Integrated Home Care Research Articles

Impact of Integrated Home care in Catalonia

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Relationship between frailty and long-term care needs in Chinese community-dwelling older adults: a cross-sectional study

ObjectivesOur study aimed to investigate the relationship between the severity of frailty and the long-term care (LTC) needs of older adults from Chinese communities.DesignA cross-sectional study.SettingThree Chinese community health centres....

How to Scale Up Quality and Safety Program with the Home Care Accreditation.

Introduction:The growing number of older people and the increasing burden of non-communicable diseases highlight the need for the integration between social and health services. To ensure high quality home care, common and consistent standards are essential. Our aim is to develop a validated accreditation tool for home care.Description:An integrated home care accreditation tool was developed including 26 standards and 144 items divided into six domains: Organization&Governance, Patient Safety&Risk Management, Professionals knowledge, Skills&Competences, Information&Communication, Care Integration, and Improvement&Innovation. Expert evaluation was conducted between August and November 2019; relevance and feasibility (RF) and expert agreement were analyzed.Discussion:A total of 21 experts participated in the validation process, with a response rate of 53%. A good RF score and agreement were obtained for 70% of the items and 65% of the standards. The best scores were obtained for Individualized care project (RF 8.4, agreement 100%), Integrated care pathways (RF 7.5, agreement 81%), Access to the integrated health and social care system (RF 8.1, agreement 86%), and Multidimensional assessment of needs (RF 8.1, agreement 86%).Conclusion:The existence of an integrated health and social care accreditation tool would help to improve the quality of home care, and make patients’ quality of life better and safer.

Home Health Care Scheduling Problem Under Uncertainty: Robust Optimization Approaches

This paper deals with the home health care service (HHCS) which is defined as a set of medical, paramedical and social services delivered to patients in their domicile rather than in hospital. To support decision making in HHC, optimization models have been used. However, several of those models are deterministic and do not address the dynamical and uncertainty aspects of the system and variability of some patient data. The HHC scheduling problems are facing more and more complex and specific constraints. These constraints have to be respected, meanwhile the problem objective is optimized under parameters uncertainties. This paper aims to formulate a model that integrated home care scheduling problem while taking into account human aspect -- the behavior of patients, and also another aspect like travel time uncertainty and dynamic behavior of involved medical team and social actors in HHC. Robust approaches are adopted to model and handle this uncertainty.

Integrated social and health care supported by home telemonitoring in patients with heart failure: the European SmartCare project in the Friuli Venezia Giulia Region

Home care for patients with chronic diseases and specifically with heart failure (HF) is one of the main challenges of health care for the future. Telemedicine, applied to HF, allows intensive home monitoring of the most advanced patients, improving their prognosis and quality of life. The European SmartCare project was carried out in the Friuli Venezia Giulia (FVG) region with the aim of improving integrated health and social care in patients with chronic non-communicable diseases (CNCD) through home telemonitoring (TM) and promoting self-management and patient empowerment. The SmartCare project in FVG was a prospective, randomized and controlled cohort study that enrolled, from November 2014 to February 2016, 201 patients in integrated home care ("usual care" [UC] in our study) to TM (n=100) or UC (n=101). Inclusion criteria were age >50 years, at least 1 CNCD (HF, chronic obstructive pulmonary disease, or diabetes) and 1 missing BADL. There were 19 drop-outs (9%) (12 in the TM arm; 7 in the UC arm; p=NS). All patients were followed by a multiprofessional team and stratified in the short-term pathway (3-6 months; average 4 ± 1 months; n=101), enrolled at discharge from hospitalization, or in the long-term pathway (6-12 months; mean 10 ± 3 months; n=100) for frail/chronic patients already followed in home care. The most frequent main diagnosis was HF (n=108, 54%), followed by diabetes (30%) and chronic obstructive pulmonary disease (16%). A Charlson score ≥3 was present in 75% of cases and over 60% were taking at least 7 drugs. Among the social characteristics of the enrolled population, 55% were living alone or with non-familial caregivers, 62% had primary education and 48% were non-self-sufficient. The days of hospitalization were significantly reduced only in the TM arm of the post-acute pathway (20 days of hospitalization avoided for 10 patient-months of follow-up, p=0.03) and the effect was mainly evident in patients with HF (p=0.02). A significant increase in the number of home accesses and telephone contacts were also documented in the TM group (12.7 and 13.7 more home interventions for 10 patient-months of follow-up; p=0.01 and p=0.002 in the post-acute and chronic pathway, respectively). The SmartCare-FVG project showed in patients with chronic diseases (mainly HF), in the post-acute phase of the disease, to significantly reduce the days of hospitalization with a limited and sustainable increase in the use of nursing home care resources.

