Health Care Nurses Research Articles

NCD prevention and control in Kenya: feasibility study of health kiosks in markets “HEKIMA Study”

Abstract Introduction Non-communicable diseases (NCDs) account for 50% of hospital admissions and 55% of hospital mortality in Kenya. Cardiovascular diseases (CVDs) lead NCD mortality at 14% due to high prevalence of multiple risk factors. Community markets are social institutions with untapped potential for public health. HEKIMA is a multi-phased theoretically driven intervention exploring whether health kiosks in community markets, manned by community health workers (CHWs) and supervised by health centre (HC) nurses, can improve the reach of preventive care to vulnerable communities. Methods A mixed methods study in Vihiga County targeting 320 participants aged 15 years and above. Nurses and CHWs were trained to deliver evidence-based CVD health promotion, risk screening, and early intervention. Multi-sector stakeholder consultations, readiness assessments of markets and HCs, and semi-structured interviews informed intervention development. Evaluation use the Re-AIM framework. Results At 6 months of intervention there 2224 kiosk users which exceeded target of 300; 61% primary school education; 77% females; median age - males 48y, females 52y. Proportion with high blood pressure, overweight, obesity, and diabetes 48%, 32%, 25% and 12% respectively. 30% were referred to HC, and 34% followed up at least once at the kiosk. High acceptability of HEKIMA among CHWs, nurses and market users led to HEKIMA kiosks being integrated in the primary healthcare pathway. Key enablers were multi-sectoral alliance of government, civic organisations, community market champions, local businesses and health sector; culture centred coproduction and capacity building Challenges included understaffing, commodity supplies and seasonality. Conclusions HEKIMA successfully promoted NCD prevention and control, particularly among vulnerable populations. Scaling up across Kenya is planned to explore translational impacts in different contexts. Key messages • Multisectoral alliance critical for prevention of NCDs. • Theoretically underpinned complex systems interventions addresse inequities.

Mental Health Nursing Care for Mrs. R with the Main Issue of Risk of Violent Behavior Due to Paranoid Schizophrenia in the Brotojoyo Ward, Dr. Amino Gondohutomo Psychiatric Hospital

Background: Paranoid schizophrenia is a mental disorder characterized by severe psychopathological symptoms, including delusions and hallucinations, which often lead to a risk of violent behavior. Purpose: This case study aims to provide nursing care for patients with paranoid schizophrenia at RSJD dr. Amino Gondohutomo, Central Java. The case discussed involves Mrs. R, who experiences a risk of violent behavior as a consequence of paranoid schizophrenia. Methods: The method used in this discussion is a case study with a mental health nursing care approach, including assessment, nursing diagnosis, intervention, implementation, and evaluation. Results: The results of the nursing care show that appropriate interventions, such as physical and verbal anger control exercises, as well as spiritual approaches, can reduce the intensity of violent behavior in the patient. Family support and patient compliance in undergoing pharmacological therapy also play a significant role in the recovery process. Conclusion: In conclusion, comprehensive and collaborative nursing care can improve the patient's psychological condition and reduce the risk of violent behavior.

Assessment of Knowledge and Practice on Prevention of Pressure Ulcer among Nurses in Palestine- Cross Sectional Study

Pressure Ulcers (PUs) are localized skin injuries caused by long-term compression of soft tissue between an external pressure source and a bony prominence. They are one of the iatrogenic causes of extra morbidity for hospitalized patients. This study aimed to assess knowledge and practices regarding preventing PUs among nurses in Palestine. A cross-sectional study was conducted on 430 nurses in various Palestinian hospitals and health centers between February 15, 2024, and April 14, 2024. Convenience sampling was used to collect samples for this study. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 27. Data analysis included descriptive and inferential statistics. The study showed that 65.61% of participants correctly answered questions about PU prevention. Regarding practice, 55.3% of nurses demonstrated a good level, with an average score of 2.37. Additionally, there was a significant association between demographic variables and levels of knowledge and practice in PU prevention, with P values ranging from 0.01 to 0.05. The study found that male nurses had higher knowledge and practice scores than female nurses, with significant differences in mean scores. The overall level of knowledge and practice among Palestinian nurses was found to be good; however, there is room for improvement in several aspects of both knowledge and practice. Variables such as gender, age, marital status, qualification, and job experience were found to have significant correlations with the level of knowledge and practice among nurses.

