Home infusion therapy (HIT) is a value-based healthcare delivery model where patients receive intravenous medications with home health services (HHS) outside the hospital. Our objective was to provide a comprehensive review of HIT services, tracing its historical development and examining its current role as a critical component of healthcare delivery worldwide. We evaluated peer-reviewed papers and online resources on HIT and HHS, published in English from 1959 to May 2025. Our review supports HIT services globally for three reasons: advance long-term care for the aging population, decrease antimicrobial resistance, and improve healthcare affordability, efficiency and access with continuation of post-acute complex care. The US has pioneered and dominated this field of HIT since 1970’s, providing affordable, safe, effective and convenient services to patients, especially those requiring long-term care. While Canada, Europe, and Australia have offered HIT services, many other countries, including low- and middle-income countries (LMICs), provide limited to absent HIT services due to lack of regulations, experience, knowledge and training. HIT is viewed as a cost-effective alternative to hospital care, and payers have generally accepted higher home-based charges as long as they remain below inpatient costs. The strategic roadmap to safe and cost-effective HIT implementation must include provisions for a robust regulatory framework; competitive reimbursement structures to foster scalability; accreditation and certification standards to ensure patient safety; and access with modern technologies and digital transformation. Both HIT and HHS offer a safe, effective, and economical alternative to inpatient care. Policy reforms that initiate or expand coverage and streamline provider entry can strengthen this growing industry while improving patient outcomes and system-wide efficiency. KEYWORDS: Outpatient parenteral antibiotic therapy, antibiotic resistance, home infusion therapy, global health

Abstract Introduction Co-production approaches are increasingly used in research. However, they are not often evaluated in care home settings. The study aimed to explore how co-production occurred in a series of workshops around falls management in care homes. Methods Sixteen stakeholders (care home residents and relatives, care home staff, health and social care professionals) participating in co-production workshops in a systematic action research study were invited to take part in a qualitative evaluation. The workshops were developing a model for delivering falls training in care homes across Nottinghamshire. Non-participant observations of workshops explored stakeholder interactions. Nine stakeholders participated in reflection meetings to share their experiences of the process. Framework analysis mapped key themes to the National Institute for Health and Care Research’s (NIHR) co-production principles. Results Nine themes were identified. Sharing power was influenced by opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and wider integration challenges across the health and social care system. Inclusion of all perspectives was affected by variable involvement of key stakeholders in the workshops and supported by a flexible approach. Respecting and valuing knowledge was influenced by self-confidence and supported by appreciating diverse stakeholder expertise and experiences. All stakeholders reported benefits of participating in co-production workshops, for example helping others and learning about falls management. However, reputational concerns and fatigue were potential harms of participation. Team dynamics changed as relationships developed. Conclusions Co-production was largely a positive experience for stakeholders and the NIHR’s key principles were partially achieved based on our qualitative findings. Co-production in care home settings is a complex process affected by multiple factors, including the individuals involved, stakeholder relationships, organisational priorities, and integration across the system. Future research should consider organisational power dynamics at all stages and create safe spaces for inclusive participation.

