Home Health Care Patients Research Articles

Quality of life among Saudi Arabian Patients Receiving Private Healthcare: Household-Based Survey

Background: As an alternative to hospitalization, home healthcare programs are assuming greater significance on a global scale due to the expanding geriatric population and the prevalence of chronic and acute diseases that require ongoing monitoring and care. In describing and evaluating the quality of life (QOL) and associated determinants of patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia, was the overarching purpose of this study. Methods: Participants in this cross-sectional study were HHC program enrolled patients. Utilizing the World Health Organization QOL questionnaire (WHOQOL-BREF), information regarding the various domains of patients' QOL was gathered. By fitting logistic regression models, factors associated with a low QOL score were identified. Results: In the research, 253 patients participated. Age distribution: 67.05 (± 20.0). Morbid and sociodemographic characteristics had a substantial impact on the overall quality of life of HHC patients. The final multivariate logistic regression models identified independent associations between marital status, psychological disorders, stroke, and number of illnesses and the overall quality of life (QOL) of HHC patients (p =.022, p =.002, p =.031, and.057, respectively). In a retrospective analysis, the physical health domain score exhibited significant associations with educational attainment, psychological issues, and stroke (p =.028, p =.002, p =.007). Conversely, the psychological domain score demonstrated a significant association with age (p < 0.001) and three distinct forms of chronic ailments—pulmonary (p =.002), psychological problems (p = 0.001), and p =.002. Only the marital status exhibited a significant association with the social domain score (p =.026). There was a significant association between the environmental domain and both education level and stroke incidence (p =.017 vs..027). Conclusions: Multiple factors are substantially correlated with the overall QOL and its domains. A significant number of these factors can be monitored and improved by enhancing the efficacy of HHC services; consequently, this will enhance patients' QOL.

PATIENT-CLINICIAN RELATIONSHIPS IN HOME HEALTH CARE

Abstract Patient-clinician relationships are fundamental attributes of high-quality home health care (HHC); yet little is known about patient-clinician relationships in HHC (where 5 million Medicare beneficiaries receive care annually). The objective of the study was to describe perspectives of HHC patients and HHC clinicians about patient-clinician relationships in HHC. We conducted a secondary qualitative analysis of semi-structured interviews (n=34) from a completed qualitative study investigating perspectives of older adult HHC patients (or caregivers as proxy) and their HHC clinicians (17 pairs) on discharge preparedness in a large HHC organization in North-Carolina. A conceptual model of patient-clinician relationships guided content analysis of the interview data. HHC patients identified as White (65%) and black (35%). Most HHC patients reported female sex (53%) and average age was 83 years (range= 69-93). Clinicians were registered nurses and physical therapists. Across the patient-clinician pairs, HHC patients valued relationships with clinicians with shared commonalities and those who provided reciprocal informational exchange and respected their autonomy. HHC clinicians valued relationships in which they felt helpful and respected as a healthcare professional. Relational conflicts arose when there was discordance in expectations of care (e.g., type of HHC services provided). Conflicts also arose when organizational constraints, such as disruptive scheduling, limited HHC visit time, and when limited continuity of care prevented the formation of patient-clinician relationships. Relational conflicts and organizational constraints influence patient-clinician relationships in HHC. Multi-level interventions (targeting modifiable factors at the patient, clinician, and organizational levels) are needed to improve the patient-clinician relationships and the quality of HHC.

Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults.

Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient's home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD). We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors. PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4% vs 32.1%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002). Findings highlight HHC's importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation.

Where Patients Live Matter in Emergency Department Visits in Home Health Care: Rural/Urban Status and Neighborhood Socioeconomic Status.