Experience of Nurses in Carrying Out the Main Duties and Functions of Nurses at UPT Puskesmas Panamas, Kapuas Regency, in 2023 / 2024

This research explores the experiences of nurses in carrying out their main duties and functions at the Panamas Community Health Center. Qualitative methods with a phenomenological approach are used to gain an in-depth understanding of this phenomenon. Data was collected through in-depth interviews with 12 nurses selected by purposive sampling. Data analysis using the Colaizzi method produced five main themes: (1) Nurses' activities in health services, (2) Tasks carried out by community health center nurses, (3) The importance of good health program management, (4) Management of duties and authority in health services, and (5) Shortage of health and non-health personnel and multifunctionality in health services. Research results show that nurses often have to take over the roles of doctors, administrative staff, and pharmacists due to limited human resources even though these tasks should not be their responsibility. This causes nurses to lose focus in carrying out their main duties, nurses feel that their main role as care providers is disturbed. Nurses also run various health programs and serve as physician assistants, although these roles often exceed their duties. The importance of good health program management was emphasized, as many participants experienced difficulties in achieving targets, reporting and patient monitoring. Management of tasks and authority includes handover of tasks, delegation of daily tasks, and delegation of authority, however socialization to staff has not been comprehensive. Lack of human resources causes nurses to carry out multiple roles which hinders their professional development. This research recommends strengthening competency and further training for nurses, increasing legal awareness regarding the delegation of authority, integrating health management education in the nursing curriculum, as well as increasing the number and qualifications of human resources in community health centers.

The The Design of an Interprofessional Health Record Form for Diabetes Mellitus Care at Primary Health Care Facility: A Recommendation

This research focuses on the pillars of primary care transformation by increasing primary services' capacity and capability, especially Diabetes Mellitus (DM) care. The study aims to produce a recording form containing simple, interprofessional records of DM patient care that can be used by various professions and can be applied in multiple primary health facilities. The design was developed through a development research approach with stages of form modification, expert and practitioner review, revision, trial, focus group discussion, and final revision. The trial was carried out by Community Health Center (Puskesmas) nurses in services at the Puskesmas through home visits for DM patients, Posbindu services, and outpatient care. Data from expert opinions, user opinions, and observations of the forms tested were analyzed qualitatively using the Technology Acceptance Model concept approach. The resulting form consists of two pages containing primary patient data and daily progress notes in tabular form. Research participants showed positive beliefs, attitudes, and behavior toward the forms being tested—the actual use of the form on an average of 3 patients per participant. The completeness was 90 percent filled. They expressed their intention to use the form further and recommended widespread dissemination to implement it in practice. The form is acceptable and ready to be applied for outpatient care, health monitoring, and home care for DM cases. Recommendations can be given to policymakers and health service providers to implement in services. Apart from that, the form can be further developed in electronic form by information technology developers.

