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Srithumsuk W, Prachusilpa G, Thunyawan S, Somkome T. Identification of Nursing Outcomes and Quality Indicators for Home Health Care in Older Adults with End-Stage Cancer. Asian Pac J Cancer Prev 2024; 25:1189-1193. [PMID: 38679977 DOI: 10.31557/apjcp.2024.25.4.1189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE This study aimed to identify nursing outcomes and quality indicators for older adults with end-stage cancer receiving home health care. METHODS Nineteen experts and professional caregivers, including palliative doctors, nursing faculty, advanced practice nurses, and registered nurses, participated in the Delphi technique. Final medians and interquartile ranges were calculated. RESULT Seven components with 43 nursing outcomes and quality indicators for older adults with end-stage cancer were developed, encompassing physical pain relief, symptom management, physical well-being, complication prevention, psychosocial support, caregiver and family roles in end-of-life care, and advance care planning. CONCLUSION The caregiver and family's role in end-of-life care had the most indicators, reflecting the significance of family involvement in Thailand's cultural context. Consistent implementation of these indicators is crucial, and correlational analysis of indicator scores can enhance their validity.
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Affiliation(s)
- Werayuth Srithumsuk
- Faculty of Nursing Sciences and Allied Health, Phetchaburi Rajabhat University, Thailand
| | | | | | - Thunyasiri Somkome
- Department of Pediatric Nursing, Boromarajonani College of Nursing Chagwat Nonthaburi, Nonthaburi, Thailand
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Pogorzelska-Maziarz M, Chastain AM, Perera UGE, Cohen CC, Stone PW, Woo K, Shang J. Health Information Technology Adoption at U.S. Home Health Care Agencies: Results from a Multi-Methods Study. Home Health Care Manag Pract 2023; 35:97-107. [PMID: 38155728 PMCID: PMC10752454 DOI: 10.1177/10848223221141902] [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: 12/30/2023]
Abstract
Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR; (2) Benefits of EHR; (3) Benefits of other HIT; (4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR; an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.
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Affiliation(s)
| | | | | | | | | | - Kyungmi Woo
- Columbia University School of Nursing, New York, NY, USA
- Seoul National University, Seoul, Korea
| | - Jingjing Shang
- Columbia University School of Nursing, New York, NY, USA
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Sterling MR, Ringel JB, Riegel B, Goyal P, Arbaje AI, Bowles KH, McDonald MV, Kern LM. Home Health Care Workers' Interactions with Medical Providers, Home Care Agencies, and Family Members for Patients with Heart Failure. J Am Board Fam Med 2023; 36:369-375. [PMID: 36948539 PMCID: PMC10329236 DOI: 10.3122/jabfm.2022.220204r2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Despite providing frequent care to heart failure (HF) patients, home health care workers (HHWs) are generally considered neither part of the health care team nor the family, and their clinical observations are often overlooked. To better understand this workforce's involvement in care, we quantified HHWs' scope of interactions with clinicians, health systems, and family caregivers. METHODS Community-partnered cross-sectional survey of English- and Spanish-speaking HHWs who cared for a HF patient in the last year. The survey included 6 open-ended questions about aspects of care coordination, alongside demographic and employment characteristics. Descriptive statistics were performed. RESULTS Three hundred ninety-one HHWs employed by 56 unique home care agencies completed the survey. HHWs took HF patients to a median of 3 doctor appointments in the last year with 21.9% of them taking patients to ≥ 7 doctor appointments. Nearly a quarter of HHWs reported that these appointments were in ≥ 3 different health systems. A third of HHWs organized care for their HF patient with ≥ 2 family caregivers. CONCLUSIONS HHWs' scope of health-related interactions is large, indicating that there may be novel opportunities to leverage HHWs' experiences to improve health care delivery and patient care in HF.
