National Healthcare Quality and Disparities Report
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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
101 to 125 of 141 Research Studies DisplayedSobotka 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
Wang SY, Aldridge MD, Canavan M
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
The purpose of this paper is to identify hospice and patient characteristics associated with the use of continuous home care (CHC) and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. The researchers found that patients who were white, had cancer, and had more comorbidities were more likely to use CHC and that patients who used CHC were less likely to have hospice disenrollment and less likely to be hospitalized after hospice enrollment.
AHRQ-funded; HS023900.
Citation: Wang SY, Aldridge MD, Canavan M .
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
J Pain Symptom Manage 2016 Dec;52(6):813-21. doi: 10.1016/j.jpainsymman.2016.05.031.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care
Thomas KS, Allen SM
Interagency partnership to deliver veteran-directed home and community-based services: interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.
The objective of this article is to describe the Aging and Disability Network agency (ADNA) personnel's perceptions of the implementation of the VD-HCBS program with partner Department of Veterans Affairs medical centers (VAMCs). Results suggest that the majority of ADNA personnel interviewed perceive the collaboration experience to be positive. Interviewees reported several key mechanisms for facilitating a successful partnership.
AHRQ-funded; HS000011.
Citation: Thomas KS, Allen SM .
Interagency partnership to deliver veteran-directed home and community-based services: interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.
J Rehabil Res Dev 2016;53(5):611-18. doi: 10.1682/jrrd.2015.02.0019.
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Keywords: Community-Based Practice, Provider: Health Personnel, Home Healthcare, Training
Wang Y, Pandolfi MM, Fine J
Community level association between home health and nursing home performance on quality and hospital 30-day readmissions for Medicare patients.
Using CMS data from 2010 to 2012, the researchers evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients. They found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases in community-level risk-standardized readmission rates.
AHRQ-funded; HS023000.
Citation: Wang Y, Pandolfi MM, Fine J .
Community level association between home health and nursing home performance on quality and hospital 30-day readmissions for Medicare patients.
Home Health Care Manag Pract 2016 Nov;28(4):201-08. doi: 10.1177/1084822316639032.
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Keywords: Quality of Care, Hospital Readmissions, Home Healthcare, Nursing Homes, Provider Performance
Valdez RS, Holden RJ
Health care human factors/ergonomics fieldwork in home and community settings.
The researchers offered several strategies that human factors and ergonomics professionals can use before, during, and after home and community site visits to optimize fieldwork and mitigate challenges in these settings.
AHRQ-funded; HS022930; HS018809.
Citation: Valdez RS, Holden RJ .
Health care human factors/ergonomics fieldwork in home and community settings.
Ergon Des 2016 Oct;24(4):4-9. doi: 10.1177/1064804615622111.
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Keywords: Caregiving, Community-Based Practice, Home Healthcare, Workflow
Gleason HP, Coyle CE
Mental and behavioral health conditions among older adults: implications for the home care workforce.
The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities. In focus group discussions, aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery.
AHRQ-funded; HS017589.
Citation: Gleason HP, Coyle CE .
Mental and behavioral health conditions among older adults: implications for the home care workforce.
Aging Ment Health 2016 Aug;20(8):848-55. doi: 10.1080/13607863.2015.1040725.
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Keywords: Elderly, Home Healthcare, Behavioral Health, Provider
Garfield CF, Lee YS, Kim HN
Supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application.
This study determined whether parents of Very Low Birth Weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU) transitioning home with the NICU-2-Home smartphone application have greater parenting self-efficacy, are better prepared for discharge and have shorter length of stay (LOS) than control parents. It found that a smartphone application can improve parenting self-efficacy, discharge preparedness, and LOS with improved benefits based on usage.
AHRQ-funded; HS020316.
Citation: Garfield CF, Lee YS, Kim HN .
Supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application.
Internet Interv 2016 May;4(Pt 2):131-37. doi: 10.1016/j.invent.2016.05.004.
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Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Health Information Technology (HIT), Home Healthcare, Hospital Discharge
Hassol A, Deitz D, Goldberg H
Health information exchange: perspectives from home healthcare.
Home health agencies (HHAs) often lack the timely and accurate patient information that they require for transition planning. The authors argue that health information exchanges (HIEs) offer information that supports timely visit scheduling, safe and appropriate care planning, coding and documentation, and HHA efficiency.
AHRQ-funded; HS018865.
Citation: Hassol A, Deitz D, Goldberg H .
Health information exchange: perspectives from home healthcare.
Comput Inform Nurs 2016 Apr;34(4):145-50. doi: 10.1097/cin.0000000000000240.
