Home Health Care Services Research Articles

Exploring performance profiles of home health care agencies: A two-stage analytical approach.

Public reporting of home health care agencies' performance metrics, including patient satisfaction, care processes, and health outcomes, aims to inform customer decisions and encourage agencies to improve the quality of services. However, there is limited research that examines the heterogeneous performance of home health care agencies. The aim of this study was to analyze the performance of home health care agencies by identifying distinct subgroups of agencies with similar performance profiles and describing the relationships between agency characteristics and such subgroups. We propose a two-stage analytical approach employing unsupervised machine learning methods. First, clustering analysis is applied to performance measures, allowing the partitioning of agencies into homogeneous subgroups based on similarities in performance. Then, association rule mining is used to uncover the relationships between cluster assignments and agency characteristics. The two-stage analytical approach identified four clusters with significantly different performance profiles and agency characteristics: cost-efficient agencies with high patient satisfaction (Cluster 1), high-cost agencies with high-quality care (Cluster 2), urban agencies with low patient satisfaction (Cluster 3), and small agencies with low-quality care (Cluster 4). This study contributes to understanding agency performance in the U.S. home health care industry. By identifying distinct subgroups of agencies and understanding the factors influencing their performance, we can enhance home health care services' overall quality and effectiveness. Our study uncovered diverse performance profiles and associated characteristics among home health care agencies, highlighting the need for tailored strategies and targeted interventions to improve the quality of care across clusters. Health care administrators and policymakers should consider cluster-specific recommendations.

Home Healthcare Medication Safety risks among older adults with chronic diseases: a qualitative study

BackgroundOlder adults receiving home care often face significant safety risks related to medication management due to their chronic diseases and complex health needs. Despite the increasing reliance on home healthcare services, the specific factors contributing to medication safety risks in this demographic remain inadequately explored.Objective/AimThis study aims to explore the key factors involved in medication safety risks among older adults with chronic diseases receiving home healthcare in Iran.MethodsQualitative research employing conventional content analysis was conducted using Graneheim and Lundman’s approach. was conducted in three home care centers in Tehran (Iran) from August 2020 to July 2022. Data were collected through semi-structured interviews with 7 nurses, 2 supervisors, 2 nursing assistants (experts in non-nursing careers), 1 home care inspector (expert of the Deputy of Treatment), and 3 family caregivers in home settings, along with four participatory observations and visual methods (narrative photography) focusing on medication safety challenges. The trustworthiness of the research was evaluated using Lincoln and Guba’s four criteria for qualitative studies.FindingsFactors associated with medication safety risks were found to rely on its major components Patients’ attribution, Families’ characteristics, Home care centers’ condition, Health caregivers’ characteristics, and the Homes’ situations, where these factors all account for various medication safety risks. Indeed, a medication safety risk can be attributed to more than one of the factors associated with medication safety risk by participants at home.ConclusionAs a result, the analysis of factors associated with medication safety risks highlights a complex interplay among various elements, including patients, families, home care centers, health caregivers, and the home environment. These interconnected factors are crucial for identifying the diverse medication safety challenges faced by participants in home settings. A comprehensive understanding of these dynamics is essential for improving medication safety protocols and enhancing health outcomes for this vulnerable population.

Contributing factors to the length of stay and discharge destination of home health care patients: 10-year electronic health record analysis using the Donabedian model.

To identify the factors affecting the length of stay (LOS) and discharge destination (DD) of home health care (HHC) patients in South Korea. A retrospective cross-sectional study was conducted using the electronic health records of 1769 patients from a hospital in South Korea. Data were collected from January 2013 to December 2022. We categorized the independent variables into patient context, structure, and process factors following a modification of Donabedian's model. Hierarchical and multinomial logistic regression analyses were used. The mean length of stay was 26.41 days. Patients were discharged to the following locations: 35.0% continued HHC, 21.0% died, 19% were discharged to their homes, 17.0% were admitted, and 8.0% were sent to other locations. Patients' sex, type of insurance coverage, and primary caregiver as well as the number of nurse visits, HHC admission route, and type of nursing service were predictors of their LOS. Operation history, a high Charlson comorbidity index, the type of insurance coverage, HHC admission route, and certain nursing care services were associated with admission and death as the DD. Process variables (e.g., number of nurse visits, HHC admission route, type of nursing services) have a considerable influence on determining the LOS and DD of HHC patients. This result provides new insights into the use of HHC services and care transitions out of the hospital for patients living in their home, offering evidence to reduce unnecessary readmissions and ensure more effective and efficient HHC.

