Home Health Care Companies Research Articles

Home care reimbursement for intravenous ganciclovir therapy.

Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing agencies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem basis, and 9 did not provide care to fee-for-service patients. The mean total daily reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $129.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest mean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.

5380504 Treatment of gold bearing ore

In today’s competitive environment, one of the most critical objectives for Home Health Care (HHC) companies is to meet the demand of patients in a timely fashion. According to the feedback from HHC companies, caregivers have to deal with some uncertainties when carrying out a given schedule to visit their patients. However, a majority of the previous work only considers the deterministic models which ignore the uncertainties, and solutions obtained by these deterministic models are usually less robust in case of any possible changes in practical situations. Inspired by this point, in this work, we formulate a model for an HHC Routing and Scheduling Problem with taking into account uncertain travel and service times, from the perspective of Robust Optimization (RO). Specifically, the non-deterministic variables are defined based on the theory of budget uncertainty, and then the arrival time of each caregiver is rewritten as a complicated recursive function. After that, Gurobi Solver, Simulated Annealing, Tabu Search, and Variable Neighborhood Search are adapted to solve the model respectively. Finally, a series of experiments have been performed to validate the proposed models and algorithms. Experimental results from Monte Carlo simulation highlight the strength of considering uncertainties when modeling the problem. Additional, the influences of other characters in instances, like the width of time-window, distributed location have also been empirically analyzed. Finally, the comparison performed between the solutions obtained by the stochastic model and the RO model also demonstrates the advantage of the RO model. This work provides a valuable framework for HHC companies to make a robust schedule when arranging the caregivers.

A model system. Integration of services for cancer treatment

The care of pediatric cancer patients continues to grow in complexity. Paradoxically, treatment regimens grow more intensive, while regulatory pressures mandate more outpatient care. The challenge is to integrate services around episodes of illness and encounters over periods of 1-3 years. The approach of the author's clinic has been to create seamless relationships that place the patient at the center of care and address the major boundaries patients face. The inpatient-outpatient boundary has been effectively breached by an inpatient case manager and the simultaneous temporary rotation of an inpatient nurse to the outpatient area for specialty training. Discharge planning has been improved by sharing a nurse with the clinic's major home health care company, providing a direct clinic-home health liaison for patients. Ongoing formal evaluations have documented the effects of the institution of each part of the program. These surveys have indicated that inpatient staff participating in the outpatient rotation are more satisfied with the continuity of care and the availability of divisional resources. Patient satisfaction was extremely high and pediatric oncology discharge planning was rated significantly higher than other pediatric services. Despite rapid growth of the oncology service since 1985 and the personal intensity of care, length of stay has shortened and the number of staff has not required excessive increases to meet the needs of the new model.

Home intravenous antimicrobial therapy provided by a community hospital and a university hospital

A home intravenous antimicrobial program that was implemented at both a private community hospital and a university hospital with a wide rural referral base is described. Over an 18-month period, 63 patients were screened and selected for home i.v. antimicrobial management according to stringent criteria. The hospital pharmacies and two home health-care companies were used as the central points for coordinating the preparation and distribution of drug products and providing specialty nursing services. Predischarge inhospital education for each patient was conducted by a pharmacist and a nurse. On-call pharmacists and nurses were available to monitor and assist the patients, and the patients were seen regularly by physicians during the period of home therapy. The 63 patients received a total of 1108 days of home i.v. antimicrobial therapy; the mean duration of therapy was 17.6 days. Heparin-lock peripheral cannulae were used for 51 patients, while 12 patients received their treatment through central-subclavian or Hickman catheters. Home i.v. antimicrobial treatment seemed to be as effective as comparable inpatient management for each type of infection. Drug- and i.v. catheter-related adverse effects were uncommon and seemed similar in type and frequency to those of hospitalized patients. The estimated cost savings per treatment course was $3,514 for a total net savings of $221,406 over the 18-month study period. Home i.v. antimicrobial treatment programs can be successfully implemented in both community-based and tertiary-care settings. Home therapy is a safe, efficacious, and cost-effective alternative to prolonged hospitalization for a variety of infectious diseases.