markets.
J Health Econ 2017 Jan;51:66-83. doi: 10.1016/j.jhealeco.2016.12.006.
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Keywords: Healthcare Costs, Payment, Home Healthcare, Policy
Kendall L, Eschler J, Lozano P
Engineering for reliability in at-home chronic disease management.
The researchers examined how individuals responsible for managing their own or others’ chronic conditions integrate reminders and notification systems into their daily routines. Based on the participants’ experiences, they contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance.
AHRQ-funded; HS021590.
Citation: Kendall L, Eschler J, Lozano P .
Engineering for reliability in at-home chronic disease management.
AMIA Annu Symp Proc 2014 Nov 14;2014:777-86..
Keywords: Chronic Conditions, Patient Self-Management, Home Healthcare, Patient Adherence/Compliance
Smucker DR, Regan S, Elder NC
Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.
The study objective was to explore the types and characteristics of patient safety incidents in home hospice care from the experiences of hospice interdisciplinary team members. Based on interviews of 19 experienced hospice leaders, the most commonly described categories of patient harm were injuries from falls and inadequate symptom control.
AHRQ-funded; HS018245
Citation: Smucker DR, Regan S, Elder NC .
Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.
J Palliat Med. 2014 May;17(5):540-4. doi: 10.1089/jpm.2013.0111..
Keywords: Patient Safety, Home Healthcare, Falls, Chronic Conditions
Huckfeldt PJ, Sood N, Escarce JJ
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
The researchers contrasted the effects of two Medicare payment reforms for home health agencies: the interim payment system (IPS) and the prospective payment system (PPS). The 1997 IPS reform lowered payments for both fee-for-service and episode-based care, as predicted by their conceptual model. The PPS in 2000 raised average but lowered marginal payment.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood N, Escarce JJ .
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
J Health Econ. 2014 Mar;34:1-18. doi: 10.1016/j.jhealeco.2013.11.005..
Keywords: Medicare, Healthcare Costs, Home Healthcare
Thomas KS
The relationship between Older Americans Act in-home services and low-care residents in nursing homes.
This study examining the relationship between the proportion of older adults in a State who receive in-home services funded by the Older Americans Act and the proportion of residents in nursing homes finds that for every additional 1 percent of the 65+ population that receives personal care services, there is a 0.8% decrease in the proportion of low-care residents in nursing homes.
AHRQ-funded; HS00011
Citation: Thomas KS .
The relationship between Older Americans Act in-home services and low-care residents in nursing homes.
J Aging Health. 2014 Mar;26(2):250-60. doi: 10.1177/0898264313513611..
Keywords: Elderly, Long-Term Care, Home Healthcare, Nursing Homes, Healthcare Delivery
Sockolow PS, Bowles KH, Adelsberger MC
Challenges and facilitators to adoption of a point-of-care electronic health record in home care.
In order to identify challenges to the adoption of electronic health records (EHR) in the home care setting, the researchers assessed clinician satisfaction, informed by workflow and patient outcomes. Using a combination of surveys, observations, and interviews in an agency with 137 clinicians, the researchers found that adoption challenges included: (a) hardware problems coupled with lack of field support; (b) inadequate training; and (c) mismatch of EHR usability/functionality and workflow.
AHRQ-funded; HS021008.
Citation: Sockolow PS, Bowles KH, Adelsberger MC .
Challenges and facilitators to adoption of a point-of-care electronic health record in home care.
Home Health Care Serv Q 2014;33(1):14-35. doi: 10.1080/01621424.2013.870098..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Home Healthcare
Sockolow PS, Bowles KH, Adelsberger MC
Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes.
The study objective was to assess the impact of attaining efficiency and health goals of a point-of-care EHR in home care. To realize this objective, the researchers compared clinical documentation workflow, financial time-to-billing and patient physiological and behavioral outcomes to evaluate its impact. The findings indicate that EHR use significantly improved the timeliness of clinical documentation and billing for reimbursement but had limited impact on improving patient outcomes.
AHRQ-funded; HS021008.
Citation: Sockolow PS, Bowles KH, Adelsberger MC .
Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes.
Appl Clin Inform 2014;5(2):445-62. doi: 10.4338/aci-2013-12-ra-0106..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Home Healthcare
Albrecht JS, McGregor JC, Fromme EK
A nationwide analysis of antibiotic use in hospice care in the final week of life.
This study uses data form the 2007 National Home and Hospice Care Survey to estimate antibiotic utilization in hospice care patients and identify potential infectious indications and facility and patient characteristics associated with antibiotic use in this population. It found that 27 percent of hospice patients received an antibiotic during the last seven days of life, most without a documented infectious diagnosis.
AHRQ-funded; HS021068
Citation: Albrecht JS, McGregor JC, Fromme EK .
A nationwide analysis of antibiotic use in hospice care in the final week of life.
J Pain Symptom Manage. 2013 Oct;46(4):483-90. doi: 10.1016/j.jpainsymman.2012.09.010..
Keywords: Antibiotics, Antimicrobial Stewardship, Home Healthcare, Medication, Palliative Care, Practice Patterns
Huckfeldt PJ, Sood NB, Romley JA
Medicare payment reform and provider entry and exit in the post-acute care market.
The researchers examined the impact of Medicare payment reform on the entry and exit of post-acute providers (home health agencies and skilled nursing facilities). They found that payment reforms reducing average and marginal payments reduced entries and increased exits from the market, with entries more likely to be affected.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood NB, Romley JA .
Medicare payment reform and provider entry and exit in the post-acute care market.
Health Serv Res. 2013 Oct;48(5):1557-80. doi: 10.1111/1475-6773.12059..
Keywords: Medicare, Critical Care, Healthcare Costs, Home Healthcare, Long-Term Care