Hepatitis B vaccination coverage and associated factors among nurses working at health centers in Addis Ababa, Ethiopia: a cross-sectional study

BackgroundHepatitis B virus (HBV) poses one of the most serious workplace health risks facing healthcare workers, especially nurses, due to occupational exposure. The HBV vaccination coverage among healthcare workers in Ethiopia ranged from 5.4 to 21.9%. However, little is known about HBV vaccination coverage and associated factors among nurses in Ethiopia. Therefore, the aim of this study was to assess HBV vaccination coverage and associated factors among nurses working in health centers in Addis Ababa, Ethiopia, in 2023.MethodsAn institutional-based cross-sectional study was conducted from March 2 to March 31, 2023, among 428 nurses working in 32 health centers in Addis Ababa, Ethiopia. Data were entered into Epi-Info version 7.2.5.0 and then exported to SPSS version 27 for analysis. Descriptive statistics (frequencies and proportions) were used to summarize the data on the study variables. Bivariate and multivariate logistic regression analyses were conducted to determine the strength of the association, and the statistical significance of associations between the variables was determined using adjusted odds ratio with a 95% CI and p values < 0.05.ResultsHBV-full vaccination coverage among 428 nurses in health centers in Addis Ababa, Ethiopia, was 36.9%. Male nurses [AOR = 1.78, 95% CI: 1.08, 2.95], taking training on infection prevention [AOR = 1.73, 95% CI: 1.08, 2.78], having good knowledge about HBV vaccine [AOR = 1.98, 95% CI: 1.28, 3.04], and testing for HBV [AOR = 1.98, 95% CI: 1.08, 3.64] were more likely to have HBV full vaccination coverage, whereas monthly salary ≤ 7,071 Ethiopian Birr was 54% less likely to have HBV full vaccination coverage [AOR = 0.46, 95% CI: 0.25, 0.85] at p-value < 0.05.ConclusionThis study revealed that the full HBV vaccination coverage of nurses working in health centers in Addis Ababa, Ethiopia, was low (36.9%), and consequently, the majority of nurses are at a high risk of being infected with HBV. Therefore, the Ministry of Health and health centers should promote awareness, implement prevention programs, provide diagnostic, treatment, and care services, enhance information generation and utilization, and strengthen the health system to increase vaccination coverage among nurses.

Method for Using Voicemail and Email for Qualitative Data Collection Among Nurses.

Memorializing nurses' experiences during the COVID-19 pandemic had the potential to allow scientists and policymakers to learn about the impact on the nursing profession and health care systems. Yet, nurses are considered a difficult population to recruit for research. To describe an innovative qualitative data collection method for capturing current practice experiences among nurses working during the COVID-19 pandemic. Guerilla theory served as the theoretical framework. Utilizing a qualitative descriptive design, a telephone voicemail messaging system was developed to capture nurses' experiences. Nurses were recruited with convenience and snowball sampling via social media and state listservs. The telephone voicemail messaging system, Twilio, was used. After listening to the recording of the consent form, the participants shared their experiences by leaving a voice message where they answered the prompt, "Tell us about your experiences working during the COVID-19 pandemic." Seventy voicemails were included, and the voicemails were transcribed. After a nurse shared their experience via an email sent to the research team, emails were added to the data collection; 16 emails were received. Transcripts and emails were uploaded to the qualitative data analysis software program, Dedoose, and coded by 2 researchers using content analysis. Main themes were derived and discussed among the research team. Allowing participants multiple modes of expressing their experiences promote inclusivity in data collection. Further development and standardization of this method is needed for future research.

Sleep disorder experienced by healthcare nurses after terminating Zero-COVID-19 policy

ObjectiveMedical staff, especially nurses, suffered great anxiety and stress from the COVID-19 pandemic, which negatively affected their sleep quality. In this study, we aimed to analyze the sleep quality of nursing staff after terminating the Zero-COVID-19 policy in China.Methods506 participants were involved in our study. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep status of the participants. Binary regression was performed to evaluate the impact factors related to sleep difficulty.ResultsThe majority of participants (96.44%) suffered from sleep disturbances. There were significant differences in age, education level and front-line activity between participants with good sleep quality and sleep difficulty. Younger age (16–25 years old) was independently associated with less sleep difficulty, while front-line activity was independently associated with severe sleep difficulty.ConclusionSleep disorder was very common among nurses after ending the Zero-COVID-19 policy in China. More front-line nurses suffered severe sleep difficulty in particular, which should be worthy of attention.

