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Sy M, Thacker A, Sheehan OC, Leff B, Ritchie CS. Caring for caregivers and persons living with dementia under home-based primary care: protocol for an interventional clinical trial. Pilot Feasibility Stud 2024; 10:28. [PMID: 38336779 PMCID: PMC10854016 DOI: 10.1186/s40814-024-01455-x] [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] [Received: 07/24/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Approximately 7.5 million older adults are homebound, who have difficulty and/or need assistance to leave their homes. In this growing population, the prevalence of people living with dementia (PLWD) is approximately 50%. Current dementia care models in the USA were developed for traditional office-based primary care and have not been tailored to home-based primary care (HBPC) delivery models. Literature has shown that office-based collaborative interventions can improve caregiver outcomes including caregiver stress, well-being, and morbidity and patient outcomes including improved quality of life and reduced emergency department visits (Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, JAMA Int Med 179:1658, 2019). To date, the evidence for HBPC dementia interventions is lacking. Though HBPC has demonstrated benefit in homebound older adults, there is limited literature on the effects of HBPC on persons living with dementia (Nguyen HQ, Vallejo JD, Macias M, Shiffman MG, Rosen R, Mowry V, J Am Geriatr Soc 70:1136-46, 2021). Our goal is to develop a HBPC-focused dementia care intervention that integrates the components of two previously developed dementia care models and test the feasibility of implementing it in HBPC practices to improve the quality of life and wellbeing of homebound PLWD and their caregivers. METHODS We will first conduct qualitative focus groups at two HBPC practice sites, one in the Southeast and one in Hawaii in order to obtain preliminary feedback on the proposed intervention. At each site, there will be one focus group with caregivers of PLWD and another with HBPC clinicians and staff to help develop and refine our intervention. We will then conduct an open-pilot trial of the refined intervention at the two HBPC practices. A total of up to 25 patient/caregiver dyads will be recruited at each site (N = 50 total). Outcomes measured through pre-and-post assessments and exit interviews will include (a) feasibility for the caregiver to engage with and complete baseline assessments and access educational materials and community resources and (b) feasibility for the practice to identify potential caregivers/patients, assess eligible patient/caregiver dyads, use patient and caregiver assessments, recruit patient/caregiver dyads, recruit racial and ethnic minorities, use care modules, and engage with the tele-video case conference, (c) net promoter score, (d) acceptability of the intervention to caregivers and patients to participate in the intervention, (e) caregivers feeling heard and understood, and (f) caregiver well-being. DISCUSSION Testing the feasibility and acceptability of the adapted intervention in these two HBPC practices will provide the basis for future testing and evaluation of a fully powered intervention for PLWD and their caregivers cared for in HBPC with the goal of disseminating high-quality and comprehensive dementia-care focused interventions into HBPC practices. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov NCT05849259 in May 2023.
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Affiliation(s)
- Maimouna Sy
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Ayush Thacker
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Orla C Sheehan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine Seel Ritchie
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
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Schwabenbauer AK, Merladet J, Metzner N, Salib B, Siffert K. Adapting Measurement-Based Care to VA Home-Based Primary Care Mental Health Treatment: A Quality Improvement Project. Clin Gerontol 2024:1-10. [PMID: 38226906 DOI: 10.1080/07317115.2024.2304889] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
OBJECTIVES This quality improvement project sought to develop guidance for Home-Based Primary Care (HPBC) Mental Health (MH) clinicians on integrating Measurement-Based Care (MBC) into their practice and gain participating psychologists' feedback on their experience using MBC for treating mental health concerns with HBPC Veterans. METHODS Based on feedback from the HBPC MH community and in consultation with national leadership, a workgroup of HBPC psychologists developed a guide tailoring MBC to HBPC Veterans. Eight HBPC psychologists piloted the adapted MBC approach with 53 Veterans. Participating psychologists provided feedback on measure administration, Veterans' responses to MBC, and perceived benefits and challenges. RESULTS Pilot participants' feedback suggested that MBC can be a highly useful tool for delivering mental health services in HBPC, although feedback varied about specific MBC measures. Qualitative feedback was primarily positive, but participants noted challenges based on the nature of the presenting problem and Veteran-specific characteristics. CONCLUSIONS Findings indicate that MBC can be utilized with appropriate HBPC Veterans and has the potential to benefit care. Further research is needed to clarify factors that enhance or reduce MBC's utility within HBPC. CLINICAL IMPLICATIONS HBPC MH providers identified MBC as a useful tool particularly when adapted to meet the needs of HBPC Veterans.