Falls cause millions of injuries and deaths annually, making prevention a key priority in home health care (HHC). Traditional fall risk assessments often overlook the complex interaction of personal, environmental, and behavioral factors. This study addresses these limitations by introducing a novel approach that leverages multimodal data, specifically visual frames and structured prompts, to assess fall risk in in-home patients. Using the multimodal large language model (MLLM), LLaVA-NeXTVideo-7B-hf, we analyze simulated in-home patients' video data to enable a more comprehensive and dynamic evaluation of fall risk, paving the way for intelligent, video-based fall prevention in home health care. Preliminary validation using simulated video data demonstrates the feasibility of using MLLMs for such tasks. Simulated in-home patient video data were processed into 24 equally spaced frames. Twelve visually observable fall risk factors extracted from the literature search, categorized as intrinsic, extrinsic, or behavioral, guided the creation of prompts for the MLLM. Standardized prompts were developed by testing the model with concise prompts for simple inferences and elaborated prompts for complex ones. Each prompt was run 3 times, and consensus results were compared with expert evaluations. The model achieved 85.71% accuracy with concise prompts on 7 simple risk factors and 100% accuracy with elaborated prompts on two complex ones. However, the model consistently failed for 2 risk factors that required clinical judgment or had limited visual data. MLLMs like LLaVA-NeXTVideo 7B-hf show strong potential for augmenting fall risk assessment in HHC when guided by well-structured prompts. The approach focuses on visually inferable factors and is intended to complement, rather than replace, clinical evaluation. This proof-of-concept feasibility study shows that MLLMs can support preliminary fall risk analysis using simulated home health care video data and lays the groundwork for future video-based research in this setting, where existing work remains limited. To our knowledge, this is the first study to evaluate the feasibility of MLLM-based video analysis for fall risk assessment in home health care.

HF is the most common reason for hospital admission and readmission of older adults and those readmitted within 30 days have a higher mortality rate at 6 months. The transition from hospital to community has been identified as a vulnerable time when patients must assume responsibility for their own care. No one strategy has been found to reduce 30-day readmissions or 6-month mortality rates. The Heart Failure Nurse Navigator (HFNN) is a home health registered nurse with specialized training in HF care. In this IRB-approved study, an HFNN visited intervention group participants once in the hospital, followed by weekly home visits for 1 month. Control group participants received usual care, with discharge teaching by nursing and follow-up with their provider. The qualitative research question was "What are the perceptions of older adults (≥65) with a diagnosis of HF who transition from hospital to home regarding care received from a Heart Failure Nurse Navigator?" Qualitative data were transcribed verbatim, then key thoughts and concepts were identified and organized into similar categories. Two main categories emerged: Personal Clarification of Patient Education, especially related to diet, exercise, and medications, and Feelings of Support, Reassurance, and Safety. Meeting the HFNN in the hospital was the beginning of the caring relationship that continued through the home visits. As the caring relationship developed, the HFNN, patient, and family determined together what mattered most during this crucial transition. Providing specialized HF instruction to home health nurses may give them a stronger base from which to offer comprehensive education, support, and reassurance to patients with HF.

Development and Validation of a Culturally Adapted Interactive Game-Based Digital Tool for Screening Mild Cognitive Impairment in Older Adults.

Hospital-based violence intervention programs (HVIPs) effectively reduce recidivism and improve outcomes, but their impact on posthospitalization service utilization for patients with penetrating injuries is unclear. The aim of this article is to evaluate the impact of an HVIP on posthospitalization service utilization among patients with penetrating injuries. A retrospective cohort study was conducted at our urban academic Level I trauma center in the Northeastern United States to assess posthospitalization service utilization, including inpatient rehabilitation and home health services, among patients with gunshot or stab wounds during the first year of HVIP implementation (October 2022-September 2023). Comparisons between the HVIP and non-HVIP groups were made using Mann-Whitney U and Chi-square/Fisher's exact tests. Multivariate logistic regression evaluated predictors of posthospitalization service utilization. Of the 192 patients, 62 were HVIP, and 130 were non-HVIP. The HVIP patients were younger (31 vs. 35years; p =.010) and more likely to be injured by gunfire (77.4% vs. 45.4%; p < .001), with a higher median Injury Severity Score (4 vs. 1; p =.029). Posthospitalization service utilization was significantly higher in HVIP patients (25.8% vs. 9.2%; p =.002). Predictors of posthospitalization service utilization included hospital admission (OR: 10.5, p =.033), Hispanic ethnicity (OR: 3.2, p =.035), and higher Injury Severity Score (OR: 1.2, p < .001). The HVIP involvement had a positive but nonsignificant association (OR: 2.5, p =.078). Hospital-based violence intervention programs may increase posthospitalization service utilization and promote health equity for patients with penetrating injuries. Larger studies are needed to confirm these findings.

iMprovIng the meNtal hEalth of home healTh AiDeS: A study protocol for the MINDSET study.

