Home Health Care Research Articles

Branch-Price-and-Cut algorithms for the team orienteering problem with interval-varying profits

This paper studies the team orienteering problem (TOP), wherein each vertex requires two visits, and the service profit of each vertex depends on the time interval between these two visits. Motivated by scenarios like perishable product delivery, home health care scheduling, and earth observation satellite scheduling, the paper addresses two variants: the periodic orienteering problem with a focus on the number of days (NoDs) and the team orienteering problem with attention to a combination of time windows (CoTWs). It develops mixed-integer linear programming (MILP) models for both variants and devises exact Branch-Price-and-Cut (BPC) algorithms tailored to their block diagonal structures. Furthermore, this paper proposes two strategies to improve algorithm performance. A simplification strategy streamlines the directed graph network by removing redundant vertices and arcs without compromising optimality, thereby accelerating the solution of pricing problems. Additionally, a matheuristic algorithm is proposed to obtain integer solutions quickly. Computational results demonstrate the effectiveness of these algorithms, showcasing their superiority over CPLEX. The BPC algorithm, coupled with the simplification strategy, exhibits an average computational time reduction of 70 % compared to the basic strategy. The effectiveness of the matheuristic algorithm is also confirmed. Finally, the findings presented herein offer valuable insights for refining and applying BPC algorithms.

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.

Children with medical complexity receiving home healthcare devices in Japan: a retrospective cohort study

BackgroundLimited evidence exists regarding children receiving home healthcare devices (HHDs). This study aimed to describe the range and type of HHD use by children with chronic medical conditions in Japan...

Go-Khitan's Home Care Circumcision Service Innovation Increases Customer Satisfaction

Background: Innovation has an important role in the implementation of health-related services to the community so that they can be better, cheaper and faster. Home care Go-Khitan is a health service provided by professionals at the patient's place of residence with the aim of helping to meet the patient's needs in overcoming the health problems they are experiencing. This research aims to see the extent of Go-Khitan Home Care health service innovation and its impact on circumcision customer satisfaction Methods: The type of research carried out was descriptive correlative using a cross-sectional design with a sample size of 32 respondents. Data collection was carried out by taking data through innovation questionnaires and customer satisfaction questionnaires directly and by Google forms. Results: The research results were analyzed using the Kendall Tau statistical test and the p value was 0.01. This value have meaning that Go-khitan home care health service innovation has a significant relationship with customer satisfaction Conclusion: Circumcision at home In a roundabout way, innovation will raise the bar for service excellence. Customer satisfaction will rise as service quality reaches its maximum potential.

Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality.

Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions. To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks. Development : A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing : Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied : Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists). The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%). The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.

Assessment of the occupational exposures within homes for home healthcare workers in the United Kingdom

Many of the tasks being conducted by home healthcare workers are associated with significant complex demands. Each home is a unique work environment with potentially different exposures. The purpose of this study was to investigate the plethora of exposures for home healthcare workers in the United Kingdom. The study was a cross-sectional study that utilized a trained supervisor to complete the direct observation of the healthcare worker (nursing aide and nurse). Environmental hazards that were captured included mold/mildew (8.7%) and dogs (14.5%), and secondhand smoking (15.9% with smell in home and 8.7% with active smoking). Verbal abuse was prominent for nurse aides (31% experiencing it). Ergonomic hazards were observed through various tasks such as repositioning in bed (34.8%), transfer from bed to chair (30.4%), transfer from bed to chair (26.1%), and transfer from chair to chair (26.1%) and particularly for nursing aides. The results of the current observations indicated that home healthcare workers faced a multitude of exposures that could lead to injuries. This provides a rigid platform for occupational safety and ergonomics specialists to appreciate the occupational exposures and challenges that home health care workers face in the unique home care environment and proactively identify mitigation measures of the respective occupational hazards.