Realization-based robust assignments for a nurse-to-patient assignment problem in home health care services

Realization-based robust assignments for a nurse-to-patient assignment problem in home health care services

Patterns of Comorbidity, Disability, and Home Health Care Service for Older Adults With Physical Disability: A Latent Class Analysis and Visualized Illustration.

Understanding the relationships between comorbidity, disability, and home health-care services aids in user-centered care design. This study identifies patterns of these factors among older adults with physical disability living at home and explores their associations. This cross-sectional study included community-dwelling older adults assessed for Long-term Care Insurance from September 1 to December 31, 2018, in Yiwu, Zhejiang, China. We analyzed deidentified data on sociodemographics, physical disability, chronic conditions, and care plans for 1882 participants using latent class analysis and multinomial logistic regression. Five comorbidity patterns (other sporadic diseases, cancer comorbidity, other sporadic comorbidities, coronary atherosclerotic heart disease, and fracture) and four home health-care service patterns (assistance & facilitation of elimination, bedridden assistance & stoma care, bedside assistance & stoma care, and assistance & tube feeding) were identified. Four disability patterns emerged (bedridden without incontinence, bedridden & with upper limb mobility, off-bed & ADLs limited, and bedridden with incontinence). Complex associations between these patterns were observed. The study highlights the heterogeneity and complexity of the above patterns, emphasizing the importance of person-centered home health-care services and technology-supported care strategies.

Decoding disparities: evaluating automatic speech recognition system performance in transcribing Black and White patient verbal communication with nurses in home healthcare.

As artificial intelligence evolves, integrating speech processing into home healthcare (HHC) workflows is increasingly feasible. Audio-recorded communications enhance risk identification models, with automatic speech recognition (ASR) systems as a key component. This study evaluates the transcription accuracy and equity of 4 ASR systems-Amazon Web Services (AWS) General, AWS Medical, Whisper, and Wave2Vec-in transcribing patient-nurse communication in US HHC, focusing on their ability in accurate transcription of speech from Black and White English-speaking patients. We analyzed audio recordings of patient-nurse encounters from 35 patients (16 Black and 19 White) in a New York City-based HHC service. Overall, 860 utterances were available for study, including 475 drawn from Black patients and 385 from White patients. Automatic speech recognition performance was measured using word error rate (WER), benchmarked against a manual gold standard. Disparities were assessed by comparing ASR performance across racial groups using the linguistic inquiry and word count (LIWC) tool, focusing on 10 linguistic dimensions, as well as specific speech elements including repetition, filler words, and proper nouns (medical and nonmedical terms). The average age of participants was 67.8 years (SD = 14.4). Communication lasted an average of 15 minutes (range: 11-21 minutes) with a median of 1186 words per patient. Of 860 total utterances, 475 were from Black patients and 385 from White patients. Amazon Web Services General had the highest accuracy, with a median WER of 39%. However, all systems showed reduced accuracy for Black patients, with significant discrepancies in LIWC dimensions such as "Affect," "Social," and "Drives." Amazon Web Services Medical performed best for medical terms, though all systems have difficulties with filler words, repetition, and nonmedical terms, with AWS General showing the lowest error rates at 65%, 64%, and 53%, respectively. While AWS systems demonstrated superior accuracy, significant disparities by race highlight the need for more diverse training datasets and improved dialect sensitivity. Addressing these disparities is critical for ensuring equitable ASR performance in HHC settings and enhancing risk prediction models through audio-recorded communication.

Cross-cultural adaptation, content validity, and reliability of the Amharic version of the modified John-Hopkins fall risk assessment scale among older adults who attend home health care services.

