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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 23 of 23 Research Studies Displayed
Geng F, Mansouri S, Stevenson DG
Evolution of the home health care market: the expansion and quality performance of multi-agency chains.
This study examined the growth and quality performance of multi-agency home health agency (HHA) chains from 2005 to 2018. All Medicare-certified HHAs were included. Over the time period, the number of HHAs increased from 7899 to 10,818 and the number of chain-owned HHAs more than doubled from 903 to 1841. In 2018, for-profit nonchain agencies were still the largest category - both in the number of agencies (67.8%) and number of Medicare enrollees served (40.7%). Non-chain for-profit HHAs served the highest proportion of dual eligible beneficiaries and African Americans among all agency types.
Citation: Geng F, Mansouri S, Stevenson DG . Evolution of the home health care market: the expansion and quality performance of multi-agency chains. Health Serv Res 2020 Dec;55(Suppl 3):1073-84. doi: 10.1111/1475-6773.13597..
Keywords: Home Healthcare, Provider Performance, Quality of Care
Huth HB, Skeens R, Anders S
Health management in the home: a qualitative study of pregnant women and their caregivers.
This qualitative study examined how pregnant women and their caregivers managed health in their home. Participants filled out sociodemographic surveys and had semi-structured interviews about living situations, information needs, and technology use. The authors identified themes about health management, including the physical home, help at home, community, the virtual home, and largest concerns. Caregivers often did not know how to help expectant mothers and needed to learn new roles. Many expectant families did not trust online advice.
Citation: Huth HB, Skeens R, Anders S . Health management in the home: a qualitative study of pregnant women and their caregivers. J Patient Exp 2020 Dec;7(6):1227-33. doi: 10.1177/2374373520948442..
Keywords: Pregnancy, Women, Home Healthcare, Caregiving
Nazareno J, Zhang W, Silver B
Home health utilization in assisted living settings.
The authors explored the growth in the delivery of home health agency (HHA) services to Medicare beneficiaries in assisted living (AL) compared with other home settings between 2012 and 2014. Their findings suggested that there was a slight growth in the share of HHA services being delivered in AL. HHA recipients in AL were more likely to have cognitive and activities of daily living impairments than those receiving HHA services in other settings. This study is among the first of those to examine HHA utilization in AL.
Citation: Nazareno J, Zhang W, Silver B . Home health utilization in assisted living settings. Med Care Res Rev 2020 Dec;77(6):620-29. doi: 10.1177/1077558719835049..
Keywords: Elderly, Home Healthcare, Medicare, Healthcare Utilization
Burgdorf JG, Arbaje AI, Wolff JL
Training needs among family caregivers assisting during home health, as identified by home health clinicians.
This study’s objective was to estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs. This nationally representative retrospective cohort study included 1758 Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016. More than 1 in 3 family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Training needs varied widely, from 8.6% among caregiving helping with advocacy to 48.2% among caregivers helping with medical procedures. Weighted analyses adjusted for older adults’ health and function showed family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission.
Citation: Burgdorf JG, Arbaje AI, Wolff JL . Training needs among family caregivers assisting during home health, as identified by home health clinicians. J Am Med Dir Assoc 2020 Dec;21(12):1914-19. doi: 10.1016/j.jamda.2020.05.032..
Keywords: Caregiving, Home Healthcare, Education: Patient and Caregiver, Training
Topaz M, Woo K, Ryvicker M
Home healthcare clinical notes predict patient hospitalization and emergency department visits.
About 30% of home healthcare patients are hospitalized or visit an emergency department (ED) during a home healthcare (HHC) episode. Novel data science methods are increasingly used to improve identification of patients at risk for negative outcomes. The aim of the study was to identify patients at heightened risk hospitalization or ED visits using HHC narrative data (clinical notes).
Citation: Topaz M, Woo K, Ryvicker M . Home healthcare clinical notes predict patient hospitalization and emergency department visits. Nurs Res 2020 Nov/Dec;69(6):448-54. doi: 10.1097/nnr.0000000000000470..
Keywords: Elderly, Home Healthcare, Emergency Department, Hospitalization, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Riddle SW, Sherman SN, Moore MJ
A qualitative study of increased pediatric reutilization after a postdischarge home nurse visit.
The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. The investigators sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions.
Citation: Riddle SW, Sherman SN, Moore MJ . A qualitative study of increased pediatric reutilization after a postdischarge home nurse visit. J Hosp Med 2020 Sep;15(9):518-25. doi: 10.12788/jhm.3370..
Keywords: Children/Adolescents, Home Healthcare, Hospital Discharge, Healthcare Utilization, Hospitals
Li J, Qi M, Werner RM
Assessment of receipt of the first home health care visit after hospital discharge among older adults.
Investigators examined how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Their study used Medicare data regarding the postacute home health care setting; participants were Medicare fee-for-service and Medicare Advantage beneficiaries discharged from the hospital with a referral to home health care. They found that only 54% of patients discharged received home health care services within 14 days of discharge. Of the remaining 46% discharged, 37.7% never received any home health care, while 8.3% were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White. They concluded that disparities in the use of home health care remain an issue in the US.