A branch-and-price-and-cut algorithm for the home health care routing and scheduling problem with multiple prioritized time windows

This paper addresses a variant of home health care routing and scheduling problem with endogenous time window options for patients. The objective is to minimize the total operational cost while ensuring a specified level of service satisfaction regarding patients’ prioritized time windows. We formulate the problem as a set-covering model and propose a branch-and-price-and-cut (BPC) algorithm to tackle it. Specifically, we devise a column generation procedure to obtain the lower bounds in the branch-and-bound framework, in which we employ a labeling algorithm with a multiple time windows processing mechanism to deal with the pricing sub-problems. Additionally, the lower bound is strengthened by incorporating 2-path inequalities and subset-row inequalities. The effectiveness of the BPC algorithm is demonstrated through numerical experiments conducted on the modified Solomon benchmark instances. Furthermore, we analyze the problem and derive the following managerial insights: i) Incorporating the assignment decisions of time windows for patients into the problem can significantly reduce nurse costs and travel costs, even when accounting for patients’ preferences for time windows. ii) There is a negative correlation between cost savings and the overall satisfaction levels of patients’ preferred time windows, with marginal cost savings decreasing as the overall satisfaction level declines. iii) Besides the total satisfaction level, the operational cost is also influenced by factors such as the distribution of patient locations, the width of time windows, and the proportion of patients with multiple time windows.

Health-related quality of life by veterans RAND 12 and healthcare resource utilization in cancer patients with sleep disorders: insights from the Medical Expenditure Panel Survey.

This study aims to investigate the joint effects of cancer and sleep disorders on the health-related quality of life (HRQoL), healthcare resource utilization, and expenditures among US adults. Utilizing the 2018-2019 Medical Expenditure Panel Survey (MEPS) database, a sample of 25,274 participants was categorized into four groups based on cancer and sleep disorder status. HRQoL was assessed using the VR-12 questionnaire. Generalized linear model (GLM) with a log-linear regression model combined gamma distribution was applied for the analysis of healthcare expenditure data. Individuals with both cancer and sleep disorders (C+/S+) exhibited notably lower physical health (PCS) and mental health (MCS) scores-1.45 and 1.87 points lower, respectively. They also showed significantly increased clinic visits (2.12 times), outpatient visits (3.59 times), emergency visits (1.69 times), and total medical expenditures (2.08 times) compared to those without cancer or sleep disorders (C-/S-). In contrast, individuals with sleep disorders alone (C-/S+) had the highest number of prescription drug usage (2.26 times) and home health care days (1.76 times) compared to the reference group (C-/S-). Regardless of cancer presence, individuals with sleep disorders consistently reported compromised HRQoL. Furthermore, those with cancer and sleep disorders experienced heightened healthcare resource utilization, underscoring the considerable impact of sleep disorders on overall quality of life. The findings of this study address the importance of sleep disorders among cancer patients and their potential implications for cancer care. Healthcare professionals should prioritize screening, education, and tailored interventions to support sleep health in this population.

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.

Health Care Expenses and Financial Hardship Among Medicare Beneficiaries With Functional Disability