The modified John-Hopkins fall risk assessment tool (mJH-FRAT) is a comprehensive and multi-factor fall risk assessment tool used to screen and grade older adult's fall risk levels in home health care services. This can help to identify risky individuals early, establish prevention protocols, and reduce the occurrence of injury. Nevertheless, there is a dearth of contextually valid and reliable fall risk assessment tools among this population in the study area. The aim of this study is therefore to cross-culturally adapt and assess the content validity and reliability of the modified John-Hopkins fall risk assessment tool among older adults following home health care in Ethiopia. The English version of the mJH-FRAT underwent cross-cultural adaptation into Amharic. The final Amharic version was subjected to face validity and then content validity was computed. This community-based study was conducted from November 2023 to May 2024 with a total of 150 participants selected through convenience sampling. Data collection occurred through face-to-face interviews. Epi-Info 7 and Statistical Package for the Social Sciences software version 25 facilitated data entry and analysis, respectively. Reliability was assessed by employing intra-rater and inter-rater reliability using Cohen's kappa. The CVI based on the item level of all the items was between 0.8 and 1. The S-CVI based on average for domains such as general condition and clinical condition was 0.925 and 1, respectively, and the S-CVI (average) of the scale was 0.96. The S-CVI based on the universal agreement value for the overall 8 items was 0.75. The kappa statistic coefficient value was between 0.79 and 1. The intra-rater reliability and inter-rater reliability were 0.94 and 0.93, respectively. The rigorous adaptation process, face and content validity, and reliability analyses demonstrated that the Amharic mJH-FRAT is a content valid and reliable tool for assessing the fall risk level in this population. Clinicians and researchers can utilize this tool for the advancement of both clinical practice and research work on this group of people in Ethiopia.

Negotiating care in organizational borderlands: a grounded theory of inter-organizational collaboration in coordination of care

BackgroundAlthough coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs.MethodsA qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis.ResultsCoordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as “Negotiating care in organizational borderlands.” Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from “Dividing care by disease-specific expertise” to “Establishing paths for collaboration” and ultimately “Co-constructing a comprehensive whole.” These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination.ConclusionsThe key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.

Collaborative scheduling and routing of home healthcare service across multiple communities

Collaborative scheduling and routing of home healthcare service across multiple communities

Factors affecting target INR levels in homebound and ambulatory patients who use warfarin.

To investigate the rates of reaching target international normalised ratio levels and the factors affecting these rates in patients undergoing warfarin therapy. The prospective cross-sectional study was conducted between 16.08.2023 and 16.11.2023 at Izmir Bozyaka Training and Research Hospital and comprised patients of either gender who had been reciving warfarin therapy for at least 6 months. Those who were under the care of Home Health Services were in group A, while those being followed up at the cardiology outpatient clinic were in group B. All the patients had been receiving regular monitoring for international normalised ratio. Data was collected using a self-designed 41-item questionnaire. Data was analysed using SPSS 27. Of the 200 patients, 100(50%) were in each of the 2 groups. The overall mean age of the sample was 69.54±12.70 years. There were 131(65.5%) females, 108(54%) had international normalised ratio level within the target range, 101(50.5%) stated they had received education about warfarin, 120(60%) were aware of the side effects, and 81(40.5%) indicated they experienced complications while using warfarin. Group A patients received more education/information about warfarin, and warfarin-related complications were few in such patients (p<0.05). International normalised ratio monitoring among patients under the care of Home Healthcare Service was more reliably and effective compared to cardiology inpatients.

Developing a clinical decision support framework for integrating predictive models into routine nursing practices in home health care for patients with heart failure.