Vital capacity and air volume are key physiological substrates important for voice, speech, cough, and swallowing. The current gold standard equipment to assess vital capacity and air volume is a pneumotachograph. The aim of this study was to characterize the validity of four low-cost, clinically accessible tools as potential alternative methods to accurately assess vital capacity and air volume. This laboratory-based study examined the accuracy of four low-cost tools to assess vital capacity and air volume: two balloon-based circumference methods (<$1 USD), one analogue spirometer (~$100 USD), and one consumer-grade digital spirometer (~$150 USD). In Experiment 1, known volumes of air (ground truth) were injected into each low-cost tool using a 3-liter calibration syringe. In Experiment 2, the same tools were tested against gold standard pneumotachography equipment. Agreement was assessed using descriptive statistics, Lin's concordance correlation coefficient (ρc), Bland-Altman plots, and linear regression models. Concordance was interpreted as 'moderate' if ρc = 0.90 - < 0.95, 'substantial' if ρc = 0.95 - < 0.999, and 'excellent' if ρc ≥ 0.999. All four tools showed substantial agreement with the ground truth and gold standard measurements. Median absolute differences ranged from 0.07-0.29 liters across tools. The digital spirometer demonstrated the highest agreement, with ρc ≥ 0.994 and the lowest absolute error. While balloon-based methods showed greater variability due to geometric deviations, accuracy improved significantly when correction factors from regression models were applied. The findings support the use of balloon-based circumference techniques, analogue spirometry, and digital spirometry as low-cost alternatives for measuring vital capacity. Each tool demonstrated predictable error patterns that could be corrected to yield highly accurate estimates. These results may expand access to vital capacity measurement in outpatient, home health, and resource-limited settings.

Transitions from inpatient to post-acute care are complex and often confusing for trainees, clinicians, and patients. This perspective describes the development of a visual discharge decision aid created in collaboration with case management specialists to clarify rehabilitation and post-acute care options after hospitalization. The flowchart outlines criteria for long-term acute care hospitals, acute inpatient rehabilitation, skilled nursing facilities, assisted living, home health, and independent discharge. By improving awareness of functional status requirements, intensity of services, and typical patient trajectories, the tool aims to support more informed, patient-centered disposition planning and help trainees better understand the continuum of post-acute care.

Aim: This study aimed to evaluate the levels of job satisfaction and professional burnout among healthcare workers (HCWs) providing home health care services (HHSs). Materials and Methods: A cross-sectional, descriptive design was employed. Data were collected through an online questionnaire administered to HCWs assigned to HHS units of public hospitals in Samsun Province, Türkiye. The first six items of the questionnaire assessed participants’ sociodemographic characteristics and duration of service, followed by the Maslach Burnout Inventory and the Minnesota Satisfaction Questionnaire. Results: Eighty five participants completed the survey, with a mean age of 35.71 ± 8.74 years. Gender, age, professional category, and duration of service—both overall and within HHS—had statistically significant effects on burnout levels. Age was positively correlated with emotional exhaustion and personal accomplishment scores (p = 0.027 and p = 0.002, respectively). Internal satisfaction scores of the Minnesota Satisfaction Questionnaire also showed a positive correlation with age (p = 0.035). Emotional exhaustion and depersonalization subscales of the Maslach Burnout Inventory were negatively correlated with all Minnesota Satisfaction Questionnaire subscales (p &amp;lt; 0.001), whereas the personal accomplishment subscale demonstrated a positive correlation with Minnesota Satisfaction Questionnaire scores (all p &amp;lt; 0.001). Conclusion: Higher job satisfaction among HCWs was associated with lower levels of emotional exhaustion and depersonalization and with greater perceived personal accomplishment. Enhancing job satisfaction through organizational and psychosocial support interventions may help reduce burnout and improve overall well-being among professionals working in home health care services.

