Home Health Care Research Articles

Stochastic home care transportation with dynamically prioritized patients: An integrated facility location, fleet sizing, and routing approach

We study a home health care (HHC) problem that is characterized by prioritized patients and uncertain demands. In practice, HHC supply chain networks often struggle to meet high demand due to a shortage of service vehicles. Additionally, disruptions caused by natural calamities and pandemics (e.g., COVID-19) further compound these challenges, necessitating the consideration of real-life characteristics such as patient priorities, infrastructure locations, and transportation of medical supplies with uncertain demands. To formulate the problem, we propose a multi-depot and multi-period chance-constrained optimization model with precedence constraints, assuming that the demand quantities for medical supplies are random variables. Since patients’ medical conditions vary in severity, the priority of each patient is translated into a time-dependent potential healthcare cost that changes dynamically over the planning horizon. The solution to the proposed model determines the optimal locations for the base Mobile Health Facilities (MHFs) and the fleet size of HHC vehicles, and generates scheduling and routing plans to visit patients within specified time windows. We propose a unique three-phase solution approach, integrated with stochastic simulation, to address the problem. We then assess the robustness of the proposed model based on a realistic case of HHC service provision in Hong Kong and explore the optimal values for two model parameters, namely the Vehicle Threshold Index and the MHF Threshold Index. The performance evaluation tests show that the proposed solution method is efficient and effective for solving real-world problems.

Home care practice behavior and its influencing factors of primary care providers: a multicenter cross-sectional study in Sichuan Province, China

BackgroundPrimary care providers play an important role in home health care, and their practice behavior is significant for care quality and patient outcomes. This study aimed to assess the home care practice behavior of Chinese primary care providers and to explore the factors associated with the practice behavior.MethodsA multicenter cross-sectional design with a convenience sample was used to survey 863 registered primary care providers from 62 primary health care settings in Sichuan Province, China. Descriptive statistics, t-test or ANOVA for one-way analysis, and Pearson’s correlation analyses were used to compare the differences and examine the relationships between participants’ demographics and experience of home care services and practice behavior. Multiple linear regression models were performed to identify salient variables associated with the practice behavior from among demographic and home care experience.ResultsThe score of home care practice behavior questionnaire was 97.25 ± 21.05. The average scores for the dimensions of home visit preparation, assessment, medical care behavior and safety practice were 3.70 ± 0.95, 3.76 ± 1.02, 3.66 ± 1.03, and 3.20 ± 0.46, respectively. Home care practice behavior was associated with working years, working experience in general hospitals, work area, home care experience such as client types of home care, service frequency and willingness, explaining 21.5% of the total variance.ConclusionChinese primary care providers had a medium to high level of home care practice behavior but poor implementation of safety practice. The results may provide clues to increased focus and implementation of safety practice, as well as providing targeted measures based on influencing factors.

A Clinical Nurse Specialist in Home Healthcare.

Opportunities and challenges in home healthcare are discussed from the perspective of a gerontological clinical nurse specialist who has served as an expert clinician, administrator, and compliance director of a home health agency in the Midwest United States. Home-based nursing care requires a distinct set of knowledge and skills centered on the home environment and the way the home health patient responds emotionally and physically to become confident and self-sufficient. A Theoretical Framework for Home-Based Professional Nursing Practice is presented identifying the 6 concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy) that are building blocks to describe the experience of patients in their homes and interactions with providers. The quality of clinical care and documentation influence reimbursement for care and the financial survival of the home health agency. Six management priorities both within the administrative office and the clinical teams are highlighted to improve quality of care, promote efficiency, and retain staff. Exciting opportunities are available for the clinical nurse specialist in home-based care.