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Affiliation(s)
| | - John Merladet
- Behavioral Health, Orlando VA Medical Center, Orlando, Florida, USA
| | - Neil Metzner
- Behavioral Health, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Brea Salib
- Behavioral Health, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kevin Siffert
- Behavioral Health, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Choi JW, Yoo AJ. The Impact of Home-Based Primary Care on Outcomes Among Older Adults in South Korea. J Am Med Dir Assoc 2023; 24:985-990.e2. [PMID: 37060921 DOI: 10.1016/j.jamda.2023.03.009] [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: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES Although Korea issued a law and developed benefits of National Health Insurance (NHI) to enable the provision of home-based primary care (HBPC) along with implementation of a pilot project for community care for older adults in August 2019, the outcomes of HBPC services were not surveyed in Korea. This study aimed to assess the outcomes of HBPC among older adults. DESIGN Analyses were conducted using data from the National Health Insurance Service in connection with administrative survey data. Difference-in-differences analysis was performed using a generalized estimating equation and Cox proportional hazards model. SETTING AND PARTICIPANTS Overall, 538 older adults who used HBPC services in a pilot project for community care and 2059 propensity score-matched older individuals who did not use HBPC services in Korea were included. METHODS The length of home stay, total costs of NHI, hospitalizations, and admission to long-term care (LTC) facilities were measured as outcomes, and the outcomes of the participants were compared to those of the control group. RESULTS The findings indicated an increase of 8.3 days (95% CI 2.1-14.5) in the length of home stay and a reduction of US$1241 (95% CI -2342 to -139) in total costs of NHI among older adults who used HBPC services compared to the control group. The odds ratio for rates of hospitalization among older adults who utilized HBPC services was 0.77 (95% CI 0.60-0.98) and the hazard ratio for the admission of LTC facilities was 0.12 (95% CI 0.04-0.32) in comparison to the control group. CONCLUSIONS AND IMPLICATIONS The HBPC intervention has resulted in an increased length of home stay and reduced total costs, hospitalizations, and admission to LTC facilities among Korean older adults. In the future, new HBPC models must be developed to provide interprofessional team-based HBPC services with a standardized protocol of service provision.
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Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| | - Ae Jung Yoo
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea.
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Mills WR, Huffman MM, Roosa J, Pitzen K, Boyd R, Schraer B, Poltavski D. Provision of Home-Based Primary Care to Individuals With Intellectual and/or Developmental Disability Is Associated With a Lower Hospitalization Rate Than a Traditional Primary Care Model. J Am Med Dir Assoc 2022:S1525-8610(22)00403-0. [PMID: 35714700 DOI: 10.1016/j.jamda.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this study was to determine if providing home-based primary care (HBPC) to individuals with intellectual and/or developmental disabilities (IDD) was associated with a lower hospitalization rate than a control group receiving traditional primary care. DESIGN AND INTERVENTION Individuals with IDD living in supported residential settings in Ohio were offered HBPC. Individuals electing HBPC made up the intervention group. Those who did not opt for HBPC continued to receive traditional primary care services and made up the control group. Hospitalizations were tracked in both groups. SETTING AND PARTICIPANTS The 757 study participants had IDD diagnoses and received residential support services throughout the study period. METHODS Annualized hospitalization rate was determined in both groups and was compared using generalized estimating equations while controlling for patients' age and hospitalization rate in the year prior to the study. RESULTS The results showed that group membership had a significant effect on the hospitalization rate (Wald χ2 = 20.71, P < .01). Being in the control group was associated with a 2.12-fold increase in annual hospitalization rate for a given patient. The overall population hospitalization rate was 329 hospitalizations per 1000 per year in the HBPC-receiving individuals and 619 hospitalizations per 1000 per year in the control group. CONCLUSIONS AND IMPLICATIONS We found that individuals with IDD receiving HBPC were hospitalized at a lower rate than a control group receiving traditional primary care. Expanding access to HBPC may be a worthwhile priority for organizations that support individuals with IDD.
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Cox MB, McGregor MJ, Huggins M, Moorhouse P, Mallery L, Bauder K. Evaluation of an initiative to improve advance care planning for a home-based primary care service. BMC Geriatr 2021; 21:97. [PMID: 33530930 PMCID: PMC7852206 DOI: 10.1186/s12877-021-02035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively. Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.
