Home Health Care Services Research Articles

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.

Impacts of chronic diseases and multimorbidity on health-related quality of life among community-dwelling elderly individuals in economically developed China: evidence from cross-sectional survey across three urban centers

ObjectiveAs the ageing process in China further accelerates and the average life expectancy increases, chronic disease prevalence and multimorbidity rates are constantly rising, especially among elderly individuals. However, few previous studies have explored the impacts of chronic diseases and multimorbidity on health-related quality of life (HRQoL). This study aimed to investigate this association among community-dwelling elderly individuals in China.MethodsA cross-sectional study was conducted in communities in three cities (Suzhou, Qingdao, and Guangzhou). The basic characteristics, chronic diseases and HRQoL of participants were collected, and HRQoL was measured by the EuroQol 5-Dimensions 3-Level version (EQ-5D-3L). Logistic regression, Tobit regression and generalized linear models were used to assess the impacts of chronic diseases and multimorbidity on HRQoL.ResultsApproximately 83.2 percent of the 1,218 respondents had chronic conditions, with 30 percent having multimorbidity. After controlling for sociodemographic and health behaviour factors, patients with stroke were more likely to report problems in all five dimensions of the EQ-5D and had a lower EQ-5D utility index (UI) (b = -0.342) than patients with other chronic conditions. Patients with chronic pulmonary obstruction had a lower EuroQol Visual Analog Scale (EQ-VAS) (b = -11.169) than patients with other chronic conditions. Furthermore, patients with multimorbidity had worse HRQoL (P < 0.001).ConclusionsBoth chronic condition probability and multimorbidity rates were high among Chinese community-dwelling elderly individuals. Different disease types had varying degrees of impact on HRQoL, and patients with multimorbidity had worse HRQoL. This study proposes that the government enhance the quality of life of community-dwelling elderly individuals with multimorbidity by establishing long-term care insurance and expanding comprehensive community-based home health care services.

Increasing expenditures on home- and community-based services: Do home care workers benefit?

To examine the association of Medicaid home- and community-based services (HCBS) expenditures on the home care workforce. We use two national, secondary data sources from 2008 to 2019: state-level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households. Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass-through policies, and state and year fixed effects. We exclude states with incomplete reporting of expenditures. States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnant at $11-12/h. We find no association between changes in Medicaid HCBS expenditures and wages. For every additional $1 million in Medicaid HCBS expenditures, the expected number of workers increases by 1.2 and the probability of working overtime increased (0.0015% points; p < 0.05). Results are largely robust under multiple sensitivity analyses. We find no evidence of a statistically significant relationship between changes in state-level changes in Medicaid HCBS expenditures and worker wages but do find a significant, but small, association with hours worked and workforce size.

Prevalence and Predictors of Potentially Inappropriate Prescribing in Older People Receiving Home Health Care in Saudi Arabia According to the American Geriatrics Society Beers Criteria 2019.

Potentially inappropriate prescribing (PIP) is a common health problem in older adults and is associated with negative health outcomes such as the occurrence of adverse drug events. Several studies have been conducted in different countries and settings to assess the prevalence of PIP, including in Home Care Services. However, data on the prevalence of PIP in home-care services in Saudi Arabia are limited. This study aimed to evaluate PIP use among older patients receiving home healthcare services in Saudi Arabia and to identify the predictors and commonly implicated medications.; Methods: A cross-sectional study was conducted over an 8-month period between January and August 2023. Data were collected from the medical records of patients older than 65 years who were currently receiving home health care services at King Faisal Hospital in Taif City, Saudi Arabia. PIPs were identified using the 2019 updated Beers Criteria.; Results: A total of 375 patients were included. Out of these, 285 PIPs were identified, of which 219 patients (58.4%) received at least one PIP. The most common therapeutic class associated with the PIPs was gastrointestinal medications (66.3%). Patient age and number of medications were significant predictors of PIP.; Conclusions: Our study found a high prevalence of PIP among elderly patients receiving home health care in Taif, Saudi Arabia. This study highlights the need for improved patient data automation and implementation of the Beers criteria to prevent PIPs in the future.