To Assess the Impact of the Quality and Level of Family Support to Pregnant Women on Maternal and Fetal Outcomes

Abstract Background: Throughout pregnancy, women need support from the family to gain better maternal and fetal outcomes. Emotional distress in women during pregnancy is known to increase the risk of adverse outcomes in women and newborns. Increasing family support can improve birth outcomes and maternal wellbeing and can reduce complications in mother and increased neonatal birth weight. Aim and Objective: This study aims to evaluate the influence of the level and quality of family support during pregnancy on maternal and fetal outcomes and to identify any association between sociodemographic variables and the impact of the level and quality of family support during the third trimester. Materials and Methods: This study used a quantitative approach combined with a survey research design. Data were collected from four primary health centers (Rethare, Vadgaon, Kale, and Supane) at Karad, Maharashtra, India. A consecutive sampling technique was used to select the 344 subjects from the Rethare, Vadgaon, Kale, and Supane areas of Karad Taluka. Data were collected before the completion of the first trimester, then during the second trimester, and post-delivery. Upon evaluation, the tool was validated by experts representing the fields of community health nursing, mental health nursing, obstetric gynecology, and pediatric care. A pilot study was conducted on 30 samples. The data collected were analyzed by using descriptive and inferential statistics. Result: Findings regarding level of family support show that 133 women (38.7%) received good total support, 164 (47.7%) received moderate support, and 47 (13.7%) received poor family support during the third trimester. Results regarding maternal outcomes show that there was a significant association found between type of delivery and family support received after delivery with maternal outcomes and total support during the third trimester (P &lt; 0.05). It means that physical, emotional, and psychosocial support (total support) received by women would prevent complications during delivery, i.e., prevent Cesarean sections, results in the mother giving normal birth to baby. Hence, the mother needs total support during the third trimester. Conclusion: Total family support is needed by pregnant women during the third trimester to achieve maternal and fetal outcomes.

Exploring Nurse Responses to Spontaneous Breastfeeding Episodes During Routine Infant Health Checks in Finland: A Multimodal Conversation Analytic Approach

ABSTRACT Support for mothers’ uptake and longevity in breastfeeding is a global health priority. The benefits of breastfeeding are well documented, ranging from immediate health benefits for the infant that include provision of the best nutrition, to longer-term impacts such as reducing the risk of future digestive complications and obesity in adulthood. We analyze how impromptu breastfeeding might be supported by health-care nurses in Finnish maternity and child health clinics during routine infant health checks. The video data analyzed explore naturally occurring breastfeeding during these clinic encounters, using the analysis of ethnomethodology and conversation analysis (EMCA) approach to explore breastfeeding interactions between mothers, infants, and nurses. Findings demonstrate that, in extract 1 the nurse makes herself freely available, offering verbal and physical support when needed, and in extract 2 the mother manages a close intimate interaction feeding her baby whilst also engaging in knowledge exchange regarding important information with the nurse. We discuss how spontaneous breastfeeding interactions during routine clinic visits provide opportunities for nurses to support breastfeeding, where they are acknowledged as rather complex activities requiring focus. Considerations for professional practice are made by exploring how these early perinatal visits provide opportunities for nurses to observe and converse with mothers about how they are managing breastfeeding. A further conclusion suggests that an EMCA methodological exploration of breastfeeding interactions can inform future nurse practice in Finland and other countries.

Research competencies in healthcare nurses

Research competencies in healthcare nurses

Family Support to Women During Pregnancy and Its Impact on Maternal and Fetal Outcomes.