Medicare beneficiaries with functional disabilities often require more medical care, leading to substantial financial hardship. However, the precise magnitude and sources of this hardship remain unknown. To quantify the financial burden from health care expenses by functional disability levels among Medicare beneficiaries. This cross-sectional study used data, including demographic and socioeconomic characteristics, health status, and health care use, from a nationally representative sample of Medicare beneficiaries from the 2013 to 2021 Medical Expenditure Panel Survey. Functional disability was measured using 6 questions and categorized into 3 levels: none (no difficulties), moderate (1-2 difficulties), and severe (≥3 difficulties). Data were analyzed from December 2023 to March 2024. Financial hardship from health care expenses was assessed using objective measures (annual out-of-pocket spending, high financial burden [out-of-pocket spending exceeding 20% of income], and catastrophic financial burden [out-of-pocket spending exceeding 40% of income]) and subjective measures (difficulty paying medical bills and paying medical bills over time). We applied weights to produce results representative of national estimates. The sample included 31 952 Medicare beneficiaries (mean [SD] age, 71.1 [9.7] years; 54.6% female). In weighted analyses, severe functional disability was associated with a significantly higher financial burden from health care expenses, with out-of-pocket spending reaching $2137 (95% CI, $1943-$2330) annually. This exceeded out-of-pocket spending for those without functional disability by nearly $700 per year ($1468 [95% CI, $1311-$1625]) and for those with moderate functional disability by almost $500 per year ($1673 [95% CI, $1620-$1725]). The primary factors that played a role in this difference were home health care ($399 [95% CI, $145-$651]) and equipment and supplies ($304 [95% CI, $278-$330]). Beneficiaries with severe functional disability experienced significantly higher rates of both high and catastrophic financial burden than those without disability and those with moderate disability (13.2% [12.2%-14.1%] vs 9.1% [95% CI, 8.6%-9.5%] and 9.4% [95% CI, 9.1%-9.7%] for high financial burden, respectively, and 8.9% [95% CI, 7.8%-10.1%] vs 6.4% [95% CI, 6.1%-6.8%] and 6.0% [95% CI, 5.6%-6.4%] for catastrophic financial burden, respectively). Similar associations were observed in subjective financial hardship. For example, 11.8% (95% CI, 10.3%-13.3%) of those with severe functional disability experienced problems paying medical bills, compared with 7.7% (95% CI, 7.6%-7.9%) and 9.3% (95% CI, 9.0%-9.6%) of those without functional disability and those with moderate functional disability, respectively. Notably, there were no significant differences in financial hardship among those with Medicaid based on functional disability levels. In this cross-sectional study of Medicare beneficiaries, those with severe functional disability levels experienced a disproportionate burden from health care costs. However, Medicaid played a pivotal role in reducing the financial strain. Policymakers should explore interventions that effectively relieve the financial burden of health care in this vulnerable population.

An assessment of various disinfectants using the Kirby-Bauer Method with disc diffusion to determine their effectiveness against locally isolated pathogens

This study aimed to assess the effectiveness of various disinfectants against locally isolated pathogens using the Kirby-Bauer Method with disc diffusion. Indigenous strains of Salmonella typhimurium, E. coli, Campylobacter, Citrobacter freundii, and Staphylococcus aureus were obtained from the bacterial depository bank and sub-cultured on their respective selective media. A 0.5 McFarland Turbidity Standard was prepared, and eight commercially available disinfectants were tested for efficacy. The results of this study will inform the selection of appropriate disinfectants for use in preventing the spread of disease in various settings, including home sanitation, healthcare, and industrial manufacturing processes. The disinfectants used in this study produced different results against the targeted pathogens. Hydrogen peroxide and Formalin produced larger zones of inhibition, while Povidone Iodine and Hydrochloric acid produced intermediate zones. Ethanol, Methanol, and Dettol produced smaller .zones of inhibition. Benzalkonium Chloride was effective only against S. aureus, while all other indigenous isolates resisted it. Keywords: Disinfectants, Sal. typhimurium, E.coli, Campylobacter, Citrobacter freundii, Staphylococcus auerus, Antibiotic sensitivity test

Respect for the Patient-Oncologist Relationship May Limit Serious Illness Communication by Acute and Postacute Care Clinicians After Discharge to a Skilled Nursing Facility