AHRQ-funded; HS024266; HS026836.
Citation: Li J, Qi M, Werner RM . Assessment of receipt of the first home health care visit after hospital discharge among older adults. JAMA Netw Open 2020 Sep;3(9):e2015470. doi: 10.1001/jamanetworkopen.2020.15470..
Keywords: Elderly, Hospital Discharge, Home Healthcare, Disparities, Access to Care, Racial / Ethnic Minorities
Keller S, Salinas A, Williams D
Reaching consensus on a home infusion central line-associated bloodstream infection surveillance definition via a modified Delphi approach.
A consensus on a central line-associated bloodstream infection (CLABSI) surveillance definition in home infusion is needed to standardize measurement and benchmark CLABSI to provide data to drive improvement initiatives. Experts across fields including home infusion therapy, infectious diseases, and healthcare epidemiology convened to perform a 3-step modified Delphi approach to obtain input and achieve consensus on a candidate home infusion CLABSI definition. This paper describes the process.
Citation: Keller S, Salinas A, Williams D . Reaching consensus on a home infusion central line-associated bloodstream infection surveillance definition via a modified Delphi approach. Am J Infect Control 2020 Sep;48(9):993-1000. doi: 10.1016/j.ajic.2019.12.015..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Home Healthcare
Physical therapy in the COVID-19 pandemic: forging a paradigm shift for rehabilitation in acute care.
This point-of-view article discusses the importance of physical therapy for COVID-19 survivors in home and community-based settings as well as in post-acute care facilities, concluding that it is necessary to react to new and difficult circumstances with growth and self-advocacy in order to forge a future characterized by intensive skilled rehabilitation services in the inpatient setting, simultaneously benefiting the health care systems and the patient populations.
Citation: Keeney T . Physical therapy in the COVID-19 pandemic: forging a paradigm shift for rehabilitation in acute care. Phys Ther 2020 Aug 12;100(8):1265-67. doi: 10.1093/ptj/pzaa097..
Keywords: Rehabilitation, COVID-19, Transitions of Care, Home Healthcare, Healthcare Delivery
Callister C, Jones J, Schroeder S
Caregiver experiences of care coordination for recently discharged patients: a qualitative metasynthesis.
Caregivers of patients often provide key support for patients after hospitalization. This qualitative metasynthesis described caregiver perspectives about care coordination for patients discharged from the hospital. A literature search of Ovid Medline and CINAHL completed on May 23, 2018, identified 1,546 studies. Twelve articles were included in the final metasynthesis. Caregiver perspectives about care coordination were compiled into overall themes.
Citation: Callister C, Jones J, Schroeder S . Caregiver experiences of care coordination for recently discharged patients: a qualitative metasynthesis. West J Nurs Res 2020 Aug;42(8):649-59. doi: 10.1177/0193945919880183..
Keywords: Caregiving, Care Coordination, Hospital Discharge, Home Healthcare
Sockolow PS, Bowles KH, Wojciechowicz C
Incorporating home healthcare nurses' admission information needs to inform data standards.
Patient transitions into home health care (HHC) often occur without the transfer of information needed for critical clinical decisions and the plan of care. Owing to a lack of universally implemented standards, there is wide variation in information transfer. In this study, the investigators sought to characterize missing information at HHC admission. They conducted a mixed methods study with 3 diverse HHC agencies.
Citation: Sockolow PS, Bowles KH, Wojciechowicz C . Incorporating home healthcare nurses' admission information needs to inform data standards. J Am Med Inform Assoc 2020 Aug;27(8):1278-86. doi: 10.1093/jamia/ocaa087..
Keywords: Home Healthcare, Transitions of Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Greenhawt M, Shaker M
Keeping risk in context while rethinking the setting of asthma biologics in patient-centered care.
This perspective article discusses the benefits and risks of patients with severe asthma self-administering asthma biologics at home instead of at a physician’s office. While most biologics are now FDA-approved to be administered at home, many of them are also recommended by the FDA to be administered by a health care professional with post-injection monitoring due to the possibility of post-injection anaphylaxis. The authors argue that there can be more risk associated with getting into an automobile accident on the way to or from the clinic or office. Given the current circumstances with limited patient visit hours due to COVID-19 it is even more important that patients can administer the biologic themselves.
AHRQ-funded; K08 HS024599.
Citation: Greenhawt M, Shaker M . Keeping risk in context while rethinking the setting of asthma biologics in patient-centered care. Ann Allergy Asthma Immunol 2020 Aug;125(2):124-25. doi: 10.1016/j.anai.2020.05.029..
Keywords: Asthma, Respiratory Conditions, Home Healthcare, Medication, Patient-Centered Healthcare
Berridge C, Wetle TF
Why older adults and their children disagree about in-home surveillance technology, sensors, and tracking.
Researchers compared preferences of older adult women and their adult children for three remote monitoring technologies. They found that adult children preferred each technology more than their mothers did and underestimated both their mothers' ability to comprehend the functions of the technologies and the importance of engaging them fully in decision making. For both groups, privacy was the most-cited concern, and participants perceived significant overlap between values of privacy, independence, identity, and freedom. They recommended shared decision-making tools to promote remote monitoring use consistent with older adults' values and to prevent conflict and caregiver overreach.