Impact of the Hospital Frailty Risk Score on Outcomes following Primary Total Elbow Arthroplasty

The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA. The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016 to 2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. non-frail patients. Mean and relative costs, total hospital length of stay (LOS), and discharge disposition for frail and non-frail patients were also compared. We identified 2,049 primary TEA in frail patients and 3,693 in non-frail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; p < 0.001), urinary tract infections (12.3% vs. 0.0%; p < 0.001), transfusions (3.9% vs. 1.1%; p < 0.001), pneumonia (1.1% vs. 0.2%; p < 0.001), acute respiratory distress syndrome (3.2% vs 0.6%; p < 0.001), sepsis (0.7% vs. 0.1%; p < 0.001), and hardware failure (1.2% vs 0.1%; p < 0.001). Frail patients also experienced higher rates of readmission (37% vs. 25%; p < 0.001) and death (1.7% vs. 0.2%; p < 0.001), while being less likely to undergo revision (6.5% vs. 17%; p < 0.001). Frail patients incurred higher healthcare costs ($28,497 vs. $23,377; p < 0.001) and longer LOS (5.3 days vs. 2.6 days; p < 0.001), with reduced likelihood of routine hospital stays (36% vs. 71%; p < 0.001) and increased utilization of short-term hospitalization (p < 0.001), care facilities (p < 0.001), and home health care services (p < 0.001). HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.

Evaluation of Nutrition, Pressure Ulcer and Fall Risk Status and Related Factors in Individuals Receiving Home Health Care Services

Objective: In this study, the aim is to evaluate the factors associated with nutrition, pressure ulcers, and fall risks in individuals receiving home health care. Methods: A retrospective study was designed by examining the files of the patients registered in the Home Health Care. Mini Nutritional Assessment Short Form, Modified Norton Scale and Itaki Fall Risk Scale scores were recorded. Results: The study included 334 patients. 197 (59%) of them were female and the mean age was 74.15±16.12 (min: 18, max: 101). The most common chronic diseases was hypertension (HT) (n=167, 50%), whereas the two most common comorbidities were DM and HT (n=77,23.1%). Patients receiving home health care were found to be at risk for malnutrition, pressure ulcers and falls. Being semi-bedridden and wheelchair bound were found to be predictors for the risk of developing pressure ulcers according to regression analysis results. Also it was identified that the age and dependency levels of the patients receiving home health care explained 12% of the falling behaviours of the older people. Conclusion: Necessary warnings should be given at every visit, so that receiving home health care should not be neglected in terms of risks and preventive measures should be taken for this patient group.

Evaluation of Home Healthcare Services By Service Providers and Users

Background: On May 15, 2017, the Turkish Ministry of Health transferred the coordination and delivery of home healthcare services from primary healthcare facilities to hospitals. Objective:This study aims to find out what the patients, their families, and home healthcare providers think about this organizational change that has been made to the service delivery process. Methods: In the quantitative research, the survey created using the results of qualitative research was administered to 396 individuals, comprising 322 patients or their relatives and 74 medical staff members. The survey's reliability was assessed using Cronbach's alpha coefficient, its validity was assessed using exploratory and confirmatory factor analyses, and the t-test was used to test the hypotheses. Results: Following the transfer of home health service delivery and coordination from primary healthcare institutions to hospitals, it was found that visit frequency-satisfaction, equity, monitoring-evaluation, and socio-economic support were the dimensions in which patients and their relatives participated more than healthcare personnel. However, compared to patients or patient relatives, healthcare personnel participate more in the areas of access to services, personnel-financial support, and private sector-security support. Conclusions: According to these findings, it is noteworthy that both groups have a much higher level of participation in issues that directly concern them. Thus, it is believed that improving the problems that clients and staff find objectionable will enhance home health services. Keywords: Home care; healthcare providers; healthcare users; primary healthcare; hospitals

Prevalence and Risk Factors of Pressure Injury in Home Care Patients

The present study aimed to determine the prevalence of pressure injury in home care patients and the risk factors that affected its occurrence. The study was conducted in a descriptive-cross-sectional design to 6 months between November 2021 and May 2022 with 170 home care patients who were registered to the Home Health Care Service at a public hospital a city western in Turkey and met the inclusion criteria. The data were collected with the in-person interview method by using the investigator-created Patient Evaluation Form, National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System, and Glasgow Coma Scale (GCS). The prevalence of pressure injury was found to be 33.5% in the study. The prevalence of pressure injury was statistically and significantly higher in the patients younger than 75 years of age ( p = .043), underweight, and with normal Body Mass Index (BMI) ( p = .009). The prevalence of pressure injury was found to be lower in those who were oriented according to GCS ( p = .000). No statistically significant differences were detected between the presence of pressure injury and gender, education levels, marital status, income status, presence of systemic or chronic disease, continuous medication use, type of medication used, and duration of receiving home care services ( p &gt; .05). The results of the present study showed that the prevalence of pressure injury was high in home care patients and that age, BMI, and level of consciousness variables were factors that influenced the development of pressure injury.