Family support is one of the determinants of lifestyle habits and relevant health behavior for pregnancy outcomes. In India, the joint family system is still practiced. Due to education, urbanization, and industrialization, the family institution continues to play a central role in people's lives.Pregnancy is a crucial period in women's lives. Good care during pregnancy is important for the health of the mother and the newborn baby. During this period, hormonal changes are complex and involve multiple hormones working together to support the developing fetus and prepare the mother's body for labor, delivery, and breastfeeding. To avoid maternal and fetal complications, she needs support from her family throughout pregnancy and the postnatal period. This study aims to evaluate the influence of the level and quality of family support during pregnancy on maternal and fetal outcomes and to identify any association between the sociodemographic variables and the impact of the level and quality of family support during the first trimester. This study used a quantitative approach with a survey research design. Data were collected from four Primary Health Centers at Karad, Maharashtra, India, i.e., Rethare, Vadgaon, Kale, and Supane. A consecutive sampling technique was used to select the 344 subjects from the Rethare, Vadgaon, Kale, and Supane areas of Karad Taluka. Data were collected before the completion of the first three months of pregnancy, then during the second trimester and after delivery. Upon evaluation, the tool was validated by experts representing a range of specialties, including community health nursing, mental health nursing, obstetric gynecology, and pediatric care. A pilot study was conducted on 30 samples. The data collected were analyzed by using descriptive and inferential statistics. The findings of the study show a significant association between the psychosocial support received in the first trimester and the total gestational weeks completed at the time of delivery (p < 0.05). The study suggests the need for psychosocial support during the first trimester for better maternal and fetal outcomes. Psychosocial family support is needed by pregnant women during the first trimester to achieve maternal and fetal outcomes.

Another nursing is possible: Ethics, political economies, and possibility in an uncertain world.

Overtaxed by the realities laid bare in the pandemic, nursing has imminent decisions to make. The exigencies of pandemic times overextend a health care infrastructure already groaning under the weight of inequitable distribution of resources and care commodified for profit. We can choose to prioritise different values. Invoking philosopher of science Isbelle Stengers's manifesto for slow science, this is not the only nursing that is possible. With this paper, I pick up threads of nursing's historical ontology, drawing previous scholarship on the historical narratives nurses use to understand themselves. Peeling back nursing's myth to alternate points of origin allows me to consider alternate lines of flight, a speculative adventure in paths not taken but paths that exist nonetheless. I go on to examine what a collective ethic of nursing could be, when we make space for these alternate histories, considering the confluences and conflicts that enable nurses to care and those that inhibit them from doing so. The imperative for this lies in the central importance of the reproductive labour of nursing health care, which leads me to a critique of nursing's capitulation to the pressures of late stage capitalism. This is a problem with ethical and ontological implications both for nursing, and also for those who require nursing care, an imperative to think about the kinds of present/futures for health, care, and health care we might cocreate in collaboration and solidarity with the communities in which nurses are imbricated, shedding the trappings of neoliberalism. There is significant power in the vision and praxis of 28 million nurses and midwives worldwide. Our ethics can guide our imagination which can in turn create possibility. This kind of endeavour-that of dreams and imagination-leads us to what could be, if only we leap.

Application of family nursing documentation in Tarakan City, Indonesia

Documentation of nursing care is authentic proof of nursing service activities, serving as the basis for fulfilling nurses' responsibilities and accountabilities. Family nursing documentation holds distinct characteristics compared to other nursing practice settings. The Indonesian nursing professional organization has established three standards for nursing care: diagnosis, intervention, and outcome. This research aimed to understand how the implementation of family nursing care documentation is conducted by community nurses in Tarakan City. The research was a correlational study with a cross-sectional approach. The study population consisted of all the nurses working in Community Health Centers in Tarakan City, totaling 80 individuals. The sample was selected using total sampling. The research variables included demographic factors, nurses' knowledge about the documentation concept, and the application of family nursing documentation; these were measured using a modified researcher-made questionnaire and declared valid and reliable. The analysis of research data used descriptive analysis and the Spearman Rank correlation test. This research identified that the majority of community nurses in Tarakan City did not implement family nursing documentation, and the level of knowledge regarding nursing documentation concepts was low. The Spearman's rank correlation test yielded a p-value of 0.874, indicating no significant correlation between the level of knowledge and the implementation of family nursing documentation. The inhibiting factors for the implementation of family nursing care documentation primarily included a high workload, a limited number of health center nurses, motivation, and the lack of clear and uniform documentation guidelines.

