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Arbaje AI, Hsu YJ, Zhou Z, Greyson S, Gurses AP, Keller S, Marsteller J, Bowles KH, McDonald MV, Vergez S, Harbison K, Hohl D, Carl K, Leff B. Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID-19. J Am Geriatr Soc 2024; 72:1079-1087. [PMID: 38441330 DOI: 10.1111/jgs.18839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Skilled home healthcare (HH) provided in-person care to older adults during the COVID-19 pandemic, yet little is known about the pandemic's impact on HH care transition patterns. We investigated pandemic impact on (1) HH service volume; (2) population characteristics; and (3) care transition patterns for older adults receiving HH services after hospital or skilled nursing facility (SNF) discharge. METHODS Retrospective, cohort, comparative study of recently hospitalized older adults (≥ 65 years) receiving HH services after hospital or SNF discharge at two large HH agencies in Baltimore and New York City (NYC) 1-year pre- and 1-year post-pandemic onset. We used the Outcome and Assessment Information Set (OASIS) and service use records to examine HH utilization, patient characteristics, visit timeliness, medication issues, and 30-day emergency department (ED) visit and rehospitalization. RESULTS Across sites, admissions to HH declined by 23% in the pandemic's first year. Compared to the year prior, older adults receiving HH services during the first year of the pandemic were more likely to be younger, have worse mental, respiratory, and functional status in some areas, and be assessed by HH providers as having higher risk of rehospitalization. Thirty-day rehospitalization rates were lower during the first year of the pandemic. COVID-positive HH patients had lower odds of 30-day ED visit or rehospitalization. At the NYC site, extended duration between discharge and first HH visit was associated with reduced 30-day ED visit or rehospitalization. CONCLUSIONS HH patient characteristics and utilization were distinct in Baltimore versus NYC in the initial year of the COVID-19 pandemic. Study findings suggest some older adults who needed HH may not have received it, since the decrease in HH services occurred as SNF use decreased nationally. Findings demonstrate the importance of understanding HH agency responsiveness during public health emergencies to ensure older adults' access to care.
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Affiliation(s)
- Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zehui Zhou
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sylvan Greyson
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ayse P Gurses
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara Keller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Home Care Policy & Research, VNS Health, New York City, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, VNS Health, New York City, New York, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York City, New York, USA
| | - Katie Harbison
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, Maryland, USA
| | - Kimberly Carl
- Johns Hopkins Home Care Group, Baltimore, Maryland, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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Arbaje AI, Hsu YJ, Keita M, Greyson S, Wang J, Werner NE, Carl K, Hohl D, Jones K, Bowles KH, Chan KS, Marsteller JA, Gurses AP, Leff B. Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality. Qual Manag Health Care 2023; Publish Ahead of Print:00019514-990000000-00046. [PMID: 37348080 PMCID: PMC10730761 DOI: 10.1097/qmh.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions. OBJECTIVE To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks. METHODS Development: A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing: Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied: Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists). RESULTS The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%). CONCLUSIONS The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.
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Affiliation(s)
- Alicia I. Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Maningbe Keita
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sylvan Greyson
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin—Madison, Madison, Wisconsin
| | | | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, Maryland
| | - Kate Jones
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Kathryn H. Bowles
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Kitty S. Chan
- MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and Medstar Georgetown University Hospital, Washington, DC
| | - Jill A. Marsteller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ayse P. Gurses
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland
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Keita-Fakeye M, Sharma R, Greyson S, Samus Q, Gurses A, Keller S, Arbaje A. Systems Barriers to Medication Management During Hospital to Home Transitions of Older Adults With Dementia. Innov Aging 2021. [PMCID: PMC8969829 DOI: 10.1093/geroni/igab046.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The hospital-to-home transition is a high-risk period for medication errors and adverse events for older adults living with dementia. Researchers conducted a qualitative study using semi-structured interviews and participant solicited diaries. Caregivers of adults ages 55 and older were recruited to understand barriers to medication management during hospital to skilled home health care transitions. We used a human factors engineering approach to guide our understanding of systems level barriers. At least two researchers independently coded each transcript using content analysis and the ATLAS.ti software. We interviewed 23 caregivers and identified five barrier types stemming from systems breakdowns related to: (1) knowledge and information, (2) access to and use of resources and tools, (3) caregiver burden, (4) pandemic concerns, and (5) health limitations. Caregivers grappled with receiving overwhelming, insufficient, incorrect, or conflicting information, and had difficulty managing information from different sources. Latinx caregivers encountered language barriers that impeded role and task clarity. Caregivers expressed mistrust in health systems elements and inability to access resources. Caregivers were in need of additional caregiving assistance, financial aid, and tools to manage medications. Balancing multiple medications and responsibilities left caregivers burdened. The health limitations of the older adult and COVID-19 concerns related to reduced access to resources and ability to deliver and receive in person care complicated task management. Altogether these barriers reflect systems level breakdowns impeding task understanding, execution, and overall management. These findings will inform the development of interdisciplinary strategies to ensure safer care transitions.
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Affiliation(s)
| | - Rhea Sharma
- Virginia Commonwealth University, Virginia Commonwealth University, Virginia, United States
| | - Sylvan Greyson
- Bayview Medical Center, Baltimore, Maryland, United States
| | - Quincy Samus
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ayse Gurses
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Sara Keller
- Johns Hopkins School of Medicine, Lutherville-Timonium, Maryland, United States
| | - Alicia Arbaje
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Arbaje AI, Greyson S, Keita M, Sharma R, Keller S, Gurses A, Samus QM. Cultural perceptions of medication management during hospital‐to‐home transitions of older Latino adults living with dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.051181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alicia I Arbaje
- Johns Hopkins University School of Medicine Baltimore MD USA
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Sylvan Greyson
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Maningbe Keita
- Johns Hopkins University School of Medicine Baltimore MD USA
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Rhea Sharma
- Johns Hopkins University School of Medicine Baltimore MD USA
- Virginia Commonwealth University School of Medicine Richmond VA USA
| | - Sara Keller
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ayse Gurses
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Quincy M Samus
- Johns Hopkins University School of Medicine Baltimore MD USA
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