Bridging the gap and developing a home-based palliative care model for cancer patients

ObjectiveEarly integration of palliative care into home health care services is essential for cancer patients to improve their Quality of Life and reduce their health care costs. Thus, this study aimed to develop a home-based palliative care model for adult cancer patients in Iran. MethodsThis is a health policy and systems research based on the World Health Organization guide. It consists of four phases; an integrative review, a qualitative study through individual semi-structured interviews (n ​= ​37), and one focus group interview (n ​= ​8), integrating these results in the third phase and generating model indicators. In the last phase, the evaluation of the importance of the indicators and the validation of the model were carried out during four classic Delphi rounds. ResultsBarriers to home-based palliative care were extracted from the first phase, and then 22 categories in eight pillars emerged from the qualitative phase. The indicators created for the model from two phases were integrated in the third phase (n ​= ​118). After the four-round of the Delphi, a conceptual model for home-based palliative care in cancer patients, including 92 indicators within eight pillars was created. ConclusionsAlthough this model was designed for our society, it can be utilized as a useful guide in other similar societies to design practical models and innovative programs to provide home-based palliative care in cancer patients. The application of the model in predicting different outcomes should be investigated in future trials.

Falls among Pediatric Patients Receiving Home Care.

Children with medical complexity (CMC) often require home healthcare services to manage chronic health conditions. Evaluation of home safety is recommended when children transition from hospital to home care, though despite best efforts, safety events, such as falls, still occur. Understanding the prevalence and causal factors of falls in CMC is critical for the development of fall prevention interventions and protocols. This study aims to describe demographics and reasons for falls reported in CMC receiving home healthcare services. A retrospective analysis was performed using data from an incident reporting database from January 2019 to March 2023. Participants included CMC who received home healthcare services from a single institution and had at least one documented fall. A total of 43 falls were experienced by 31 unique participants. The participants were predominantly male (58.1%), White (71.0%), and non-Hispanic/Latino (96.8%), with a median age of 10 years at the time of the fall. Primary diagnoses of CMC with falls included neurological disorders (41.9%), congenital chromosomal abnormalities (25.8%), and oncological conditions (16.1%). The most common reasons for falls were loss of balance (32.6%), unknown factors (19.6%), and trip/slips (17.4%). Half of falls were deemed to be potentially preventable. This study provides valuable insight into falls among CMC receiving home healthcare services and emphasizes the multifactorial nature of fall risks in this population. Understanding demographic characteristics, diagnoses, and causal factors of falls is critical in the development of proactive fall prevention strategies. Responding proactively to mitigate fall risks is an important step in enhancing the safety and quality of life for CMC. Future collaborative research efforts are warranted to validate findings and evaluate potentially successful fall prevention interventions.

Hospital-to-Home-Health Transition Quality (H3TQ) Index: Further Evidence on its Validity and Recommendations for Implementation.

We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time. Assess the validity of H3TQ in a large sample across diverse communities. A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and New York, NY. There were five hundred eighty-seven participants (309 older adults, 141 informal caregivers, and 137 HH providers). Older adults, caregivers, and HH providers rated 747 unique transitions. Of these, 403 were rated by both the older adult/caregiver and their HH provider, whereas the remaining transitions were rated by either party. Construct, concurrent, and predictive validity were assessed via the overall H3TQ rating, correlation with the care transition measure (CTM), and the Medicare Outcome and Assessment Information Set (OASIS). Proportion of transitions with quality issues as identified by HH providers and older adults/caregivers, respectively; Baltimore 55%, 35%; NYC 43%, 32%. Older adults/caregivers across sites rated their transitions as higher quality than did providers (P<0.05). H3TQ summed scores showed construct validity with the CTM-3 and concurrent validity with OASIS measures. Summed H3TQ scores were not significantly correlated with 30-day ED visits or rehospitalization. The H3TQ identifies care transition quality issues in real-time and demonstrated construct and concurrent validity, but not predictive validity. Findings demonstrate value in collecting multiple perspectives to evaluate care transition quality. Implementing the H3TQ could help identify transition-quality intervention opportunities for HH patients.

Effectiveness of an interdisciplinary home care approach for older adults with chronic conditions: A systematic review and meta-analysis.