Indicators of an Integrated Home Care Model Shaped by the Needs of Patients Discharged from the Emergency Department.

Introduction:Developing community care models aims to satisfy the needs of patients’ in-home care comprehensively. This is crucial to decrease adverse events and prevent rehospitalization.Methods:A cross-sectional study was conducted among 200 emergency department patients (EDPs) and 200 general practice patients (GPPs). The modified version of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Health Behavior Inventory (HBI), the Generalized Self-Efficacy Scale (GSES), the Patient Satisfaction Questionnaire (PSQ), and the Multidimensional Health Locus of Control Scale (MHLCS) were used.Results:The study indicated the higher level of unmet needs in EDPs than in the population of GPPs (p = 0.008). The unmet needs increased risk of hospitalization in both groups: OR = 0.28 [95%CI 0.15–0.52] for EDP and OR = 0.33, [95%CI 0.17–0.62] for GPPs groups. We also found a significant relationship between the low levels of needs satisfaction and social-demographic variables, including health profile and the level of health behavior, generalized self-efficacy, health locus of controls, and healthcare measures in general practice.Discussion and Conclusion:We suggest that the identified factors should be included into the integrated community care model to advance satisfaction of patients’ needs, especially in patients discharged from an emergency department.

Determinants Associated With the Risk of Emergency Department Visits Among Patients Receiving Integrated Home Care Services: A 6-Year Retrospective Observational Study in a Large Italian Region.

Background: Allowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC). Methods: A retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient’s health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable. Results: A total of 29209 ED visits were recorded during the 66433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR]=1.29), younger patients, those with a family caregiver (OR=1.13), and those with a higher number of cohabitant family members. Long travel distance from patients’ residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR=1.91) showed the highest risk of ED visits. Conclusion: Evidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.

The French Brain Council Advocacy for 10 priorities regarding the National Brain and Mental Health plan in Europe

Summary The French Brain Council, which has a balanced representation of Neurology, Psychiatry and Neurosciences, participated in the launch of a survey on the current status of care for patients suffering from brain diseases with the aim to identify 10 consensual priorities to be emphasized in the building the National Brain Plan in all European member states. This National Brain and Mental Health plan was approved by the National Brain Councils of 17 European member states. The present report details the 11 responses that obtained a consensus, the top five (over 90% of agreement) being the needs to: (1) improve multidisciplinary integrated home care and structures of coordinated health care, (2) increase homogeneity within regions for current state of prevention, (3) develop evidence based and socially responsible policy by collecting data from ongoing clinical trials and basic research to optimally address unmet needs, (4) promote education on innovative technologies, and (5) facilitate translational research.

Effects of enteral nutrition on patients with pressure lesions: a single center, pilot study.

Protein-energetic malnutrition (PEM) affects prognosis and mortality in elderly patients as an inadequate nutritional status is a risk factor for the development and worsening of pressure sores (PS). We aimed to evaluate the incidence of PEM in outpatients with PS and to study the impact of nutritional support on the stage of PS. PS patients, divided in a group treated with artificial nutrition (group A) and those fed orally (group B) at home, were consecutively enrolled in the Integrated Home Care program of Ascoli Piceno between June and September 2015. At T0 the patients underwent medical history, nutritional, anthropometric/biochemical parameters assessment, and the staging of the PS. The same assessments and staging of the pressure lesions were performed three months later (T1). Group A (n=25) started from a better nutritional status vs. group B (n=25) at T0, according to MNA assessment. Group A showed a significant improvement of nutritional status correlating with detailed control of nutrients intake and improvement of PS stage (T0 vs. T1, p<0.05). On the other hand, group B showed a significant difference between nutrients intake and nutritional needs that correlated with both malnutrition state increase and worsening of the PS staging (T0 vs. T1, p<0.05). The present study shows that PEM has a significant prevalence in the elder, in general, and in older people with PS, in particular. A targeted nutritional intake can prevent and help the healing of PS.

How does information system success come about in inter-organizational networks of public services?

ABSTRACT The paper investigates how information systems in inter-organizational networks can be improved over time. The paper focuses on home care services for elderly people. DeLone and McLean's conceptual model of information system success was used to understand changes in the quality of the case study information system. The analysis highlights the importance of the governance of information systems at the inter-organizational level. IMPACTLooking at a network of home care integrated services for non self-sufficient elderly people, the authors show how an information system in an inter-organizational network can be optimised. Policy-makers and managers of municipalities, local health authorities and central/regional governments need to make sure that the information system at the inter-organizational level is properly governed and managed. In particular, it is important to agree upon the rules to be followed and the responsibilities to be assigned to the various operators involved in the process of providing data for the integrated home care services as a whole. It is vital to define ‘who does what’ to oversee the processes related to collecting, processing and sending data at the network level.