PURPOSE There is a need to increase palliative care access for hospitalized older adults with cancer discharged to a skilled nursing facility (SNF) at risk of poor outcomes. Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care intervention developed to address this gap. This study gathered perspectives from clinicians across care settings to describe perceptions on serious illness communication and care coordination for patients with cancer after discharge to a SNF to guide ALIGN refinements. METHODS We conducted 37 semistructured interviews with clinicians and leaders in hospital medicine (n = 12), oncology (n = 9), palliative care (n = 12), home health care (n = 6), and hospice (n = 4). Some participants had experience working in more than one specialty. The Practical Robust Implementation and Sustainability Model framework was used to develop the interview guide that explored barriers to care, prognosis discussions, and hospice recommendations. Interviews were coded and analyzed using thematic content analysis. RESULTS Analysis identified four themes: (1) discharge to a SNF is recognized as a time of worsening prognosis; (2) care silos create communication and information barriers during a period of increasing palliative care need; (3) family caregiver distress escalates following care transitions; and (4) lack of clarity of roles and respect for the patient-oncologist relationship limits prognostic communication and changes in focus of treatment. CONCLUSION These findings suggest that acute and postacute care clinicians defer serious illness conversations to the oncologist when patients are on a steep trajectory of decline, experiencing multiple care transitions, and may have limited contact with their oncologist. There is a need to clarify roles among nononcology and oncology clinicians in discussing prognosis and recommending hospice for older adults discharged to SNF.

Analysis of the Design of Household First Aid Kits

In the post-epidemic era today, people are increasingly concerned about health issues and have a newer understanding of home health, which in turn is accompanied by the expansion of home healthcare needs. As an important household healthcare device, the demand for first aid kits is also gradually rising, further highlighting the need for them. Although it plays an important role as a home medical care device, deficiencies such as simple structure, lack of function, and lack of intelligence are also presented. Based on this the first aid kit will be transformed and upgraded, innovating the design of its internal and external structure, overall function, and other aspects, to create a set of diverse functions and an intelligent medical care system, so that the family health care can better integrated into people’s lives.

Alone and together: registered nurses’ experiences of work satisfaction in municipal home healthcare

BackgroundThe need for advanced home healthcare (HHC) is expected to increase, with registered nurses (RNs) as key figures. Given the difficulties recruiting and retaining RNs in the HHC sector, understanding their work satisfaction is imperative.AimThis study aimed to explore RNs’ experiences of work satisfaction in the municipal HHC.MethodsIndividual interviews were conducted with RNs (n = 8) in four municipalities in Norway. The data were evaluated using qualitative content analysis.ResultsWork satisfaction in HHC was organised into one theme ‘alone and together’ under four categories—the patient, the co-worker, the registered nurse, and the organisation—and 15 subcategories, including patient diversity, supportive co-workers and professional environment, appropriate workload and responsibilities, and provision of preconditions for self-management.ConclusionsPatients, co-workers, and organisations were identified as crucial areas affecting RNs’ work satisfaction in the municipal HHC. Awareness of these areas is essential to promote RNs’ work satisfaction. Patients’ diversity adds positively to RNs’ work satisfaction. Notably, RNs working alone can affect their work satisfaction not only negatively but also positively.

A Highly Durable and UV‐Resistant Graphene‐Based Knitted Textile Sensing Sleeve for Human Joint Angle Monitoring and Gesture Differentiation

Flexible strain sensors based on textiles have attracted extensive attention owing to their light weight, flexibility, and comfort when wearing. However, challenges in integrating textile strain sensors into wearable sensing devices include the need for outstanding sensing performance, long‐term monitoring stability, and fast, convenient integration processes to achieve comprehensive monitoring. The scalable fabrication technique presented here addresses these challenges by incorporating customizable graphene‐based sensing networks into knitted structures, thus creating sensing sleeves for precise motion detection and differentiation. The performance and real‐world application potential of the sensing sleeve are evaluated by its precision in angle estimation and complex joint motion recognition during intra‐ and intersubject studies. For intra‐subject analysis, the sensing sleeve only exhibits a 2.34° angle error in five different knee activities among 20 participants, and the sensing sleeves show up to 94.1% and 96.1% accuracy in the gesture classification of knee and elbow, respectively. For inter‐subject analysis, the sensing sleeve demonstrates a 4.21° angle error, and it shows up to 79.9% and 85.5% accuracy in the gesture classification of knee and elbow, respectively. An activity‐guided user interface compatible with the sensing sleeves for human motion monitoring in home healthcare applications is presented to illustrate the potential applications.