The effectiveness of interdisciplinary home healthcare service consisting of at least two or more healthcare providers, such as a nurse, physician and physiotherapist, for community-dwelling older adults remains unclear. This systematic review assesses the effects of interdisciplinary home care on quality of life (QOL) and health outcomes in older adults with chronic conditions using validated tools. Databases were searched using CINAHL Plus with Full Text, PubMed, EMBASE, CENTRAL, PsycINFO, and OpenGrey from inception to January 25, 2021. Eligibility criteria included (i) an interdisciplinary home care approach, (ii) participants aged 65 years and older with chronic conditions, (iii) randomized controlled trials (RCTs), and (iv) original literature in English. The study reviewer's dyad independently screened the literature and assessed the study quality using the Cochrane's Risk of Bias 2 tool. The analysis employed qualitative and quantitative integration and Grading of Recommendations Assessment, Development, and Evaluation. This study included 13 RCTs with 4709 participants. Four RCTs indicated that interdisciplinary home healthcare services reduced hospital admissions during the initial 6 months after the start of home care interventions (risk ratio [RR] = 0.73; 95% confidence interval [CI] = 0.61-0.88; p < 0.001; I2 = 0%). However, evidence certainty was moderate; QOL and mortality showed low certainty; and institutionalization and adherence showed moderate certainty of evidence. This study suggests that the interdisciplinary home care approach reduces hospital admissions but lacks effects on other outcomes. More robust studies are required to evaluate this evidence. Geriatr Gerontol Int 2024; ••: ••-••.

A mixed integer linear programming model for quarantine-based home healthcare scheduling under uncertainty

Home healthcare companies (HHC) have emerged as vital alternatives to traditional hospitals, particularly in meeting the healthcare needs of individuals within the comfort of their homes. The COVID-19 pandemic has amplified the significance of HHC services, offering a crucial alternative for patients and the elderly to follow quarantine protocols while receiving essential healthcare at home. Consequently, HHC companies must align their planning strategies with the World Health Organization (WHO) health guidelines. This research introduces a Mixed Integer Linear Programming (MILP) model tailored for home healthcare services during COVID-19, aiming to ensure strict adherence to quarantine protocols while enhancing service efficiency and quality. The proposed vehicle routing problem with pickup/delivery and time window formulation incorporates critical elements such as patient and caregiver classification, work and break regulations adherence, workload balancing, and multi-depot capabilities. The model addresses uncertain demand and service times through a stochastic programming approach to enhance practicality. K-means clustering is applied to streamline scenarios, with a sensitivity analysis determining the optimal number of clusters. Additionally, measures intrinsic to stochastic programming, such as the Expected Value of Perfect Information (EVPI) and Value of Stochastic Solution (VSS), are computed for comprehensive analysis.

Intensity and associated factors of home health care service needs among elderly patients with chronic diseases in the community: A cross-sectional survey.

This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. A cross-sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD=7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR=1.289; 95% CI: 1.055-1.575, p=.013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p<.05). Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems.

Fairness gaps in Machine learning models for hospitalization and emergency department visit risk prediction in home healthcare patients with heart failure

ObjectivesThis study aims to evaluate the fairness performance metrics of Machine Learning (ML) models to predict hospitalization and emergency department (ED) visits in heart failure patients receiving home healthcare. We analyze biases, assess performance disparities, and propose solutions to improve model performance in diverse subpopulations. MethodsThe study used a dataset of 12,189 episodes of home healthcare collected between 2015 and 2017, including structured (e.g., standard assessment tool) and unstructured data (i.e., clinical notes). ML risk prediction models, including Light Gradient-boosting model (LightGBM) and AutoGluon, were developed using demographic information, vital signs, comorbidities, service utilization data, and the area deprivation index (ADI) associated with the patient’s home address. Fairness metrics, such as Equal Opportunity, Predictive Equality, Predictive Parity, and Statistical Parity, were calculated to evaluate model performance across subpopulations. ResultsOur study revealed significant disparities in model performance across diverse demographic subgroups. For example, the Hispanic, Male, High-ADI subgroup excelled in terms of Equal Opportunity with a metric value of 0.825, which was 28% higher than the lowest-performing Other, Female, Low-ADI subgroup, which scored 0.644. In Predictive Parity, the gap between the highest and lowest-performing groups was 29%, and in Statistical Parity, the gap reached 69%. In Predictive Equality, the difference was 45%. Discussion and ConclusionThe findings highlight substantial differences in fairness metrics across diverse patient subpopulations in ML risk prediction models for heart failure patients receiving home healthcare services. Ongoing monitoring and improvement of fairness metrics are essential to mitigate biases.