Characteristics Associated With Home Health Care Referral After Discharge From Hospital.

Since the mid-20th century, medical devices have proliferated in clinical care, operating rooms, and in everyday life via home health and wearable technologies. Medical devices include a broad range of technologies such as imaging devices, genomic assays, surgical implants, assistive devices, and health monitors. Unlike pharmaceuticals, food, and cosmetics, the United States Food and Drug Administration (FDA) did not prioritize medical device regulation in the early 1900s; devices only became a site of concern post-World War II as more complex and invasive technologies were developed and used in health care. Drawing on analysis of FDA regulations, government documents, historical media coverage, and FDA oral histories, this article traces the evolution of medical device regulation, historicizing persistent debates that position technological innovation and regulation in tension with one another. We demonstrate how limited legal authority prior to 1976 positioned FDA as lagging behind the proliferation of medical devices, which continues to haunt device regulation today. We then analyze the values embedded in device risk classifications and regulatory pathways, considering the consequences for the public's safety and trust.

Abstract Background/Introduction Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, affects 2.4 to 3.1 million people in the United States. Biologic therapies improve outcomes, but adherence is often suboptimal, especially with home infusions or self-injections. A key gap in care is lack of real-time monitoring between visits. To address this, we developed a behavioral science based clinical hovering program, called PATH-IBD (Patient Automated Text Hovering for IBD), to engage patients, support medication adherence, and enhance communication with clinicians. Aim/Objectives We evaluated the effect of PATH-IBD on quality of life, medication adherence, patient satisfaction, and health care utilization in a randomized clinical trial. METHODS Adults with IBD (ages 18+) and receiving biologics through Home Health or self-injection were individually randomized 1:1 to control (usual care) or intervention (PATH-IBD), stratified by medication type (home infusion vs. injection). The intervention included the following components via text message: (1) biologic dose reminders, (2) medication adherence check-ins after each dose, (3) weekly symptom check-ins with escalation to the patient’s care team if above threshold, and (4) feedback to identified support partner (when applicable). Patients were enrolled for a total of 4 months. The primary outcome was change in quality of life via the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Secondary outcomes included the change in Medication Adherence Report Scale (MARS-5), patient satisfaction, proportion of days covered, and healthcare utilization. RESULTS 150 patients were enrolled; 148 completed the study, and 144 were analyzed for the survey outcomes (73 control, 71 intervention). The mean age was 38.9, 52.7% were female, and 81.1% were White. No significant differences were found between arms for the change in median score from baseline to end of study for the SIBDQ, MARS-5, or patient satisfaction surveys. Medication adherence remained high across both arms, and there was no significant difference in the proportion of days covered for infusion or injection patients between arms. There was no significant difference in outpatient visits, hospitalizations, or ED visits between arms; however, patients in the intervention arm had significantly higher number of GI-related telephone/patient portal contacts than the control (difference of 2, 95% CI 0.4–3.6, p &amp;lt; 0.001). CONCLUSION PATH-IBD was well received and increased patient clinician communication. No improvements in quality of life, adherence, or satisfaction were observed, likely due to positive outcomes in the control group. These findings support the feasibility of digital engagement tools to strengthen clinician-patient connections. Future studies with larger, diverse populations and objective outcomes are needed.