An increasing body of evidence highlights the importance of an individual's place of residence on their health and functional outcomes. This study is based on Outcome and Assessment Information Set data to assess the differences in emergency department visits among Medicare home health care patients by patients' residence location (rural/urban status and neighborhood socioeconomic status). Compared to urban patients, a disproportionately higher proportion of rural patients lived in more or most disadvantaged neighborhoods (83.9% vs. 41.3%). Using linear probability regression models, patients in rural areas (coefficient = .02, p < .001) and disadvantaged neighborhoods (less disadvantaged: coefficient = .02, p < .001; more disadvantaged: coefficient = .034, p < .001; most disadvantaged: coefficient = .042, p < .001) were more likely to experience emergency department visits. Policymakers should consider utilizing area-based target interventions to mitigate gaps in home health care. Also, given that the majority of rural patients reside in disadvantaged neighborhoods, neighborhood characteristics should be considered in addressing rural-urban disparities and improving home health care.

Challenges in Deprescribing among Older Adults in Post-Acute Care Transitions to Home

ObjectivesMedications with a higher risk of harm or that are unlikely to be beneficial are used by nearly all older patients in home health care (HHC). The objective of this study was to understand stakeholders’ perspectives on challenges in deprescribing these medications for post-acute HHC patients. DesignQualitative individual interviews were conducted with stakeholders involved with post-acute deprescribing. Setting and ParticipantOlder HHC patients, HHC nurses, pharmacists, and primary/acute care/post-acute prescribers from 9 US states participated in individual qualitative interviews. MeasuresInterview questions were focused on the experience, processes, roles, training, workflow, and challenges of deprescribing in hospital-to-home transitions. We used the constant comparison approach to identify and compare findings among patient, prescriber, and pharmacist and HHC nurse stakeholders. ResultsWe interviewed 9 older patients, 11 HHC nurses, 5 primary care physicians (PCP), 3 pharmacists, 1 hospitalist, and 1 post-acute nurse practitioner. Four challenges were described in post-acute deprescribing for HHC patients. First, PCPs' time constraints, the timing of patient encounters after hospital discharge, and the lack of prioritization of deprescribing make it difficult for PCPs to initiate post-acute deprescribing. Second, patients are often confused about their medications, despite the care team's efforts in educating the patients. Third, communication is challenging between HHC nurses, PCPs, specialists, and hospitalists. Fourth, the roles of HHC nurses and pharmacists are limited in care team collaboration and discussion about post-acute deprescribing. Conclusions and ImplicationsPost-acute deprescribing relies on multiple parties in the care team yet it has challenges. Interventions to align the timing of deprescribing and that of post-acute care visits, prioritize deprescribing and allow clinicians more time to complete related tasks, improve medication education for patients, and ensure effective communication in the care team with synchronized electronic health record systems are needed to advance deprescribing during the transition from hospital to home.

Association Between Documented Severe Pain and Cognitive Impairment in Home Health Care Patients: Results from the National Outcome and Assessment Information Set Data.

Background: Despite the growing importance of home health care (HHC) in the care of older adults with cognitive impairment, limited evidence exists about factors associated with documented severe pain among older adults receiving HHC. Methods: This secondary data analysis used a 5% random national sample of the 2017 national Outcome and Assessment Information Set (OASIS) data. Multivariable Poisson regression model was used to examine the association between documented severe pain, cognitive impairment, and a range of sociodemographic, clinical, and cognitive factors. Results: HHC patients (n = 183,038) were mean age 79.7 years, 61.7% female, and 78.6% non-Hispanic White. In multivariable models, cognitive impairment was associated with lower likelihood of documented severe pain (prevalence ratio [PR] = 0.96, confidence interval [CI] = [0.94-0.98]). Other factors independently associated with less documented severe pain included Hispanic ethnicity (PR = 0.92, CI = [0.89-0.95]), the oldest (≥85 years) groups (PR = 0.65, CI = [0.63-0.66]), male patients (PR = 0.83, CI = [0.82-0.85]), those with a formal diagnosis of Alzheimer's Disease Related Dementias (PR = 0.67, CI = [0.65-0.69]), and patients with verbal- and speech-related difficulty (PR = 0.83, CI = [0.80-0.86]). Patients with history of falls (PR = 1.18, CI = [1.16-1.20]), positive screen on the Patient Health Questionnaire-2 (PR = 1.36, CI = [1.31-1.41]), shortness of breath (PR = 1.14, CI = [1.12-1.14]), anxiety daily (PR = 1.16, CI = [1.14-1.18]), and anxiety daily or more often (PR = 1.40, CI = [1.37-1.43]) were more likely to have documented severe pain. Conclusions: HHC patients with cognitive impairment were less likely to have documented severe pain even with a range of sociodemographic, clinical, functional, and cognitive characteristics were considered. These findings may reflect a link between cognitive impairment missed opportunities for clinicians to provide pain management. Tailored interventions are needed to better assess and manage pain in this vulnerable group of HHC patients.