Risk Factors Associated with Pressure Ulcers among Home Health Care Patients; Riyadh, Saudi Arabia

Background: Patients, professionals, and health care systems are faced with a serious problem of pressure ulcers. They represent a significant occurrence and prevalence throughout the world. Their character iatrogenic states that its appearance is preventable, and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. Surgery may be necessary to accelerate the healing process, although most pressure ulcers are usually treated with debridement and conservative therapy. Their reported incidence and prevalence are significant worldwide. Objectives: The study's objectives are to identify the pressure ulcer risk factors in patients getting home health care, as well as to look at the quantity, type, and characteristics of pressure ulcers as well as patient comorbidities. Methods: Cross-sectional study, Home Care Nursing personnel questionnaire to determine the Risk Factors of Pressure Ulcers, patient comorbidities, and the number, and characteristics of pressure ulcers among patients receiving home care in Riyadh, Saudi Arabia. Results: PU is prevalent among the studied participants in Saudi Arabia, about 55% of these ulcers showed noticeable distraction of skin and/or deeper soft tissue against a bony prominence. We have also found a significant relationship between PU and gender, diabetes mellitus, hypertension, incontinence issues, nutritional status, and physical status, cerebrovascular accidents, trauma, and chronic kidney disease. Conclusion: Different risk factors are associated with PU such as diabetes mellitus, hypertension, and nutritional, and physical status. To monitor and promote best practices in skin care for highly dependent patients, continued measurement and evaluation of PU incidence, it is recommended more research of risk factors of PU development be assessed at home Health care Centers.

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study.

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations. This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization. A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021). In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round. The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Determination of Frail Elderly Status in a Home Healthcare Population

Determination of Frail Elderly Status in a Home Healthcare Population

Decision support framework for home health caregiver allocation using optimally tuned spectral clustering and genetic algorithm

Population aging is a global challenge, leading to increased demand for health care and social services for the elderly. Home Health Care (HHC) is a vital solution to serve this segment of the population. Given the increasing demand for HHC, it is essential to coordinate and regulate caregiver allocation efficiently. This is crucial for both budget-optimized planning and ensuring the delivery of high-quality care. This research addresses a fundamental question in home health agencies (HHAs): “How can caregiver allocation be optimized, especially when caregivers prefer flexibility in their visit sequences?”. While earlier studies proposed rigid visiting sequences, our study introduces a decision support framework that allocates caregivers through a hybrid method that considers the flexibility in visiting sequences and aims to reduce travel mileage, increase the number of visits per planning period, and maintain the continuity of care – a critical metric for patient satisfaction. Utilizing data from an HHA in Tennessee, United States, our approach led to an impressive reduction in average travel mileage (up to 42%, depending on discipline) without imposing restrictions on caregivers. Furthermore, the proposed framework is used for caregivers’ supply analysis to provide valuable insights into caregiver resource management.

Genetic Algorithm based Secure Hybrid Routing Technique for IoT Framework

Internet is gaining new heights in today’s technological environment. Internet of things (IoT) is a new class of Internet-basedheterogeneous networked application systems that uses various types of sensors/detectors and devices for the exchange and collection of data. Due to their applications in situations such as building home automation, emergencies, crisis management, energy management, and healthcare, path optimization and message security becomes of topmost importance in IoT. An optimized routing scheme using intelligent mathematical techniques including Genetic Algorithms (GA) and Analytical Hierarchy Process (AHP), is proposed here and an optimized route can be encrypted using cryptographic techniques. From the simulation results, it has been found that the overall efficiency of the IoT system can be greatly improved with the proposed model. A comparison is also provided in the discussion section which demonstrates that hybrid algorithms developed for IoT systems perform much better than traditional routing algorithms.

Why did this happen to me? Causal attributions of illness and cultural health capital

This study examines how conversations between patients and clinicians about the causes of their health conditions relate to patient engagement in care. Leveraging cultural health capital (CHC) theory, we find that patient-physician discussions of health attributions are one mechanism to build patient understanding and activate engagement. We present a qualitative interpretive analysis of data collected in three phases with adult home health care patients: phone interviews (n = 28), field observations (n = 61), and semi-structured field interviews (n = 38). We find that engaging in discussions of causal health attributions with clinicians enables patients to overcome uncertainty, envision preventive actions, and engage in setting future goals. Such discussions must be supported by acknowledgement of the co-responsibility of individual factors and structural factors such as social determinants of health. These discussions are not easy to navigate but they can potentially help patients transition from a mindset of treating the disease (pathogenic approach) to an awareness of their available capabilities to improve health (salutogenic approach). This study contributes to research on attribution theory and cultural health capital theory by demonstrating how discussing causes for poor health can enable patients resolve doubts and accrue instrumental and symbolic resources that facilitate healing.