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Affiliation(s)
- Madeline R Sterling
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM).
| | - Joanna Bryan Ringel
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Barbara Riegel
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Parag Goyal
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Alicia I Arbaje
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Kathryn H Bowles
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Margaret V McDonald
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
| | - Lisa M Kern
- From the Weill Cornell Medicine, New York, NY (MRS, JBR, PG, LMK); University of Pennsylvania School of Nursing, Philadelphia (BR, KHB); Johns Hopkins University School of Medicine, Baltimore, MD (AIA); Center for Home Care Policy & Research at VNS Health, New York, NY (KHB, MVM)
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Hobensack M, Song J, Scharp D, Bowles KH, Topaz M. Machine learning applied to electronic health record data in home healthcare: A scoping review. Int J Med Inform 2023; 170:104978. [PMID: 36592572 PMCID: PMC9869861 DOI: 10.1016/j.ijmedinf.2022.104978] [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: 10/17/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Despite recent calls for home healthcare (HHC) to integrate informatics, the application of machine learning in HHC is relatively unknown. Thus, this study 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 HHC setting. Our secondary aim was to evaluate the comprehensiveness of predictors used in the machine learning algorithms guided by the Biopsychosocial Model. METHODS During March 2022 we conducted a literature search in four databases: PubMed, Embase, CINAHL, and Scopus. Inclusion criteria were 1) describing services provided in the HHC setting, 2) applying machine learning algorithms to predict adverse outcomes, defined as outcomes related to patient deterioration, 3) using EHR data and 4) focusing on the adult population. Predictors were mapped to the Biopsychosocial Model. A risk of bias analysis was conducted using the Prediction Model Risk Of Bias Assessment Tool. RESULTS The final sample included 20 studies. Eighteen studies used predictors from standardized assessments integrated in the EHR. The most common outcome of interest was hospitalization (55%), followed by mortality (25%). Psychological predictors were frequently excluded (35%). Tree based algorithms were most frequently applied (75%). Most studies demonstrated high or unclear risk of bias (75%). CONCLUSION Future studies in HHC should consider incorporating machine learning algorithms into clinical decision support systems to identify patients at risk. Based on the Biopsychosocial model, psychological and interpersonal characteristics should be used along with biological characteristics to enhance risk prediction. To facilitate the widespread adoption of machine learning, stakeholders should encourage standardization in the HHC setting.
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Affiliation(s)
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA.
| | | | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Center for Home Care Policy & Research, VNS Health, New York, NY, USA.
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA; Center for Home Care Policy & Research, VNS Health, New York, NY, USA; Data Science Institute, Columbia University, New York, NY, USA.
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Irajpour A, Maleki F, Shati M, Najafii MR. Home health care of Iranian elderly with dementia: Study protocol for guideline adaptation. J Educ Health Promot 2023; 12:8. [PMID: 37034851 PMCID: PMC10079205 DOI: 10.4103/jehp.jehp_1706_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/09/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Advanced stages of dementia interfere with elderly self-care. Consequently, they need caregivers who take responsibility for their care in the long-term. Restrictions to the caregiver's access to information, resources, and organizational support have created problems in their caregiver role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing evidence-based information and training programs. As there is no clinical practice guideline for home care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the elderly with dementia. MATERIALS AND METHODS The ADAPTE process provided by the Guidelines International Network was considered as the basis. In order to identify the care needs of Iranian patients with dementia, semi-structured interviews were added to this guideline. DISCUSSION The identification and implementation of the perspectives of patients and caregivers during the process of guidelines adaptation increase the applicability of the guidelines. Improved quality of life for the patients in their place of residence is one of the expected consequences of this guideline's implementation. The developed guidelines will be used at home health care centers, and dementia and Alzheimer's associations in Iran.
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Affiliation(s)
- Alireza Irajpour
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Maleki
- Student Research Committee, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Shati
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohamad R. Najafii
- Department of Neurology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Shahnejat-Bushehri S, Kermani A, Arslan O, Cordeau JF, Jans R. A Vehicle Routing Problem with Time Windows and Workload Balancing for COVID-19 Testers: A Case Study. IFAC Pap OnLine 2022; 55:2920-2925. [PMID: 38621003 PMCID: PMC9605723 DOI: 10.1016/j.ifacol.2022.10.175] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Due to the COVID-19 pandemic, laboratories have faced unprecedented demand for in-home delivery test services. This drastic demand increase requires a rapid reaction from laboratories to manage their testers in order to respond to the high demand volume and avoid unnecessary costs. This study provides an optimization model based on the vehicle routing problem with time windows by considering the testers' workload balancing to improve laboratories' assignment and routing policies. A medical lab that has faced this situation for its in-home test services is taken as a real-world case in the current study. A mixed-integer programming model is solved for small instances using the CPLEX solver, and an adaptive large neighborhood search algorithm is implemented for large instances. Ultimately, the obtained solutions are compared to the real-world implementation of the lab on a dataset of six consecutive days, and the results are further discussed.