Risk factors for inpatient facility admission among home health care patients with diabetes

BackgroundHome health care (HHC) patients with diabetes are at high risk for inpatient admissions. PurposeTo identify variables associated with inpatient admissions among adults age ≥50 with diabetes receiving HHC in the community and in assisted living (AL). MethodsRetrospective HHC data (collected October 2021 to March 2022 in the Southern United States) from the Outcome and Assessment Information Set D were analyzed with logistic regression (n = 5,308 patients). DiscussionThe inpatient admission rate was 29.5%. For community-dwelling patients, multiple hospitalizations, depression, limited cognitive function, decreased activities of daily living (ADL) performance, and unhealed pressure ulcer or injury ≥stage 2 were significantly associated with inpatient admission. For those in AL, multiple prior hospitalizations and decreased ability to perform ADLs were associated with inpatient admission. ConclusionUnderstanding risk factors for inpatient admissions among patients with diabetes can support the identification of at-risk patients and inform interventions.

Investigation of Home Health Care Patients' Attitudes and Behaviors Against COVID-19 Vaccines

Introduction: We aimed to find the attitudes and behaviours of home health patients towards COVID-19 vaccines, the rates of vaccination, and the reasons for not getting the vaccine. Method: This descriptive and cross-sectional study was conducted with patients who were accepted to join this research and reachable (N:1012) registered in the Home Health Services unit of a training and research hospital in Izmir between December 2021 and March 2022. The study was conducted by contacting the patient or their relatives by phone, visiting them at home, or applying a questionnaire during their application to the polyclinic unit. Questionnaire; It consists of 15 questions that help us learn the patient's sociodemographic characteristics, current health status, and attitudes and behaviors about vaccines. The prepared database has entered the IBMSPSS 24.0 program. Results: The mean age of the participants in the study was 77.4±16.2 years. 68.6% of the participants were women. 63% of them are fully dependent on the bed. In our study, the rate of patients receiving the COVID-19 vaccine was 83.2%. 91.1% of the vaccinated individuals had the Sinovac vaccine, which was first provided to the patients. 66.1% of vaccinated individuals have accessed vaccination services at home. Those who have higher educational levels have higher vaccination rates. Those who received information from their family doctor were significantly more likely to be vaccinated. Participants most frequently stated that they were not vaccinated because they thought they did not have enough information about COVID-19 vaccines and were worried about possible side effects. Conclusion: According to this study, patients registered with Home Care Unit have a high rate of getting the COVID-19 vaccine.

Changes in Fecal Gut Microbiome of Home Healthcare Patients with Disabilities through Consumption of Malted Rice Amazake.

The aim of this study was to investigate changes in gut microbiome both during and after the consumption of malted rice amazake (MR-Amazake), a fermented food from Japan, in home healthcare patients with disabilities including patients with severe motor and intellectual disabilities (SMID). We monitored 12 patients who consumed MR-Amazake for six weeks, investigating them before and after the intervention as well as six weeks after the end of intake to compare their physical condition, diet, the type of their medication, Constipation Assessment Scale (CAS), and an analysis of their comprehensive fecal microbiome using 16S rRNA sequencing. Their constipation symptom significantly alleviated and principal coordinates analysis revealed that 30% of patients showed significant changes in gut microbiome after MR-Amazake ingestion. Furthermore, Bifidobacterium was strongly associated with these changes. These changes were observed only during MR-Amazake intake; the original gut microbiome was restored when MR-Amazake intake was discontinued. These results suggest that six weeks is a reasonable period of time for MR-Amazake to change human gut microbiome and that continuous consumption of MR-Amazake is required to sustain such changes.