Systematic Review and Psychometric Properties Analysis of First-, Middle-, and Top-Level Nurse Manager’s Core Competencies Instruments

Purpose. Healthcare organisations need to define the role of the nurse manager in light of recent global health developments. For this purpose, several core competencies essential for each hierarchical management level need to be assessed. Different measurement instruments have been developed to assess nurse managers’ competencies. This systematic review summarises the characteristics and psychometric properties of existing instruments measuring first-, middle-, and top-level nurse managers’ competencies. Methods. Following PRISMA guidelines for reporting and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines, 789 articles were retrieved from PubMed, Scopus, CINAHL, and APA PsycINFO databases with no time limitation. The review protocol was registered on PROSPERO (CRD42023425854). Results. Ten tools were identified, assessing one or more competencies among nurse managers: Competency Elements for Nurse Managers of Tertiary General Hospitals, NICA-NL, HCCI, I-FLNMMCS, NMCI, Chase Nurse Manager Competency Questionnaire, CASHN, Questionnaire for Head Nurses’ Managerial Competencies, Nurse Manager EBP Competency Scale, and the Home Healthcare Nurse Manager Assessment Tool. Conclusion. Following the COSMIN assessment, the Chase Nurse Manager Competency Instrument was the most comprehensive among the included instruments, and the CASHN questionnaire scored highest on methodological quality and level of evidence. These instruments can be used in clinical practice to evaluate competencies and as a basis for developing managerial training courses.

Integrated Health and Social Home Care Services in Catalonia: Professionals' Perception of its Implementation, Barriers, and Facilitators.

This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS. Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment. A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS. Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments.

Perspectives on supporting Veterans’ social needs during hospital to home health transitions: findings from the Transitions Nurse Program

BackgroundVeterans who need post-acute home health care (HHC) are at risk for adverse outcomes and unmet social needs. Veterans’ social needs could be identified and met by community-based HHC clinicians due to their unique perspective from the home environment, acuity of Veterans they serve, and access to Veterans receiving community care. To understand these needs, we explored clinician, Veteran, and care partner perspectives to understand Veterans’ social needs during the transition from hospital to home with skilled HHC.MethodsQualitative data were collected through individual interviews with Veterans Health Administration (VHA) inpatient & community HHC clinicians, Veterans, and care partners who have significant roles facilitating Veterans’ hospital to home with HHC transition. To inform implementation of a care coordination quality improvement intervention, participants were asked about VHA and HHC care coordination and Veterans’ social needs during these transitions. Interviews were recorded, transcribed, and analyzed inductively using thematic analysis and results were organized deductively according to relevant transitional care domains (Discharge Planning, Transition to Home, and HHC Delivery).ResultsWe conducted 35 interviews at 4 VHA Medical Centers located in Western, Midwestern, and Southern U.S. regions during March 2021 through July 2022. We organized results by the three care transition domains and related themes by VHA, HHC, or Veteran/care partner perspective. Our themes included (1) how social needs affected access to HHC, (2) the need for social needs screening during hospitalization, (3) delays in HHC for Veterans discharged from community hospitals, and (4) a need for closed-loop communication between VHA and HHC to report social needs.ConclusionsHHC is an underexplored space for Veterans social needs detection. While this research is preliminary, we recommend two steps forward from this work: (1) develop closed-loop communication and education pathways with HHC and (2) develop a partnership to integrate a social risk screener into HHC pathways.

Dementia Care in Rural Appalachia: Multilevel Analysis of Individual- and County-Level Factors.

Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (Mage = 64.7, SDage = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p = .003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = -0.21, p < .001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p = .046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions.

State- and Territory-Level Nursing Home and Home Health Care COVID-19 Policies and Disease Burden

This cross-sectional study creates a dataset and dashboard of US state- and territory-level COVID-19 policies specific to nursing homes and home health care agencies.