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Affiliation(s)
- S Shahnejat-Bushehri
- Department of Logistics and Operations Management, HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montréal, Canada
| | - A Kermani
- Department of Logistics and Operations Management, HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montréal, Canada
| | - O Arslan
- Department of Logistics and Operations Management, HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montréal, Canada
| | - J-F Cordeau
- Department of Logistics and Operations Management, HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montréal, Canada
| | - R Jans
- Department of Logistics and Operations Management, HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montréal, Canada
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Abstract
OBJECTIVES Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings. METHODS Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs. RESULTS CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p < .001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p<0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p<0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p < .001). DISCUSSION CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, NY, USA
| | - Meiling Ying
- Department of Public Health Sciences, University of Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, NY, USA
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Reckrey JM, Tsui EK, Morrison RS, Geduldig ET, Stone RI, Ornstein KA, Federman AD. Beyond Functional Support: The Range Of Health-Related Tasks Performed In The Home By Paid Caregivers In New York. Health Aff (Millwood) 2020; 38:927-933. [PMID: 31158023 DOI: 10.1377/hlthaff.2019.00004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Paid caregivers (for example, home health aides and personal care attendants) are formally tasked with helping older adults with functional impairment meet their basic needs at home. This study used thirty semistructured interviews with dyads of patients or their proxies and their paid caregivers in New York City to understand the range of health-related tasks that paid caregivers perform in the home and determine whether these tasks are taught in the New York State Department of Health's curriculum. We found that patients, proxies, and paid caregivers all reported that paid caregivers performed a wide range of health-related tasks that were often not part of their formal training. Creating clear competencies for paid caregivers that reflect the full breadth of health-related tasks they may perform in the home could help maximize the positive impact of the paid caregiver workforce on the lives of patients living at home with functional impairment.
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Affiliation(s)
- Jennifer M Reckrey
- Jennifer M. Reckrey ( ) is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City
| | - Emma K Tsui
- Emma K. Tsui is an assistant professor of community health and social sciences at the City University of New York School of Public Health, in New York City
| | - R Sean Morrison
- R. Sean Morrison is a professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Emma T Geduldig
- Emma T. Geduldig is a student in the Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Robyn I Stone
- Robyn I. Stone is senior vice president for research at LeadingAge, in Washington, D.C
| | - Katherine A Ornstein
- Katherine A. Ornstein is an assistant professor in the Department of Geriatrics and Palliative Medicine and the Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Alex D Federman
- Alex D. Federman is a professor in the Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
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Sockolow PS, Bass EJ, Yang Y, Le NB, Potashnik S, Bowles KH. Availability and Quality of Information Used by Nurses While Admitting Patients to a Rural Home Health Care Agency. Stud Health Technol Inform 2019; 264:798-802. [PMID: 31438034 DOI: 10.3233/shti190333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Home health care admission nurses need high quality patient information but that information is not uniformly available. Despite this challenge, these nurses must make four critical decisions at patient admission to construct the plan of care: (1) patient problems to address in the home health care episode; (2) patient medication management; (3) services in addition to skilled nursing; and (4) skilled nursing visit pattern. We observed 12 in-home admissions at a rural home health care agency and interviewed nurses before and after about these decisions. We analyzed content and quality of documents. To evaluate quality, for each decision we assessed concordance between documents. Interview responses provided context in the analysis. Across all admissions, documents and their contents were not uniformly present. Nurses rarely received visit pattern or medication management information. There was discordance in the number of patient problems among and between available documents and the plan of care. Electronic health record design recommendations include interoperability and structured, consistent, actionable information.