Does proactive care in care homes improve survival? A quality improvement project

BackgroundNHS England’s ‘Enhanced Health in Care Homes’ specification aims to make the healthcare of care home residents more proactive. Primary care networks (PCNs) are contracted to provide this, but approaches...

Effect of palliative care on economic burden in lung cancer admissions: Insights from the NIS database.

12081 Background: Lung cancer (LC) remains the leading cause of cancer mortality globally, presenting substantial challenges in symptom management and quality of life (QoL) for affected patients. Despite the crucial role of palliative care (PC) in alleviating suffering and enhancing QoL, its integration into LC treatment is inconsistent, attributed to healthcare provider perceptions and systemic barriers. This study examines the utilization of PC consultations in LC admissions using the National Inpatient Sample (NIS) database, seeking to identify patterns of use and opportunities for improved care integration. Methods: The study queried the NIS database from 2016 to 2020 for adult hospitalized patients with a primary diagnosis of LC using ICD-10 codes. The primary outcome examined was the impact of PC consultations on length of stay (LOS), total hospital charges (THC), and healthcare utilization, with inpatient mortality as a secondary outcome. Baseline characteristics were assessed using t-tests and chi-square tests, while multivariable logistic regression analysis adjusted for age, gender, race, Charlson index, insurance type, and household income was employed to evaluate the outcomes. Results: Among 584,055 LC patients, 50.4% was female and 14.6% had a PC consult. These patients were typically older (68.4 vs. 70.6 years, p &lt;0.001), more likely to be male (51.1% vs. 49.3%, p &lt; 0.001) and African American (13.3% vs. 11.9% p &lt; 0.001), and had Medicaid coverage (11.1% vs. 9.7%, p &lt; 0.001) compared to their counterparts . PC was more frequently consulted in non-teaching hospitals (16.3% vs 14.1%, p &lt; 0.001). Patients with PC consults also had a higher Charlson Comorbidity index 6.4 vs. 4.9 (p &lt; 0.001). The overall inpatient mortality rate was 7.4%, with a significantly higher rate in patients with PC (32%) versus without (3.2%) (p &lt; 0.001). While PC was associated with a longer LOS (7.6 vs. 5.9 days, p &lt; 0.001), it resulted in lower THC ($74,399 vs. $84,233, adjusted difference: $6,874 p &lt; 0.0001) and increased discharges with home health care and to nursing homes. Conclusions: PC consultations in LC patients are associated with reduced THC despite a slight increase in LOS. This finding emphasizes the economic and therapeutic value of PC in the treatment of LC, advocating for its earlier and broader integration. By addressing both symptom management and healthcare costs, palliative care can play a significant role in enhancing the comprehensive care of lung cancer patients, highlighting the need for overcoming existing barriers to its adoption. [Table: see text]

Training Opportunities for Managers in Home Health, Hospice, and Community-Based Care Settings.

The aim of this study was to identify areas for developing management skills-focused continuing education for managers working in home health, hospice, and community-based settings. Healthcare managers play a vital role in organizations, yet they have a range of management training. Researchers conducted a cross-sectional survey of managers at a large Visiting Nurse Association. Descriptive and bivariate analyses were performed to examine confidence in management skills by respondent characteristic. Factor and cluster analyses were used to examine differences by role. For all 33 management tasks, managers with 6+ years of experience reported greater confidence than managers with 0 to 5 years of experience. Tasks with the lowest confidence were budgeting, interpreting annual reports, strategic planning, measuring organizational performance, and project planning. Managers were clustered into 5 "profiles." Management training is not 1-size-fits-all. Healthcare organizations should consider investing in training specific to the identified low-confidence areas and manager roles to better support and develop a robust management workforce.

HPR71 Successfully Remaining in Community for Home Health Care Patients With Alzheimer's Disease and Related Dementia: The Role of Living Arrangements and Rural Living

HPR71 Successfully Remaining in Community for Home Health Care Patients With Alzheimer's Disease and Related Dementia: The Role of Living Arrangements and Rural Living