Children with medical complexity (CMC) have a high risk of readmission and encounter numerous barriers to care after hospital discharge. Several programs have attempted to mitigate these challenges, with variable impact on readmission rates and care fragmentation. We implemented a novel telehealth program utilizing the full scope of nursing practice to support hospital-to-home transitions and reduce readmission rates for CMC. The aim of our program was to achieve a 10% reduction in the baseline 30-day readmission rate for this population. Eligible inpatients were those with one or more home health orders, a hospital stay of at least seven days, and a previous hospitalization/ED visit in the past year or an intensive care admission during the current hospitalization. The intervention consisted of a virtual nurse visit three to seven days after discharge, with additional follow-up as needed, and handoff to the outpatient team within 30 days to reduce care fragmentation. Our primary outcome was 30-day readmission rates compared to the historical baseline for similar patients. Secondary outcomes included the identification and resolution of care barriers and 30-day ED revisit rates. From January 2020 to June 2024, 974 patients were enrolled in the program, and nurses completed 1,377 telehealth encounters. The 30-day readmission rate decreased from 17.6% to 10.1% over four years. We identified care barriers in 51% of encounters, primarily related to scheduling follow-up appointments (28.5%) and obtaining medical supplies (21.1%). The 30-day ED revisit rate declined from the preintervention baseline of 12.4% to 10.3%. By utilizing nurses working at the top of their license, readmission rates were reduced for a diverse, high-risk patient population. Novel features of the program included minimal exclusion criteria; bridging inpatient and outpatient care teams; and the ability to address clinical questions, care coordination, and social determinants of health needs through a single point of contact. Successful implementation at a second hospital suggests that the model to reduce readmission rates in complex patients could be replicated elsewhere.

Continuous heart rate monitoring is crucial for early cardiovascular disease detection. To overcome the discomfort and limitations of ECG in home settings, we propose a multimodal temporal fusion network (MM-TFNet) that integrates ballistocardiography (BCG) and photoplethysmography (PPG) signals. The network extracts temporal features from BCG and PPG signals through temporal convolutional networks (TCNs) and bidirectional long short-term memory networks (BiLSTMs), respectively, achieving cross-modal dynamic fusion at the feature level. First, bimodal features are projected into a unified dimensional space through fully connected layers. Subsequently, a cross-modal attention weight matrix is constructed for adaptive learning of the complementary correlation between BCG mechanical vibration and PPG volumetric flow features. Combined with dynamic focusing on key heartbeat waveforms through multi-head self-attention (MHSA), the model’s robustness under dynamic activity states is significantly enhanced. Experimental validation using a publicly available BCG-PPG-ECG simultaneous acquisition dataset comprising 40 subjects demonstrates that the model achieves excellent performance with a mean absolute error (MAE) of 0.88 BPM in heart rate prediction tasks, outperforming current mainstream deep learning methods. This study provides theoretical foundations and engineering guidance for developing contactless, low-power, edge-deployable home health monitoring systems, demonstrating the broad application potential of multimodal fusion methods in complex physiological signal analysis.

This study aimed to evaluate the impact of MetS on inpatient outcomes, health care utilization, and discharge patterns in hospitalized IBD patients. Inflammatory bowel disease (IBD) is a chronic, immune-mediated condition associated with rising prevalence, high hospitalization rates, and substantial health care costs. In parallel, the growing burden of metabolic syndrome (MetS) may further worsen clinical outcomes and resource utilization in this population. We conducted a retrospective analysis of the 2016-2020 National Inpatient Sample, identifying 241,772 hospitalized IBD patients. Patients were stratified by the presence of MetS, and the 2 cohorts were compared regarding inpatient outcomes including mortality, intensive care interventions, length of stay (LOS), and discharge disposition. Multivariable logistic regression models were used to assess associations between MetS, its individual components (hypertension, diabetes, obesity, and dyslipidemia), and key inpatient outcomes. Of the cohort, 6382 (2.6%) had MetS. Compared with patients without MetS, those with MetS were older, had higher comorbidity burden, longer LOS (5.77 vs 5.30 d), and increased likelihood of central line placement, intubation, and vasopressor use. Discharge to home was less frequent (57.4% vs 73.7%), with higher rates of skilled nursing or home health needs. Multivariable analysis demonstrated that MetS and individual components independently increased odds of mortality, intensive care interventions, and resource utilization. MetS significantly worsens inpatient outcomes and increases health care utilization in hospitalized IBD patients. Early identification and targeted management of metabolic comorbidities may reduce complications, optimize resource use, and improve discharge outcomes, underscoring the importance of integrated metabolic care in this population.