Antipsychotic use among older patients with dementia receiving home health care services: Prevalence, predictors, and outcomes.

Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60-day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (β = -0.70, p < 0.001). HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD.

How to Deprescribe Potentially Inappropriate Medications During the Hospital-to-Home Transition: Stakeholder Perspectives on Essential Tasks

PurposeNearly all older patients receiving postacute home health care (HHC) use potentially inappropriate medications (PIMs) that carry a risk of harm. Deprescribing can reduce and optimize the use of PIMs, yet it is often not conducted among HHC patients. The objective of this study was to gather perspectives from patient, practitioner, and HHC clinician stakeholders on tasks that are essential to postacute deprescribing in HHC. MethodsA total of 44 stakeholders, including 14 HHC patients, 15 practitioners (including 9 primary care physicians, 4 pharmacists, 1 hospitalist, and 1 nurse practitioner), and 15 HHC nurses, participated. The stakeholders were from 12 US states, including New York (n = 29), Colorado (n = 2), Connecticut (n = 1), Illinois (n = 2), Kansas (n = 2), Massachusetts (n = 1), Minnesota (n = 1), Mississippi (n = 1), Nebraska (n = 1), Ohio (n = 1), Tennessee (n = 1), and Texas (n = 2). First, individual interviews were conducted by experienced research staff via video conference or telephone. Second, the study team reviewed all interview transcripts and selected interview statements regarding stakeholders’ suggestions for important tasks needed for postacute deprescribing in HHC. Third, concept mapping was conducted in which stakeholders sorted and rated selected interview statements regarding importance and feasibility. A content analysis was conducted of data collected in the individual interviews, and a mixed-method analysis was conducted of data collected in the concept mapping. FindingsFour essential tasks were identified for postacute deprescribing in HHC: (1) ongoing review and assessment of medication use, (2) patent-centered and individualized plan of deprescribing, (3) timely and efficient communication among members of the care team, and (4) continuous and tailored medication education to meet patient needs. Among these tasks, developing patient-centered deprescribing considerations was considered the most important and feasible, followed by medication education, review and assessment of medication use, and communication. ImplicationsDeprescribing during the transition of care from hospital to home requires the following: continuous medication education for patients, families, and caregivers; ongoing review and assessment of medication use; patient-centered deprescribing considerations; and effective communication and collaboration among the primary care physician, HHC nurse, and pharmacist.

HomeADScreen: Developing Alzheimer's disease and related dementia risk identification model in home healthcare

BackgroundMore than 50 % of patients with Alzheimer's disease and related dementia (ADRD) remain undiagnosed. This is specifically the case for home healthcare (HHC) patients. ObjectivesThis study aimed at developing HomeADScreen, an ADRD risk screening model built on the combination of HHC patients' structured data and information extracted from HHC clinical notes. MethodsThe study’s sample included 15,973 HHC patients with no diagnosis of ADRD and 8,901 patients diagnosed with ADRD across four follow-up time windows. First, we applied two natural language processing methods, Word2Vec and topic modeling methods, to extract ADRD risk factors from clinical notes. Next, we built the risk identification model on the combination of the Outcome and Assessment Information Set (OASIS-structured data collected in the HHC setting) and clinical notes-risk factors across the four-time windows. ResultsThe top-performing machine learning algorithm attained an Area under the Curve = 0.76 for a four-year risk prediction time window. After optimizing the cut-off value for screening patients with ADRD (cut-off-value = 0.31), we achieved sensitivity = 0.75 and an F1-score = 0.63. For the first-year time window, adding clinical note-derived risk factors to OASIS data improved the overall performance of the risk identification model by 60 %. We observed a similar trend of increasing the model's overall performance across other time windows. Variables associated with increased risk of ADRD were “hearing impairment” and “impaired patient ability in the use of telephone.” On the other hand, being “non-Hispanic White” and the “absence of impairment with prior daily functioning” were associated with a lower risk of ADRD. ConclusionHomeADScreen has a strong potential to be translated into clinical practice and assist HHC clinicians in assessing patients' cognitive function and referring them for further neurological assessment.

Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis.

One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.

Strategies Used by Home Health Care Professionals Working With Older Adults to Navigate the Institutional Context: An Integrative Review

To respond to the needs of home healthcare (HHC) patients, HHC professionals must use strategies to navigate the influence of the institutional context, that is, laws and regulations, the administration, and the organization of HHC services. However, no synthesis of those strategies exists. This review aimed to synthesize the strategies used by HHC professionals working with older adults to navigate the institutional context. An integrative review was undertaken in 5 databases, from 2011 to January 2023. The quality of documents was assessed based on an adapted version of the Critical Review Form—Qualitative Studies (Version 2.0) in which a score was calculated out of 25, and data was analyzed through coding, data display and comparison. Thirteen documents were included. The quality of studies ranged from 13 to 21.75. Strategies are often used to overcome limited resources (e.g., time, funding). Six types of strategies were identified: Deviating (bypassing rules or processes), taking on more and more (taking additional work), offering one’s personal time (working without remuneration), reallocating resources (splitting HHC services between patients), limiting HHC visits (restricting interventions or actions) and relying on others (transferring responsibilities). The use of strategies could alleviate the discomfort felt by HHC professionals due to limited resources. However, as some strategies lead to a reduced scope of practice and to a loss of expertise, this could impede the quality of the care, resulting in non-responded needs for HHC patients.

Development and Testing of the Palliative Care-Related Knowledge, Attitudes, &amp; Confidence (PC-KAC) Questionnaires for Home Healthcare Clinicians, Patients, and Caregivers in the United States. (Sch423)

Development and Testing of the Palliative Care-Related Knowledge, Attitudes, &amp; Confidence (PC-KAC) Questionnaires for Home Healthcare Clinicians, Patients, and Caregivers in the United States. (Sch423)

Identifying unmet needs of older adults transitioning from home health care to independence at home: A qualitative study

Health care practices to prepare older adults and their family caregivers for transitions from home health care (HHC) to independence at home are rarely studied. The objective of this multiple case study was to describe HHC patient and clinician perceptions of unmet needs after HHC discharge and recommendations to address them in future research. In this qualitative study, data were collected using chart-reviews and semi-structured interviews with paired patients (or caregivers as proxy) and HHC clinicians (N=17 pairs). We identified three themes: (1) low patient and caregiver engagement in care planning increased risk for preventable health events after HHC discharge, (2) limited continuity of care restricted patient and caregiver access to community-based services, and (3) gaps in patient and caregiver education influenced independent care of chronic illnesses after discharge. Findings suggest opportunities to improve care practices to prepare older adults and their caregivers for transitions from HHC to independence at home.

MEDICATIONS ASSOCIATED WITH GERIATRIC SYNDROMES AND HOSPITALIZATION RISK IN HOME HEALTHCARE PATIENTS

Abstract Polypharmacy is common in the home health care (HHC) setting. This study examined the prevalence, predictors, and impact of medications associated with geriatric syndromes (MAGS) use on subsequent hospitalization in HHC patients. Data from the HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims of 6,882 adults ≥ 65 years old receiving HHC from a large, non-profit HH agency in New York State in CY 2019 were used. MAGS use was identified from active medications reconciled during HHC visits and defined as total count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable. Regression analyses were conducted to identify predictors of MAGS use, and survival analyses were conducted to examine the association between MAGS use and hospitalization. Nearly all (98%) of the HHC patients used at least one MAGS and 41% of all active medications were MAGS. A higher MAGS count was found among HHC patients who were non-white, community-referred, with more comorbidities, depressive symptoms, and functional limitations. A higher MAGS count was also related to increased risk for hospitalization. Moreover, higher quartiles of MAGS use combined with having ≥10 diagnoses predicted a 2.5-fold increase in hospitalization risk, relative to the lowest quartile of MAGS use and having &amp;lt; 10 diagnoses. In conclusion, over 40% of medications taken by HHC patients are MAGS, which, along with multimorbidity, increased hospitalization risk. HHC clinicians should identify MAGS use to inform deprescribing discussion with patients and their prescribers.