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Affiliation(s)
- Paulina S Sockolow
- Drexel University, College of Nursing and Health Professions, Philadelphia PA USA
| | - Ellen J Bass
- Drexel University, College of Nursing and Health Professions, Philadelphia PA USA.,Drexel University, College of Computing and Informatics
| | - Yushi Yang
- Drexel University, College of Computing and Informatics
| | - Natasha B Le
- University of Pennsylvania School of Nursing, Philadelphia, PA USA
| | - Sheryl Potashnik
- Drexel University, College of Nursing and Health Professions, Philadelphia PA USA
| | - Kathryn H Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA USA.,Visiting Nurse Service of New York, New York, New York, USA
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Tsuchiya R, Yoshie S, Kawagoe S, Hirahara S, Onishi H, Murayama H, Nishinaga M, Iijima K, Tsuji T. Development of an inter-professional educational program for home care professionals: Evaluation of short-term effects in suburban areas. Nihon Koshu Eisei Zasshi 2017; 64:359-370. [PMID: 28966291 DOI: 10.11236/jph.64.7_359] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.
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Affiliation(s)
- Rumiko Tsuchiya
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Satoru Yoshie
- Center for Home Care Medicine, Faculty of Medicine, The University of Tokyo
| | | | | | - Hirotaka Onishi
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo
| | | | | | | | - Tetsuo Tsuji
- Institute of Gerontology, The University of Tokyo
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Abstract
OBJECTIVE To examine whether home health agencies selectively discontinue services to areas with socio-economically disadvantaged people after the introduction of Home Health Compare (HHC), a public reporting program initiated by Medicare in 2003. STUDY DESIGN /METHODS We focused on agencies' initial responses to HHC and examined selective market-area exits by agencies between 2002 and 2004. We measured HHC effects by the percentage of quality indicators reported in public HHC data in 2003. Socio-economic status was measured by per capita income and percent college-educated at the market-area level. DATA SOURCES 2002 and 2004 Outcome and Assessment Information Set (OASIS); 2000 US Census file; 2004 Area Resource File; and 2002 Provider of Service File. PRINCIPAL FINDINGS WE FOUND A SMALL AND WEAK EFFECT OF PUBLIC REPORTING ON SELECTIVE EXITS: a 10-percent increase in reporting (reporting one more indicator) increased the probability of leaving an area with less-educated people by 0.3 percentage points, compared with leaving an area with high education. CONCLUSION The small level of market-area exits under public reporting is unlikely to be practically meaningful, suggesting that HHC did not lead to a disruption in access to home health care through selective exits during the initial year of the program.
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Affiliation(s)
- Kyoungrae Jung
- The Pennsylvania State University-College of Health and Human Development
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Al-Hazmi AM, Kurashi NY. The profile of long-term care patients in Al-khobar and dammam, saudi arabia. J Family Community Med 2006; 13:25-30. [PMID: 23012099 PMCID: PMC3410074] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES.: To find out the profile of patients who stay more than 20 days in hospital in Al-Khobar and Al-Dammam. METHODS.: A cross sectional descriptive study was designed using a questionnaire completed by health care providers (physicians, nurses, physiotherapists, and social workers) of a random sample of 159 patients out of 318 patients identified as having stayed in the hospital for more than 20 days. RESULTS.: The mean length of stay of the patients were 358.6 ±776 days in government hospitals, and 1014.4 ±1018.3 days in private hospitals. Patients were seen as stable by their doctors, 66.7% in government hospitals and 93.9% in private hospitals (statistically significant different at p<0.001. Physicians agreed that about two thirds of the patients could have been managed at home. 57.2% of the patients had no active problems. Diseases of the nervous system and sense organs accounted for 67.9% of the diagnoses, followed by endocrine, nutritional, and metabolic diseases (37.1%), diseases of the circulatory system (32.7%), and neoplasms (1.9%). Diabetes mellitus was the commonest illness making up 53.2% and 57.1% of the long-term patients in private and government hospitals respectively. The active problems of 25% and 23.5% of the patients was tracheostomy care and ventilation respectively. CONCLUSIONS.: Long-term patients tended to stay longer in private hospitals than in government hospitals, had diseases related to the nervous and endocrine systems and nutritional metabolism, were in stable condition with no active problems, and could thus, be managed at home.
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Affiliation(s)
- Ali M. Al-Hazmi
- Ministry of Health & College of Health Sciences, Jizan, Saudi Arabia
| | - Nabil Y. Kurashi
- Department of Family & Community Medicine, College of Medicine, King Faisal University, Dammam, Saudi Arabia,Correspondence to: Dr. Nabil Y. Kurashi, Department of Family & Community Medicine, College of Medicine, King Faisal University, P.O. Box 40024, Al-Khobar 31952, Saudi Arabia - E-mail:
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