The healthcare industry increasingly values high-quality and personalized care. Patients with heart failure (HF) receiving home health care (HHC) often experience hospitalizations due to worsening symptoms and comorbidities. Therefore, close symptom monitoring and timely intervention based on risk prediction could help HHC clinicians prevent emergency department (ED) visits and hospitalizations. This study aims to (1) describe important variables associated with a higher risk of ED visits and hospitalizations in HF patients receiving HHC; (2) map data requirements of a clinical decision support (CDS) tool to the exchangeable data standard for integrating a CDS tool into the care of patients with HF; (3) outline a pipeline for developing a real-time artificial intelligence (AI)-based CDS tool. We used patient data from a large HHC organization in the Northeastern US to determine the factors that can predict ED visits and hospitalizations among patients with HF in HHC (9362 patients in 12,223 care episodes). We examined vital signs, HHC visit details (e.g., the purpose of the visit), and clinical note-derived variables. The study identified critical factors that can predict ED visits and hospitalizations and used these findings to suggest a practical CDS tool for nurses. The tool's proposed design includes a system that can analyze data quickly to offer timely advice to healthcare clinicians. Our research showed that the length of time since a patient was admitted to HHC and how recently they have shown symptoms of HF were significant factors predicting an adverse event. Additionally, we found this information from the last few HHC visits before the occurrence of an ED visit or hospitalization were particularly important in the prediction. One hundred percent of clinical demographic profiles from the Outcome and Assessment Information Set variables were mapped to the exchangeable data standard, while natural language processing-driven variables couldn't be mapped due to their nature, as they are generated from unstructured data. The suggested CDS tool alerts nurses about newly emerging or rising risks, helping them make informed decisions. This study discusses the creation of a time-series risk prediction model and its potential CDS applications within HHC, aiming to enhance patient outcomes, streamline resource utilization, and improve the quality of care for individuals with HF. This study provides a detailed plan for a CDS tool that uses the latest AI technology designed to aid nurses in their day-to-day HHC service. Our proposed CDS tool includes an alert system that serves as a guard rail to prevent ED visits and hospitalizations. This tool can potentially improve how nurses make decisions and improve patient outcomes by providing early warnings about ED visits and hospitalizations.

Effectiveness of a Training Program for the Prevention of Pressure Ulcers on Caregivers of Elderly Patients.

The aim of this study is to evaluate the impact of face-to-face education on pressure ulcer prevention and care provided to caregivers of patients with pressure ulcers in home healthcare services, specifically on the progression of the ulcers and their effects on the patients. This prospective, analytical intervention study assessed the training program implemented using the presentation teaching strategy for caregivers of patients with pressure ulcers, from the perspective of the patient and caregiver. The participants were 91 patients with pressure ulcers in the Home Health Care Unit and 91 caregivers. The data collection tool, consisted of questions regarding sociodemographic data prepared by researchers and questioning the knowledge of caregivers' knowledge about pressure ulcer. The Barthel Index, Pressure Ulcer Scale for Healing, Braden Risk Assessment Scale, and Care Assessment Inventory provided by family members were used to assess the level of dependence in patients' daily living activities. The patients' average age was 77.21±13.26 years and 58.2% of them were women. The caregivers' average age was 53.32±11.45 years and 83.5% of them were women. A statistically significant increase was observed between knowledge scores before and after training (p<0.001). Indicating that the training positively affects the caregivers' level of knowledge. Factors such as a private room, caregiver support, caregiver competence, and caregiving difficulties were significantly related to changes in knowledge scores. Training programs for caregivers on pressure ulcer handling in home health care patients are effective and should be planned from a broader perspective to include caregivers within the family.

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.

Needs assessment survey among healthcare professionals to implement the 4Ms framework: a cross-sectional study from Qatar

Background Worldwide, the evidence-based 4Ms framework of the Age-Friendly Health System (AFHS) improves the experience of caring for older adults. This study aimed to examine healthcare professionals’ perceptions, attitudes, and behaviors regarding the AFHS and 4Ms before they were implemented. Methods This study was a questionnaire-based survey of 252 healthcare professionals in geriatrics and long-term care departments, Rumailah Hospital, Acute Care Services in Hamad General Hospital, and home healthcare services to assess their perceptions, attitudes, and behaviors regarding 4Ms from November 1, 2022, to July 31, 2023. Results Most respondents acknowledged the benefits of providing care through AFHS. However, only 62% of respondents reported using the 4Ms framework. The most commonly used types of age-friendly care provided by health care professionals were reviews of high-risk medication use (64.2%) and screening for mobility limitations (55.8%). Conclusion The findings suggest that there is a need for more training and education regarding the 4Ms framework for health care providers. This training should focus on specific aspects of the framework, such as how to assess what matters most to older adults; how to manage their mobility, mentation, and medication; and how to coordinate care across settings.

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