A multiobjective approach for weekly Green Home Health Care routing and scheduling problem with care continuity and synchronized services

Home Health Care (HHC) services are essential for delivering healthcare programs to patients in their homes, with the goal of reducing hospitalization rates and improving patients’ quality of life. However, HHC organizations face significant challenges in scheduling and routing caregivers for home care visits due to complex criteria and constraints. This paper addresses these challenges by considering both caregiver assignments and transportation logistics. The objective is to minimize the total travel distance and CO2 emissions while ensuring a balanced workload for caregivers, meeting patients’ preferences, synchronization, precedence, and availability constraints. To tackle this problem, we propose a multiperiodic Green Home Health Care (GHHC) framework. In the first stage, we utilize multiobjective programming and the NSGA-II algorithm to generate Pareto front solutions that consider travel distance and CO2 emissions. In the second stage, a Mixed-Integer Linear Programming (MILP) model is proposed to balance caregivers’ workload by assigning them to the patient routes generated in the first stage. The results highlight the trade-off between shorter routes and lower emissions. Furthermore, we examine the impact of prioritizing continuity of care and patient satisfaction. This research provides valuable insights into addressing the scheduling and routing challenges in HHC services, contributing to a more efficient and environmentally friendly healthcare delivery.

Safe Medication Assessment Toward Patient Safety in Home Health Care: A Qualitative Study

Collaboration across hospital-primary-community healthcare continuum is crucial to ensuring secure medication management at home, particularly among elderly persons. The study aim was to describe older adult’s experiences of medication assessment using Safe Medication Assessment (SMA) in connection to home visits. A study was conducted, with data from 44 participants analyzed through qualitative content analysis (semi-structured interviews) at baseline, 1-month, and 3-month follow-ups based on SMA’s 20 items. The results include 1 theme “Personcentredness due to medication management,” and 2 categories, “Systematic approach towards safe medication at home” and “Taking control over prescribed drugs.” SMA ensures a systematic work approach during home visits conducted by mobile team units, working in partnership with all involved parties (elderly, care providers, relatives) improving safe medication management at home.

The Paradox of Choice in Palliative Care Decision-Making in Managed Long-Term Care: A Qualitative Study

Palliative care offers undeniable advantages to elderly patients with multiple chronic illnesses in managed long-term care. However, only approximately 14% of those who require palliative care actually receive it. To investigate factors influencing decision-making regarding palliative care acceptance, and healthcare providers’ communication strategies, which patients or family caregivers perceive during managed long-term care. Qualitative thematic content analysis study. Two data sources from home and community-based health care organization in a metropolitical city in the Northeastern United States were used: (a) retrospectively collected 79 phone call audio recordings between patients and/or family caregivers with healthcare providers when initiate palliative care option, and (b) prospectively collected 10 exploratory qualitative interviews with patients and/or family caregivers for this study purpose. From a total of 89 conversations, 7 themes emerged during palliative care decision-making: (a) capability for self-management; (b) symptom severity; (c) perceptions of chronic disease; (d) satisfaction with current health services; (e) code status; (f) caregiver burden and (g) other reasons, including financial considerations and service affiliations. In addition, from 10 qualitative interviews, 4 key themes in healthcare providers’ communication that optimize palliative care conversations were indicated: (i) trust and relationship dynamics; (ii) positive reinforcement and personal connection; (iii) conversation setting and initiator; and (iv) collaborative approach to care coordination. Enhancing decision-making around palliative care and improving acceptance of palliative care services may be improved through the integration of personalized care plans, empathetic communication, use of symptom-inclusive assessments for timely care, and proactively addressing caregiver burden.

Exploring the knowledge and skills for effective family caregiving in elderly home care: a qualitative study.