Citation: Berridge C, Wetle TF . Why older adults and their children disagree about in-home surveillance technology, sensors, and tracking. Gerontologist 2020 Jul 15;60(5):926-34. doi: 10.1093/geront/gnz068..
Keywords: Elderly, Caregiving, Telehealth, Health Information Technology (HIT), Home Healthcare
Amar-Dolan LG, Horn MH, O'Connell B B
"This is how hard it is". family experience of hospital-to-home transition with a tracheostomy.
This study explores the experience of family caregivers of children and young adults with a tracheostomy during the transition from hospital to home care. Researchers sought to identify the specific unmet needs of families to direct future interventions. Using semi-structured interviews, they found a need for family-centered discharge processes including coordination of care and teaching focused on emergency preparedness.
Citation: Amar-Dolan LG, Horn MH, O'Connell B B . "This is how hard it is". family experience of hospital-to-home transition with a tracheostomy. Ann Am Thorac Soc 2020 Jul;17(7):860-68. doi: 10.1513/AnnalsATS.201910-780OC..
Keywords: Transitions of Care, Home Healthcare, Caregiving, Patient Experience, Care Coordination, Hospital Discharge, Hospitals, Children/Adolescents, Patient-Centered Healthcare
Dowding D, Russell D, Trifilio M
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Investigators sought to understand if and how home care nurses identify patients at high risk of infection and which strategies they use to mitigate that risk. Interviews with fifty nurses were audio recorded and transcribed. Factors identified by the nurses as putting a patient at higher risk of infection included being older, having diabetes, and inadequate nutrition as well as inadequate clinical information available at start of care. The main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviors and the ability to adjust a patient's plan of care according to their infection risk.
Citation: Dowding D, Russell D, Trifilio M . Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study. Int J Nurs Stud 2020 Jul;107:103617. doi: 10.1016/j.ijnurstu.2020.103617..
Keywords: Home Healthcare, Community-Acquired Infections, Infectious Diseases, Patient Safety, Prevention, Nursing, Decision Making
Tubbs-Cooley HL, Riddle SW, Gold JM
Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period.
The purpose of this study was to describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge. The investigators analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected.
Citation: Tubbs-Cooley HL, Riddle SW, Gold JM . Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period. J Adv Nurs 2020 Jun;76(6):1394-403. doi: 10.1111/jan.14341..
Keywords: Children/Adolescents, Home Healthcare, Hospital Discharge, Provider: Nurse, Provider
Mroz TM, Patterson DG, Frogner BK
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
This analysis looked at the impact of Medicare’s rural add-on payments on supply of home health agencies serving rural counties. The authors used data from Home Health Compare. The results suggest that while supply changes are similar in rural counties adjacent to urban areas and urban counties regardless of add-on payments, only higher add-payments of 5 to 10 percent to rural counties keep them on pace with those in urban counties.
Citation: Mroz TM, Patterson DG, Frogner BK . The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties. Health Aff 2020 Jun;39(6):949-57. doi: 10.1377/hlthaff.2019.00952..
Keywords: Elderly, Medicare, Home Healthcare, Rural Health, Payment, Access to Care
Shang J, Russell D, Dowding D
A predictive risk model for infection-related hospitalization among home healthcare patients.
Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted.
Citation: Shang J, Russell D, Dowding D . A predictive risk model for infection-related hospitalization among home healthcare patients. J Healthc Qual 2020 May/Jun;42(3):136-47. doi: 10.1097/jhq.0000000000000214..
Keywords: Elderly, Home Healthcare, Infectious Diseases, Community-Acquired Infections, Risk, Hospitalization, Emergency Department
Wilson ME, Dobler CC, Morrow AS
Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis.
The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain. The purpose of this study was to evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia.
Citation: Wilson ME, Dobler CC, Morrow AS . Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA 2020 Feb 4;323(5):455-65. doi: 10.1001/jama.2019.22343..
Keywords: Respiratory Conditions, Chronic Conditions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Home Healthcare
Weerahandi H, Bao H, Herrin J
Home health care after skilled nursing facility discharge following heart failure hospitalization.
Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. In this study, the investigators examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.
Citation: Weerahandi H, Bao H, Herrin J . Home health care after skilled nursing facility discharge following heart failure hospitalization. J Am Geriatr Soc 2020 Jan;68(1):96-102. doi: 10.1111/jgs.16179..
Keywords: Home Healthcare, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Hospital Readmissions, Transitions of Care, Rehabilitation, Value
Jarrin OF, Nyandege AN, Grafova IB
Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits.
The authors compared the validity of two race/ethnicity variables found in Medicare administrative data against a gold-standard source also available in the Medicare data warehouse. They found that the race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data. They conclude that future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.
Citation: Jarrin OF, Nyandege AN, Grafova IB . Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits. Med Care 2020 Jan;58(1):e1-e8. doi: 10.1097/mlr.0000000000001216..
Keywords: Racial / Ethnic Minorities, Home Healthcare, Medicare, Data, Disparities, Research Methodologies
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.
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.
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