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Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Home Healthcare
Berry JG, Hall M, Dumas H
Pediatric hospital discharges to home health and postacute facility care: a national study.
The researchers assessed the national prevalence of, characteristics of children discharged to, and variation in use across states of home health care (HHC) and facility-based postacute care (PAC) for children. They found that HHC and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states.
AHRQ-funded; HS023092.
Citation: Berry JG, Hall M, Dumas H .
Pediatric hospital discharges to home health and postacute facility care: a national study.
JAMA Pediatr 2016 Apr;170(4):326-33. doi: 10.1001/jamapediatrics.2015.4836.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Home Healthcare, Children/Adolescents, Children/Adolescents, Critical Care
Fonarow GG, Liang L, Thomas L
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
The researchers evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. They concluded that in a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year.
AHRQ-funded; HS019479; HS016964.
Citation: Fonarow GG, Liang L, Thomas L .
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
Stroke 2016 Mar;47(3):836-42. doi: 10.1161/strokeaha.115.011599.
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Keywords: Medicare, Stroke, Elderly, Home Healthcare, Patient-Centered Outcomes Research
Jubelt LE, Goldfeld KS, Chung WY
Changes in discharge location and readmission rates under Medicare bundled payment.
To control costs, NYU Langone Medical Center attempted to shift referrals from facility-based to home-based postacute care. In the context of this shift in referrals, the researchers examined the change in hospital readmission rates. Their findings suggest that institutions may be able to shift some patients from facility-based to home-based postacute care without adversely affecting hospital readmission rates or the length of hospital stay.
AHRQ-funded; HS023683; HS022882.
Citation: Jubelt LE, Goldfeld KS, Chung WY .
Changes in discharge location and readmission rates under Medicare bundled payment.
JAMA Intern Med 2016 Jan;176(1):115-7. doi: 10.1001/jamainternmed.2015.6265.
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Keywords: Medicare, Hospital Discharge, Hospital Readmissions, Home Healthcare, Healthcare Costs
Koru G, Alhuwail D, Topaz M
Investigating the challenges and opportunities in home care to facilitate effective information technology adoption.
This investigation of the pressing challenges and opportunities for achieving effectiveness in IT adoption found that coordinating clinical and administrative workflows was an important challenge. Inadequate access to patients' medical history and difficulties with medication reconciliation detracted from the quality of care. Hiring, training, scheduling, and retaining qualified personnel constituted another important challenge.
AHRQ-funded; HS022352.
Citation: Koru G, Alhuwail D, Topaz M .
Investigating the challenges and opportunities in home care to facilitate effective information technology adoption.
J Am Med Dir Assoc 2016 Jan;17(1):53-8. doi: 10.1016/j.jamda.2015.10.008.
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Keywords: Home Healthcare, Health Information Technology (HIT), Quality of Care
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
Rivera-Hernandez M, Yamashita T, Kinney JM
Identifying naturally occurring retirement communities: a spatial analysis.
The authors analyzed naturally occurring retirement communities (NORCs) and whether there were spatiotemporal patterns in Ohio between 2000 and 2010. They found that there were different patterns including emerging, disappearing, and enduring NORCs and disproportionate distributions of NORCs across the state between 2000 and 2010. They recommended that locating NORCs could aid governments to create "aging in place" sensitive policies to address issues of independence, social care, health care, volunteerism, and community participation.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M, Yamashita T, Kinney JM .
Identifying naturally occurring retirement communities: a spatial analysis.
J Gerontol B Psychol Sci Soc Sci 2015 Jul;70(4):619-27. doi: 10.1093/geronb/gbu077.
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Keywords: Elderly, Home Healthcare
Rhee SM, Valle MF, Wilson LM
Negative pressure wound therapy technologies for chronic wound care in the home setting: a systematic review.
The researchers conducted a systematic review on the efficacy and safety of negative pressure wound therapy (NPWT) for the treatment of chronic wounds in the home setting. Data were limited by variability in the types of comparator groups, methodological limitations, and poor reporting of outcomes. The researchers were unable to draw conclusions about the efficacy or safety of NPWT for the treatment of chronic wounds in the home setting due to the insufficient evidence.
AHRQ-funded; 290201200007I.
Citation: Rhee SM, Valle MF, Wilson LM .
Negative pressure wound therapy technologies for chronic wound care in the home setting: a systematic review.
Wound Repair Regen 2015 Jul-Aug;23(4):506-17. doi: 10.1111/wrr.12295..
Keywords: Injuries and Wounds, Home Healthcare, Comparative Effectiveness, Treatments, Chronic Conditions