Family caregivers play a crucial role in providing physical, emotional, and social support to the elderly, allowing them to maintain their independence and stay in their preferred living environment. However, family caregivers face numerous challenges and require specific knowledge and skills to provide effective care. Therefore, understanding the knowledge and skills required for effective family caregiving in elderly home care is vital to support both the caregivers and the elderly recipients. The research was carried out in Mekelle City, Ethiopia, utilizing the phenomenology study design and purposive sampling technique. A total of twenty-two in-depth interviews were conducted. Individuals with experience in providing care for elderly people in their homes were targeted. Data was gathered through the use of an open-ended guide, transcribed word-for-word, inputted into ATLAS.ti8 software, and translated. Codes and themes were then extracted from the transcribed data, and a thematic analysis was performed. To minimize personal biases, the collected data were coded independently by the data collection assistants and the PI. The analysis was carried out by authors who were not involved in the data collection process. The interviews were conducted in a quiet place. A total of 22 in-depth interviews were conducted as part of this research. The results indicated that although the participants had knowledge about common health problems experienced by older people, they were uninformed about how to manage these conditions at home and were unaware of specialized healthcare resources for the elderly. Furthermore, they had limited knowledge about suitable exercise routines, strategies to prevent falls, and home healthcare practices for older individuals. On the other hand, they exhibited a solid comprehension and awareness of abusive behaviors specifically directed at older adults. The results emphasized the importance of enhancing education and training for family caregivers in handling elderly health issues, raising awareness about specialized healthcare services catered to the elderly, improving understanding of activities of daily living (ADLs) and fall prevention, and offering inclusive training in healthcare tasks related to elder care. Participants should receive comprehensive education and training programs to enhance their knowledge and skills in managing these conditions. Efforts should also be made to raise awareness about the availability of geriatric hospitals or specialized nurses for the elderly. Participants need to be educated about suitable exercise routines for the elderly and fall prevention strategies. Healthcare skills training is also necessary for participants, focusing on activities such as wound dressing, vital sign monitoring, and establishing a specific schedule for changing positions.

Length of Stay and Discharge Disposition After Total Hip Arthroplasty: A Large Multicenter Propensity Matched Comparison of Robotic-Assisted and Manual Techniques

BackgroundRobotic-arm assistance continues to gain popularity in total hip arthroplasty (THA) for its potential to improve component placement accuracy and patient outcomes. Nonetheless, there is limited data on the impact of robotic-assisted THA (RA-THA) on hospital length of stay (LOS) and discharge location. This study thus aimed to compare LOS, discharge location, and readmission rate for propensity-matched cohorts of RA-THA versus manual THA (M-THA). MethodsA retrospective review of a multi-hospital database was performed to identify patients who underwent THA between January 2016 and December 2021 from surgeons who performed both RA-THA and M-THA at 77 geographically diverse hospitals. The RA-THA and M-THA cohorts were 1-to-1 matched based on patient sex, age, and body mass index, resulting in 8,536 patients per cohort. Insurance type, LOS, same-day discharge, discharge disposition, and 90-day all-cause readmission rate were compared using Mann-Whitney U and Chi-square tests. ResultsAverage LOS was significantly shorter for RA-THA patients (1.39 ± 0.85 days) than for M-THA patients (1.48 ± 0.91 days, P < .001). Compared to 5.6% of M-THA patients, 5.3% of RA-THA patients underwent same-day discharge (P = .38). There were statistically significant differences in discharge disposition between cohorts, with more RA-THA cases discharged home without home healthcare compared to M-THA (47.9 versus 45.5%, P = .001) and fewer RA-THA cases discharged to a skilled nursing facility compared to M-THA (5.6 versus 6.9%, P = .001). The 90-day all-cause readmission rate for RA-THA cases was 3.0%, compared to 3.4% for M-THA cases (P = .26). ConclusionsCompared to M-THA, RA-THA had a shorter average LOS, a similar percentage of patients with same-day discharge, fewer patients who had skilled nursing facility discharge, and a similar all-cause 90-day readmission rate. These results may be of interest to surgeons participating in bundled payment programs and engaging in cost savings.

Identification of Nursing Outcomes and Quality Indicators for Home Health Care in Older Adults with End-Stage Cancer.

This study aimed to identify nursing outcomes and quality indicators for older adults with end-stage cancer receiving home health care. 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. 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. 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.