The Development of Services System of Integrated Home Care for the elderly based on Omaha System

Objective To develop a comprehensive services system of integrated home care for the elderly based on Omaha System. Methods The Omaha system was used to determine relevant indicators of the content of integrated home care services for the elderly, and identified through the Delphi expert consultation. Results After two rounds of expert correspondence consultation, the effective recovery rate of the questionnaire was 100.00%, the authoritative coefficient of the experts was 0.872 and 0.851, the variation coefficient of the first and second indexes in the second round of expert correspondence consultation was 0.00 to 0.28, The mean importance ratings ranged from 3.80 to 5.00 on a 5-point scale, and the full score was 33.33% to 100.00%. Finally, four first-level indicators including physiological field, social-psychological field, health-related behavior field, environmental field and other fields were established, as well as 43 second-level indicators. Conclusions The indicators related to the services system of integrated home care services for the elderly based on Omaha system are reliable and scientific, which can provide reference basis for further understanding the needs of the elderly of integrated home care services, improving the quality of medical care and old-age care services for the elderly. Key words: Elderly; Omaha system; Integrated care; The service contents

Using Cost-Effectiveness Analysis in Mixed Methods Research: An Evaluation of an Integrated Care Program for Frequently Hospitalized Older Adults in Singapore

Traditional evaluation techniques are often not suitable for studying health interventions operating in real-world settings, particularly when interventions operate through complex causal pathways. We describe a mixed methods design for evaluating an integrated home care and social support service targeting mature and older adults (55+ years) in Singapore. Here, nurses and community health workers visit patients’ homes to address health and social needs while facilitating linkages to community-based services and providing caregiver support. Our mixed methods evaluation plan is composed of three components: quantitative comparison of hospital-based service utilization, cost-effectiveness analysis, and qualitative investigation into the experiences of patients, caregivers, and individuals who declined services. This article contributes a description of how cost-effectiveness analysis adds value when incorporated into mixed methods studies.

Co-designing a framework for integrated home care planning with older adults, family caregivers and health care providers

Background: Older persons want to remain in their own homes as long as possible, making home care services essential for maintaining independence, completing daily activities and delaying entry into institutional care 1. While home care has the potential to improve health and well-being and reduce health care costs, provision of these services to the geriatric population is complicated by complex, multi-morbid health issues requiring care from a range of providers who work in isolation of each other. Improved integration from planning through delivery is a key priority for Canadian home care 2. Aims: This study aimed to develop an implementation framework for an integrated geriatric care planning approach in home care. Key objectives were to: a investigate current geriatric assessment practices; b collect ideas for improving person- and family-centred goal setting; and c co-design solutions for more integrated geriatric care planning with older adults, family caregivers and health care providers. Methods: This study applied a sequential transformative mixed methods design 3. Quantitative data were collected through a web-based survey that was developed with and delivered to frontline home health care nurses, occupational therapists and physiotherapists n=303. Qualitative data were collected in-person through solutions-focused key informant interviews with older adults and family caregivers n=24. Statistical and thematic analysis of the data was iterative and ongoing. Survey and interview data were brought together during the interpretation phase, where older adults, family caregivers, and health care providers n=19 were engaged in a workshop to co-design solutions for more integrated geriatric home care planning. Results: An implementation framework for integrated geriatric care planning in home care was developed. Components of the framework include: a common clinical and non-clinical information needed by everyone involved; b key touch points and actions for achieving the integrated care planning experience everyone involved wants; and c nine ideas for tools and technology to support integrated data collection, goal-setting and communication. Conclusions: Older adults, family caregivers and health care providers have both common and unique needs for sharing and receiving information to support planning care in the home. Home care planning should begin with a holistic baseline understanding of an individual person that prioritizes and applies information on personal background, goals, needs and preferences in seeking to understand individuals’ health challenges and plan for their care. Limitations: This study was conducted in a single region within Ontario, Canada. Suggestions for Future Research: Next steps for this research include additional co-design workshops in other regions, to develop prototypes of these new processes and tools for integrated geriatric care planning to be pilot tested in home care practice.

Patient and Family-Centred Home and Community Care: Realizing the Opportunity.