UNMET TRANSITIONAL CARE NEEDS OF OLDER ADULTS DISCHARGED FROM HOME HEALTH CARE: A QUALITATIVE NEEDS ASSESSMENT

Abstract Transitional care is widely recognized as a set of time-limited services to support older adults during transfers between settings and providers of care; however, little is known about services that prepare older adults and their caregivers for transitions from Home Health Care (HHC) to independent self-care at home. The objective of this study was to describe HHC patients and clinician perceptions of unmet needs after HHC discharge and recommendations to address them in future research. A multiple case-study design was used in a single large HHC organization in North Carolina. Data were collected using chart reviews of HHC records and semi-structured interviews with paired patients (or caregivers as proxy) and HHC clinicians (Nf17 pairs). A transitional care intervention model was used as a conceptual framework to guide framework analysis of interview transcripts. Most patients were White (65%) and female (53%) with mean age of 83 years. Clinicians were Registered nurses and Physical therapists. Across cases, 17 patient and clinicians pairs described three unmet needs: (1)skills for symptom management; (2)community-based support for transportation, food, social engagement, and health services; (3)in-home support to assist with safety, and activities of daily living. HHC patients recommended new services while clinicians emphasized the need for resources to improve their capacity to prepare patients for discharge. These findings will inform an innovative adaptation of transitional care and other supports to prepare older adults and caregivers for transitions from HHC to independent self-care at home. Future research should explore adding transitional care services to address these needs.

Self-reported gaps in care coordination and preventable adverse outcomes among older adults receiving home health care.

Older adults see multiple outpatient providers and increasingly use home health care (HHC) services. Previous studies attempting to draw inferences about the association between HHC use and patient outcomes have been mixed. Whether HHC is associated with care coordination and how both influence outcomes are unknown. In addition, prior studies have not taken the patient perspective into account. We examined the association between receiving HHC and self-reported gaps in care coordination and separately, preventable adverse outcomes. The analysis for this cross-sectional study was conducted between October 2021 and June 2022, using data on 4296 Medicare beneficiaries from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who completed a survey on care coordination from 2017 to 2018. The associations between the receipt of HHC and two outcomes (a gap in care coordination, and separately, a preventable adverse event) were examined with Poisson models with robust standard errors. Potential confounders were accounted for through propensity score-based inverse probability weighting. Among 4296 participants, 430 (10%) received HHC and they were older and had more comorbidities and ambulatory visits than those without HHC. HHC was not associated with differences in self-reported gaps in care coordination (33.3% HHC vs. 32.5% no-HHC, p=0.70). HHC recipients reported more preventable drug-drug interactions (9.1% vs. 4.0%, p < 0.001) but not more preventable ED visits or hospital admissions. In IPW-adjusted models, HHC was not associated with gaps in care coordination (p=0.60) but was associated with double the risk of a preventable adverse outcome (aRR 2.06; CI: 1.37, 3.10, p < 0.001). HHC recipients were significantly more likely (than those without HHC) to report a potentially preventable adverse event (particularly a drug-drug interaction), suggesting an opportunity to improve patient safety by leveraging the observations of older adults receiving HHC.

Use of Voice-Assisted Technology to Enhance the Home Health Care Patient Experience.

One of the greatest challenges for older, homebound patients receiving health care is accessibility, particularly following a hospitalization. The current study evaluates the effects of using voice-activated technology in the homes of recently discharged patients and its effects on health care outcomes. Voice-based software was embedded in a smart device, which allowed patients to ask questions and receive answers about their own specific care plan. A pre-post study design was used. Forty-eight patients completed the pre and post survey. There was a 63% reduction in emergency department visits and a 26% reduction in physician calls. There was no change in the number of patients requiring hospitalization. More than one half of patients used the smart device daily for their health care needs. More than 70% of patients believed the device was helpful for their general health care needs and assisted in the achievement of care goals. This is the first study of its kind to evaluate patient engagement and outcomes after the use of a smart device with embedded health care directions. [Journal of Gerontological Nursing, 48(12), 17-24.].