Measurement of health human capital and its economic effect in China

Improving individual health not only enhances labor productivity but also boosts the productivity of society as a whole. China’s economic development is in urgent need of transitioning from being driven by factors to being driven by innovation, which places higher demands on Health Human Capital (HHC). An evaluation system consisting of 18 indicators across four dimensions—basic health, preventive healthcare, medical resources, quality, and healthy environment—was used to calculate the HHC index of 31 provinces and cities in China from 2005 to 2019 using the entropy method. Following that, this study assessed the influence of HHC on economic growth using endogenous growth theory and the Corgis production function. Firstly, we discovered that the level of home healthcare services in China is on a steady incline, with eastern China showing better results compared to western and northeastern regions. Secondly, enhancing HHC will lead to a rise in the local real per capita GDP and foster economic growth, although there may be regional disparities. Thirdly, provinces with a higher level of economic development exhibit a more significant promoting effect, with southern China showing a greater impact than northern China. China should continue to prioritize both efficiency and equity in the allocation of medical and health resources, while also working to reduce the disparities in HHC development among different regions.

A queueing-based approach for integrated routing and appointment scheduling

This paper aims to address the integrated routing and appointment scheduling (RAS) problem for a single service provider. The RAS problem is an operational challenge faced by operators that provide services requiring home attendance, such as grocery delivery, home healthcare, or maintenance services. While considering the inherently random nature of service and travel times, the goal is to minimize a weighted sum of the operator’s travel times and idle time, and the client’s waiting times. To handle the complex search space of routing and appointment scheduling decisions, we propose a queueing-based approach to effectively deal with the appointment scheduling decisions. We use two well-known approximations from queueing theory: first, we use an approach based on phase-type distributions to accurately approximate the objective function, and second, we use an heavy-traffic approximation to derive an efficient procedure to obtain good appointment schedules. Combining these two approaches results in a fast and sufficiently accurate hybrid approximation, thus essentially reducing RAS to a routing problem. Moreover, we propose the use of a simple yet effective large neighborhood search metaheuristic to explore the space of routing decisions. The effectiveness of our proposed methodology is tested on benchmark instances with up to 40 clients, demonstrating an efficient and accurate methodology for integrated routing and appointment scheduling.

Effectiveness of Home Health Care Services in the Qassim Region

This study aimed to assess the effectiveness of home healthcare services provided by both governmental and private sectors in the Qassim Region, Saudi Arabia, during 2021. A survey was conducted involving 210 participants, comprising 2,304 patients from 20 governmental home health care (HHC) sections in hospitals and 199 patients from one private home health care section in private hospitals in the Qassim Region. The majority of respondents were married Saudi men who preferred home visits and faced literacy challenges. Home health care (HHC) was found to be a viable and cost-effective alternative to hospital care, with an average visit duration of approximately 65 minutes and costs amounting to about $400.5 for the private sector and $1,622.694 for the government sector per patient monthly. Despite higher perceived costs, home healthcare remained more economical than hospital-based care. Noteworthy is the continued cost difference between governmental and private sectors on a per-patient monthly basis, indicating potential non-financial factors influencing service delivery. Participants rated HHC services as effective, particularly in assisting with transitions and identifying nutritional deficiencies, although patient deterioration and re-admission received lower ratings. In conclusion, home healthcare services in the Qassim Region were effective across both sectors, highlighting HHC as a cost-effective alternative despite variations in costs between governmental and private providers. It is essential to note the exclusion of home health care coverage from the Council of Cooperative Health Insurance (CCHI) policy. Keywords: Home health care, Care systems, Quality, Costs

Impacts of medication adherence and home healthcare on the associations between polypharmacy and the risk of severe hypoglycemia among elderly diabetic patients in Taiwan from 2002 to 2012: A nationwide case-crossover study

AimTo assess how medication adherence and home healthcare support influence the role of polypharmacy in induced hypoglycemia events among elderly diabetic patients. MethodsThis case-crossover study retrieved records on diabetic patients >=65 years with severe hypoglycemia from 2002 to 2012 in Taiwan. Case period defined as 1–3 days before severe hypoglycemia was compared with a preceding control period of the same length, with an all-washout period of 30 days. Moreover, the modifiable effects of medication adherence and home healthcare service use were evaluated by stratified analysis. ResultsTotally 2,237 patients were identified. Polypharmacy use was associated with the risk of severe hypoglycemia. Patients receiving polypharmacy without home healthcare services (aOR: 1.34; 95 % CI: 1.16–1.54) and those with poor adherence to anti-diabetic medications (aOR: 1.48; 95 % CI: 1.24–1.77) were significantly associated with an elevated risk of severe hypoglycemia. In patients with good adherence, non-home healthcare users being prescribed with polypharmacy had a higher risk of severe hypoglycemia. In the group that received home healthcare services, patients with poor adherence using polypharmacy had a higher risk of severe hypoglycemia. ConclusionsGood adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients, regardless of the fact whether they were prescribed with polypharmacy.

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.