As jurisdictions around the world transform their healthcare systems, the home and community care sector represents both a significant challenge and a critical opportunity for the future. One of the biggest challenges is that home and community care lags behind hospitals and primary care in most health systems in funding, policy, and infrastructure. At the same time, home and community care is an ideal foundation for a health system which is patient and family-centred and provides care options that are delivered closer to home. This article builds on the patient-centred care concepts in an article by Sharkey and Lefebvre (2017) and identifies how nurses can lead the way to health system transformation by working with patients and families to co-design changes to achieve a higher quality, more integrated and patient-centred home and community care system.

Role of rehabilitation in the elderly after an acute event: insights from a real-life prospective study in the subacute care setting.

Any acute event, either primary or secondary to a chronic disease, is generally followed by some degree of physical impairment. Subacute care (SAC) represents one of the inpatient intermediate care settings aimed at completing recovery and restoring functional capacity. Debate exists on the role of the rehabilitation treatment in the SAC setting. The aim of this study was to compare the outcomes of patients managed in two different SAC Units where A) patients undergo an individualized rehabilitation program on top of optimal medical therapy (OMT) B) patients receive OMT only. Real-life prospective study. SAC units. Seventy-five chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) patients transferred after an acute hospitalization. Upon SAC admission, the following scales were obtained: cumulative illness rating scale comorbidity and severity (CIRSC and CIRSS), mini mental state examination (MMSE), Performance-Oriented Mobility Assessment (POMA), Barthel Index (BI), the 10-meter walking test (10MWT). Pre-admission BI was also collected based on history. Upon SAC discharge, BI, POMA, and 10MWT were repeated. Patients (44 in Group A, 31 in Group B) were similar with regard to age, gender, MMSE, clinical complexity, pre-admission BI, admission 10MWT, POMA, and bedrest conditions. Admission BI was lower in Group A. In both groups BI was lower when compared to the respective pre-admission score. Upon discharge, Group A patients were characterized by a higher BI and POMA compared to Group B. Indeed, BI and POMA improved at discharge only in Group A patients. Only this latter group reached the pre-morbid BI. Upon discharge the number of bedrest patients decreased only in Group A. The percentage of patients discharged home was also much higher in Group A, while a greater number of Group B patients were transferred to a rehabilitation ward or were enrolled in an integrated home care assistance program. In a real-life prospective experience, a better outcome is demonstrated in elderly CHF and COPD patients undergoing a rehabilitative approach during their in-hospital SAC stay. An individualized rehabilitation program should integrate medical treatment of CHF and BPCO patients in the SAC setting. This approach demonstrates a better cost-effectiveness management of these patients.

Case Manager Resource Allocation Decision-Making for Adult Home Care Clients: With Comparisons to a High Needs Pediatric Home Care Clients

Home care programs have become integral parts of the overall health service system in Canada and in many other developed nations. Resource allocation decision-making by home care case managers (CM) is a complex task where CMs are challenged to meet the dual responsibilities for clients, in order that they achieve high quality care, and to the system to contain costs. The purpose of this study was to extend what is known about resource allocation decision-making factors identified in a previous systematic literature review and ethnographic study within a high needs pediatric context conducted by the principal investigator in Western Canada. Spradley’s ethnoscience method was used in this research. The study sample consisted of 17 home care CMs, professional practice leads, and their managers from two separate home care offices. All participating CMs had assigned caseloads and were involved in the assessment and implementation of care planning for clients. Purposive sampling methods were employed. In keeping with Spradley’s ethnoscience approach, data collection occurred in three distinct phases or rounds. The first round of data collection began with a series of one-on-one interviews with card sorts, the second round of data collection was another series of one-on-one interviews with CMs who were not interviewed in the prior round, and the third and final round of data collection was a focus group to accomplish further refinement and verification of our established categories. Participants identified five categories of factors that effected their resource allocation decision-making. The categories were related to one of five main areas: the client, the CM, the home care program, community resources, or the health care system. The findings of this study reinforced the complexity of CM resource allocation decision-making in home care. This study provides new insights into CM resource allocation decision-making based on multidisciplinary, integrated home care teams caring for adults, the majority of whom are 65 years and older. This study also provides the comparison of taxonomy that differs between pediatric and adult home care populations that influence resource allocation decision-making.

Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce.

Development of a Localized Community-Based Integrated Home Care System: Model Swapping through an International Symposium

Development of a Localized Community-Based Integrated Home Care System: Model Swapping through an International Symposium

Integrated Home Care Programs for frail older people: evidence from a systematic review

Integrated Home Care Programs for frail older people: evidence from a systematic review

Care at home for elderly – lessons learnt from the Swiss Red Cross “Integrated Home Care” in Eastern Europe/CIS

Care at home for elderly – lessons learnt from the Swiss Red Cross “Integrated Home Care” in Eastern Europe/CIS