As the aging population grows and more elderly individuals live independently, the demand for reliable, unobtrusive home health monitoring becomes increasingly important. Existing in-home health monitoring systems often face limitations such as privacy concerns, dependence on unreliable wearable devices, degraded accuracy in complex environments, and lack of continuous monitoring capability. To address these challenges, we propose a long-term home health monitoring system that primarily relies on audio sensing, supplemented by other noninvasive modalities. Our approach is able to accurately detect and recognize overlapping acoustic events with fine-grained temporal resolution, surpassing conventional audio-based methods for activity recognition. The system incorporates a transformer-based time-frequency fusion module and a category dynamic threshold strategy to improve detection performance under semi supervised conditions. Experiments on real-world dataset demonstrate that our method outperforms existing baselines, achieving PSDS$_{1}$, PSDS$_{2}$, and EB-F1 scores of 0.581, 0.930 and 55.1%, with improvements of 0.054, 0.019, and 2.3%, respectively. In addition, a 30 day field deployment involving 10 elderly participants confirms the robustness and practicality of the system for real-world applications. By allowing continuous passive monitoring of daily activities and abnormal acoustic events, our system has significant potentials for early detection of health risks, behavioral anomalies, and long-term wellness tracking in aging in place scenarios.

Post-acute care (PAC) utilization following sepsis hospitalization remains understudied, particularly concerning racial and ethnic and urban-rural disparities. To examine trends and disparities in PAC utilization after sepsis hospitalization, focusing on race, ethnicity, and rurality. A comprehensive search of databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) was conducted for eligible studies using data through March 2020. The Social Ecological Model guided the review. Eleven studies met inclusion criteria. Our synthesis found a discontinuous increase in PAC use, with a shift from home discharges toward greater use of nursing homes and home health care after 2006. White patients had higher PAC utilization than racial and ethnic minority individuals. Rural and urban non-teaching hospitals discharged more sepsis survivors to long-term care hospitals, while urban teaching hospitals had more discharges to HHC. This review establishes a pre-reform, pre-pandemic baseline for PAC utilization among sepsis survivors. Despite overall gains, disparities in PAC utilization persist by race, ethnicity, and hospital type. As payment and care delivery models have evolved since 2016, future research should leverage this historical baseline to assess the impact of new policies on equitable PAC access for sepsis survivors.

Summary:Discharge destination following hospitalization plays a critical role in surgical recovery, long-term outcomes, and healthcare resource use. Although postacute care facilities are increasingly used, there is limited literature within plastic surgery addressing their role and implications. This review outlined the continuum of discharge options available to plastic surgery patients, including long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, assisted living facilities, postoperative guest suites, and home with or without home health care. Each destination differs significantly in patient acuity, level of available services, and payer coverage. Plastic surgery patients undergoing complex procedures such as free tissue transfer, trauma reconstruction, or burn care may require specialized facilities for wound management, rehabilitation, or close monitoring. Medicare and Medicaid policies influence access, and coverage varies widely across facility types and states. Home discharge is generally associated with superior outcomes and more predictable costs, but nonhome postacute care facilities remain essential for patients with higher medical and functional needs. For plastic surgeons, knowledge of these discharge settings is essential to effective discharge planning, directly impacting readmission rates, reimbursement, and patient recovery. Plastic surgeons must engage actively in discharge planning by advocating for the most appropriate level of care, aligning patient safety, functional recovery, and financial stewardship.

Healing at Home: Receipt of Home Health Care and Patient-Centered Outcomes Among Older Adults After Acute Myocardial Infarction.