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Affiliation(s)
- Michelle B Cox
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,HomeViVE Program, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Madison Huggins
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Paige Moorhouse
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Laurie Mallery
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Katie Bauder
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
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Gillespie SM, Manheim C, Gilman C, Karuza J, Olsan TH, Edwards ST, Levy CR, Haverhals L. Interdisciplinary Team Perspectives on Mental Health Care in VA Home-Based Primary Care: A Qualitative Study. Am J Geriatr Psychiatry 2019; 27:128-137. [PMID: 30424995 DOI: 10.1016/j.jagp.2018.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/14/2018] [Accepted: 10/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This qualitative study describes the structure and processes of providing care to U.S. Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) enrollees with mental health care needs; explains the role of the HBPC psychologist; and describes how mental health treatment is integrated into care from the perspective of HBPC team members. DESIGN HBPC programs were selected for in-person site visits based on initial surveys and low hospitalization rates. SETTING Programs varied in setting, geographic locations, and primary care model. PARTICIPANTS Eight site visits were completed. During visits, key informants including HBPC program directors, medical directors, team members, and other key staff involved with the HBPC program participated in semi-structured individual and group interviews. MEASUREMENTS Recorded interviews, focus groups, and field observation notes. RESULTS Qualitative thematic content analysis revealed four themes: 1) HBPC Veterans have not only complex physical needs but also co-occurring mental health needs; 2) the multi-faceted role of psychologists on HBPC teams, that includes providing care for Veterans and support for colleagues; 3) collaboration between medical and mental health providers as a means of caring for HBPC Veterans with mental health needs; and 4) gaps in providing mental health care on HBPC teams, primarily related to a lack of team psychiatrists and/or need for specialized medication management for psychiatric illness. CONCLUSIONS Mental health providers are essential to HBPC teams. Given the significant mental health care needs of HBPC enrollees and the roles of HBPC mental health providers, HBPC teams should integrate both psychologists and consulting psychiatrists.
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Affiliation(s)
- Suzanne M Gillespie
- Canandaigua VA Medical Center, Canandaigua, NY; Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY.
| | - Chelsea Manheim
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care, Aurora, CO
| | - Carrie Gilman
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care, Aurora, CO
| | - Jurgis Karuza
- Canandaigua VA Medical Center, Canandaigua, NY; Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY; Department of Psychology, S.U.N.Y at Buffalo State, Buffalo, NY
| | - Tobie H Olsan
- Canandaigua VA Medical Center, Canandaigua, NY; School of Nursing, University of Rochester, Rochester, NY
| | - Samuel T Edwards
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon; Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland Oregon
| | - Cari R Levy
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care, Aurora, CO; University of Colorado, Anschutz Medical Campus, School of Medicine, Department of Medicine, Division of Health Care Policy and Research, Aurora, Colorado
| | - Leah Haverhals
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centric & Value Driven Care, Aurora, CO
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Huang CH, Umegaki H, Kamitani H, Asai A, Kanda S, Maeda K, Nomura H, Kuzuya M. Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study. BMC Geriatr 2019; 19:21. [PMID: 30678632 PMCID: PMC6345012 DOI: 10.1186/s12877-019-1040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care. Methods Our prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up period. Patients’ demographic data, socioeconomic status, physical diseases, medication use, feeding intake status, nutritional status, and functional status were measured annually. The 4-item quality of life index (QOL-HC [home care]) including self-perceived and family-reported QOL ratings that had been developed and previously validated in home care settings was used. Linear regression models were used for cross-sectional and longitudinal analyses. Results The participants’ mean age was 78.8 ± 10.8 years, and 55.9% of the sample was male. Most patients were frail, disabled, and/or malnourished. Self-perceived and family-reported QOL scores dropped sequentially on annual follow-ups. In the multivariate longitudinal analysis, patients who were divorced (β = 1.74) had high baseline QOL scores (β = 0.75) and reported higher QOL ratings. In addition, high functional dependency was associated with a low self-perceived QOL rating, with a β-value of − 1.24 in the pre-bedridden group and − 1.39 in the bedridden group. Given the family-reported QOL rating, the baseline QOL scores (β = 0.50) and Mini-Nutritional Assessment–Short-Form scores (β = 0.37) were found to have positive associations with the QOL rating. Conclusions For the disabled receiving home-based primary care, independent functional status and divorce were positively associated with better self-perceived QOL, whereas nutritional status was correlated with better family-reported QOL.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Department of Family Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China.,School of Medicine for International Students, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hiroko Kamitani