Self-reported competence among advanced practice nursing students in Denmark, Finland and Norway: a cross-sectional multicentre study.

The health care systems in the Nordic countries and worldwide are under pressure due to increased longevity and a shortage of nurses. Providing nurses with a high level of education, such as advanced practice nursing, is of great importance to ensure effective, safe and high-quality care. The aim of this study was to investigate self-reported competence using the Nurse Professional Competence Scale Short-Form for the first time among master's students of advanced practice nursing in the Nordic countries and to relate the findings to age, work obligations, child-rearing responsibilities, level of education and clinical nursing experience. A multicentre, cross-sectional design was used in this study conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form consisting of six competence areas was used with a maximum score of 7 per item for the analysis of single items and a transformed scale from 14.3 to 100 for analysing the competence areas (higher score equals higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. The highest mean score was found for the competence area 'Value-based nursing care'. Students living with home-dwelling children (≤ 18 years) reported significantly higher competence in 'Nursing care', while students ≥33 years reported significantly higher competence in 'Nursing care' and 'Value-based nursing care'. No significant differences were found between students working and those not working alongside their studies, between students with and without further nursing-related education, or between students with long and short experience as nurses. The findings from this study might help to further develop curricula in advanced practice nursing master's programmes to ensure high-quality nursing and sustainable health care in the future. Future high-quality master's programmes might benefit from systematic collaboration between Nordic higher education institutions as also Sweden is planning master's programme. Higher age, having children at home and working while studying should not be considered causes for concern.

Development of a Collaborative Online International Learning (COIL) Activity.

Global mobility has made global health a priority within nursing curricula and health care organizations. A collaborative online learning activity could promote international perspectives of health care delivery. Including a collaborative online international learning activity in continuing education for practicing nurses is a viable strategy that is consistent with the internationalization at home movement. Use of a qualitative descriptive evaluation approach when teaching prelicen-sure nursing students and educating practicing nurses provides effective international collaboration, promotes a global mindset, and provides an exemplar for professional development specialists to teach practicing nurses. [J Contin Educ Nurs. 2024;55(5):220-223.].

PENGETAHUAN PERAWAT TENTANG PENANGANAN RESTRAIN DALAM KEGAWATDARURATAN PSIKIATRI : DESKRIPTIF KUANTITATIF SURVEY

Background: Mental health crisis is a major issue for ODGJ and can endanger others and the environment. In handling psychiatric emergencies, the expertise of nurses is very important and needed. In the process, nurses have personal traits or qualities that can influence knowledge. Objective: The purpose of this study was to find the effect of age and education on the knowledge of health center nurses on how to handle patients with psychiatric emergencies. Methods: Using a sample of 91 respondents selected by cluster sampling technique. The research method used a cross-sectional approach. Demographic survey and knowledge assessment test (The Phisical Restraint Questionare) on how to handle psychiatric emergencies in patients were used to collect data. Results: Ordinal logistic regression analysis of the model fitting data provided results in the form of an association between the variables of age and education with knowledge and the degree of nurse expertise as indicated by a decrease in the value of -2 log Like hood decreased from 73.99 (Intercept Only) to 61.52 (Final) with p=0.029 (&lt;0.05). Conclusion: The variables show that the model fits the data, meaning that the variables of age and education level together affect the level of knowledge of nurses about handling restraints in psychiatric emergency patients. Suggestion: Training programs for nurses on physical restraints need to be carried out continuously so that the quality of care provided by nurses when physically restraining psychiatric patients is getting better. Keywords: Knowledge, Restraint, Psychiatric Emergency