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Atushi Asai
- Sanei Clinic, 3-560 Komaki, Komaki, Aichi, 485-0041, Japan
| | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital, 1-5 Tenpaku, Minami, Nagoya, Aichi, 457-0803, Japan
| | - Keiko Maeda
- Mokuren Clinic, Department of Home Medical Care, 2-21-25 Izumi, Higashi-ku, Nagoya, Aichi, 461-001, Japan
| | - Hideki Nomura
- Aichi Clinic, 2-330 Fukuike, Tenpaku, Nagoya, Aichi, 468-0049, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Norman GJ, Wade AJ, Morris AM, Slaboda JC. Home and community-based services coordination for homebound older adults in home-based primary care. BMC Geriatr 2018; 18:241. [PMID: 30305053 PMCID: PMC6180527 DOI: 10.1186/s12877-018-0931-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Medically complex vulnerable older adults often face social challenges that affect compliance with their medical care plans, and thus require home and community-based services (HCBS). This study describes how non-medical social needs of homebound older adults are assessed and addressed within home-based primary care (HBPC) practices, and to identify barriers to coordinating HCBS for patients. METHODS An online survey of members of the American Academy of Home Care Medicine (AAHCM) was conducted between March through November 2016 in the United States. A 56-item survey was developed to assess HBPC practice characteristics and how practices identify social needs and coordinate and evaluate HCBS. Data from 101 of the 150 surveys received were included in the analyses. Forty-four percent of respondents were physicians, 24% were nurse practitioners, and 32% were administrators or other HBPC team members. RESULTS Nearly all practices (98%) assessed patient social needs, with 78% conducting an assessment during the intake visit, and 88% providing ongoing periodic assessments. Seventy-four percent indicated 'most' or 'all' of their patients needed HCBS in the past 12 months. The most common needs were personal care (84%) and medication adherence (40%), and caregiver support (38%). Of the 86% of practices reporting they coordinate HCBS, 91% followed-up with patients, 84% assisted with applications, and 83% made service referrals. Fifty-seven percent reported that coordination was 'difficult.' The most common barriers to coordinating HCBS included cost to patient (65%), and eligibility requirements (63%). Four of the five most frequently reported barriers were associated with practices reporting it was 'difficult' or 'very difficult' to coordinate HCBS (OR from 2.49 to 3.94, p-values < .05). CONCLUSIONS Despite the barriers to addressing non-medical social needs, most HBPC practices provided some level of coordination of HCBS for their high-need, high-cost homebound patients. More efforts are needed to implement and scale care model partnerships between medical and non-medical service providers within HBPC practices.
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Affiliation(s)
- Gregory J. Norman
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
| | - Amy J. Wade
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
| | - Andrea M. Morris
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
| | - Jill C. Slaboda
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
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Ritchie CS, Leff B. Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care. J Pain Symptom Manage 2018; 55:1041-1046. [PMID: 29031914 DOI: 10.1016/j.jpainsymman.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population.
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Affiliation(s)
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Norman GJ, Orton K, Wade A, Morris AM, Slaboda JC. Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies. BMC Health Serv Res 2018; 18:45. [PMID: 29374478 PMCID: PMC5787297 DOI: 10.1186/s12913-018-2855-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/17/2018] [Indexed: 11/15/2022] Open
Abstract
Background Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. Methods Six practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office. Results The aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology. Conclusions Learnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.
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Affiliation(s)
- Gregory J Norman
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA.
| | - Kristann Orton
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Amy Wade
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Andrea M Morris
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Jill C Slaboda
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
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Wu LT, Brady KT, Spratt SE, Dunham AA, Heidenfelder B, Batch BC, Lindblad R, VanVeldhuisen P, Rusincovitch SA, Killeen TK, Ghitza UE. Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study. Contemp Clin Trials 2016; 46:30-38. [PMID: 26563446 PMCID: PMC4695300 DOI: 10.1016/j.cct.2015.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/11/2015] [Revised: 10/31/2015] [Accepted: 11/07/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. METHODS We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. DISCUSSION By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
| | - Kathleen T Brady
- South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Susan E Spratt
- Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - Ashley A Dunham
- Duke Translational Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Brooke Heidenfelder
- Duke Translational Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Bryan C Batch
- Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | | | | | | | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse, Bethesda, MD, USA
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