Knowledge, attitudes, and practices toward Patient Safety among nurses in health centers

ObjectiveTo assess knowledge, attitudes, and practices (KAPs) toward patient safety among nurses working at primary and comprehensive health care centers in Jordan; to identify factors that predict KAPs among nurses.MethodsA descriptive cross-sectional design was conducted using a convenience sample of 307 primary health care nurses in Jordan. A self-reported questionnaire (KAPs) toward patient safety was distributed to the nurses between August 2022 and October 2022.ResultsThe results revealed that the mean score of knowledge was 9.51 out of 11 (SD = 1.35), the mean score of attitudes was 57.66 out of 75 (SD = 9.17), and the mean score of practices was 5.64 out of 8 (SD = 1.72). Where 59% of participants reported good knowledge about patient safety. 61% of participants reported positive attitudes toward patient safety. A significant regression equation was found (R² = 0.073, F= (2.94), p = 0 0.003). Age and having information on patient safety during continuing education were significant predictors of the attitude score (p ≤ 0.05).ConclusionIt is necessary to implement patient safety education programs and training.

Community-Based Oncology Nursing: Current Status and Prospects – A Secondary Publication

Objective: Currently, it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented. The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature. Methods: A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention, cancer screening, cancer survivor care, and cancer patient hospice care. Results: The Comprehensive Cancer Care Model (CCCM) was established. The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis. On the vertical axis, public health centers, oncology hospitals, cancer convalescent hospitals, primary care physicians, and prayer centers were involved. The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed. Conclusion: It is expected that CCCM will be used for holistic, sustainable, and cost-effective cancer management. In community-based oncology nursing, the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs, while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage

Medicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with TM. To estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes. This was a cohort study using Medicare data on 4613 hospitalizations among retired Ohio state employees and 2 comparison groups in 2015 and 2016. The study investigated the association of a policy change with use of postacute care and outcomes. The policy changed state retiree health benefits in Ohio from a mandatory MA plan to subsidies for either supplemental TM coverage or an MA plan. After policy implementation, approximately 75% of retired Ohio state employees switched to TM. Hospitalizations for 3 high-volume conditions that usually require postacute rehabilitation were assessed. Data from the Medicare Provider Analysis and Review files were used to identify all hospitalizations in short-term acute care hospitals. Difference-in-difference regressions were used to estimate changes for retired Ohio state employees compared with other 2015 MA enrollees in Ohio and with Kentucky public retirees who were continuously offered a mandatory MA plan. Data analyses were performed from September 1, 2019, to November 30, 2023. Enrollment in Ohio state retiree health benefits in 2015, after which most members shifted to TM. Received care in an inpatient rehabilitation facility, skilled nursing facility, or home health, or any postacute care; the occurrence of any hospital readmission; the number of days in the community during the 30 days after hospital discharge; and mortality. The study sample included 2373 hospitalizations for Ohio public retirees, 1651 hospitalizations for other Humana MA enrollees in Ohio, and 589 hospitalizations for public retirees in Kentucky. After the 2016 policy implementation, the percentage of hospitalizations covered by MA decreased by 70.1 (95% CI, -74.2 to -65.9) percentage points (pp), inpatient rehabilitation facility admissions increased by 9.7 (95% CI, 4.7 to 14.7) pp, use of only home health or skilled nursing facility care fell by 8.6 (95% CI, -14.6 to -2.6) pp, and days in the community fell by 1.6 (95% CI, -2.9 to -0.3) days for Ohio public retirees compared with other Humana MA enrollees in Ohio. There was no change in 30-day mortality or hospital readmissions; similar results were found by comparisons using Kentucky public retirees as a control group. The findings of this cohort study indicate that after a change in retiree health benefits, most Ohio public retirees shifted from MA to TM and received more intensive postacute care with no significant change in measured short-term postdischarge outcomes. Future work should consider additional measures of postacute functional status over a longer follow-up period.