Home Care Intervention Research Articles

A systematic review evaluating the impact of paid home carer training, supervision, and other interventions on the health and well-being of older home care clients.

Interventions to support and skill paid home carers and managers could potentially improve health and well-being of older home care clients. This is the first systematic review of interventions to improve how home carers and home care agencies deliver care to older people, with regard to clients' health and well-being and paid carers' well-being, job satisfaction, and retention. We reviewed 10/731 papers found in the electronic search (to January 2016) fitting predetermined criteria, assessed quality using a checklist, and synthesized data using quantitative and qualitative techniques. Ten papers described eight interventions. The six quantitative evaluations used diverse outcomes that precluded meta-analysis. In the only quantitative study (a cluster Randomized Controlled Trial), rated higher quality, setting meaningful goals, carer training, and supervision improved client health-related quality of life. The interventions that improved client outcomes comprised training with additional implementation, such as regular supervision and promoted care focused around clients' needs and goals. In our qualitative synthesis of four studies, intervention elements carers valued were greater flexibility to work to a needs-based rather than a task-based model, learning more about clients, and improved communication with management and other workers. There is a dearth of evidence regarding effective strategies to improve how home care is delivered to older clients, particularly those with dementia. More research in this sector including feasibility testing of the first home care intervention trials to include health and life quality outcomes for clients with more severe dementia is now needed.

Older Adults, Frailty, and the Social and Behavioral Determinants of Health

<abstract> <p><bold>Objective:</bold> To examine the associations between social and behavioral determinants of health (SBDH) and frailty among older adults using an existing Omaha System dataset collected in the community.</p> <p><bold>Design:</bold> Secondary exploratory data analysis.</p> <p><bold>Setting:</bold> An existing dataset of home health records from a Midwestern region, including Omaha System problems, interventions, and Knowledge (K), Behavior (B), and Status (S) outcomes.</p> <p><bold>Participants:</bold> Older adults (n = 1,618) that were 63.7% female with an average age of 80.1 years (SD = 7.6).</p> <p><bold>Methods:</bold> This exploratory data analysis study reused an existing Omaha System dataset to reveal hidden patterns in health outcomes of frail vs. non-frail older adults relative to SBDH. Two separate metrics were used to classify SBDH and frailty. An existing summative SBDH index was derived from measures recommended by the Institute of Medicine (IOM). A new frailty index was created based on Omaha System terms mapped to frailty criteria established by Fried and colleagues. Heat maps and line graphs were developed using Microsoft Excel and R. Patterns were discovered and related hypotheses were evaluated using paired samples t-tests and two-way ANOVA tests in R.</p> <p><bold>Results:</bold> Records (n = 1,618) were divided into SBDH Group 0 with no SBDH Problems (n = 1,397) and SBDH Group 1 with one or more SBDH Problems (n = 221). Overall, there was significant improvement in KBS after home care interventions. SBDH, Frailty, and interactions between SBDH and Frailty were significantly associated with differences in KBS outcomes. Visualizations showed numerous potential patterns for further research.</p> <p><bold>Discussion:</bold> SBDH Group 1 was largely defined by having the Mental health problem. Being in SBDH Group 1 was negatively associated with KBS outcomes. This aligns with the literature on the impact of mental health on overall health and wellbeing. As frailty scores increased, KBS outcomes decreased, demonstrating a possible continuum of increasing frailty as related co-morbidities accrued. This is a new perspective on frailty that should be further investigated. SBDH group, Frailty, and SBDH-Frailty interaction were all important for understanding outcomes for final K, final S, and difference in K, B, and S. For final B, SBDH group and Frailty were important. Because interaction between SBDH and Frailty was observed for most problems and outcomes, researchers who study Frailty should account for SBDH, especially mental health. SBDH problems were infrequent in the data. This has implications for our ability to understand SBDH in home care. Future research should incorporate data that include SBDH problem assessments.</p> <p><bold>Conclusion:</bold> This exploratory data analysis study identified relationships between SBDH and frailty for older adults along a continuum of frailty using the Omaha System. Further research is needed to validate the findings and to evaluate the metrics with other datasets and populations.</p> </abstract>

Informational Needs of Postmastectomy Patients.

The aim of this study was to determine informational needs of postmastectomy patients. This descriptive study was conducted in the general surgery clinics of a university health center for medical research and practice with 72 voluntary patients. For data collection, a patient identification form was used, which was prepared by the researchers in accordance with the literature. The mean age of the patients was 52.66±13.39 years, 87% were married, 58% had primary school education, 76% had moderate economic status, and 53% had undergone simple mastectomy. It was determined that 83% of the patients wanted to be informed about hospital and home care interventions, 82% about symptoms and prevention of post-surgical problems, 76% regarding breast cancer and treatment options, and in the range of 54-68%, patients wanted information on the effects of surgery on the body, shoulder and arm exercises, breast self-examination, the effects of breast cancer on family and work life, lymphedema and prevention interventions. We recommend that patients with mastectomy should be informed about topics including care interventions, breast cancer and treatment options, effects of surgery, and reducing these effects.

Exploring Home Care Interventions for Frail Older People in Belgium: A Comparative Effectiveness Study.

To examine the effects of home care interventions for frail older people in delaying permanent institutionalization during 6 months of follow-up. Longitudinal quasi-experimental research study, part of a larger study called Protocol 3. Community care in Belgium. Frail older adults who received interventions (n = 4,607) and a comparison group of older adults who did not (n = 3,633). Organizations delivering the interventions included participants provided they were aged 65 and older, frail, and at risk of institutionalization. A comparison group was established consisting of frail older adults not receiving any interventions. Home care interventions were identified as single component (occupational therapy (OT), psychological support, night care, day care) or multicomponent. The latter included case management (CM) in combination with OT and psychological support or physiotherapy, with rehabilitation services, or with OT alone. The interRAI Home Care (HC) was completed at baseline and every 6 months. Data from a national database were used to establish a comparison group. Relative risks of institutionalization and death were calculated using Poisson regression for each type of intervention. A subgroup analysis revealed that 1,999 older people had mild impairment, and 2,608 had moderate to severe impairment. Interventions providing only OT and interventions providing CM with rehabilitation services were effective in both subpopulations. This research broadens the understanding of the effects of different types of community care interventions on the delay of institutionalization of frail older people. This information can help policy-makers to plan interventions to avoid early institutionalization.

Missing data at follow-up: The case of the interRAI home care assessment instrument in Belgium

BackgroundIn Belgium, a web application BelRAI was developed to support the use of interRAI Home Care assessments. However, not all clients have had a follow-up assessment. ObjectivesTo examine the prevalence of incomplete assessments at 6-month follow-up and to compare the profiles of persons with and without missing data. DesignObservational study of interRAI Home Care data and data from the Belgian Intermutuality Agency. SettingHome care in Belgium. ParticipantsHealthcare professionals using BelRAI in the context of an evaluation of home care interventions to delay institutionalization of frail older people. MethodsDescriptive statistics were calculated based on demographic characteristics and outcome measures. Poisson regressions for the relative risk of institutionalization and for the relative risk of death were performed for a period of 6 and 12 months. ResultsIn a sample of 4987 persons (mean age 79.90), two groups were determined: a group without and a group with missing data at 6-month follow-up. At baseline, the group with missing data at follow-up has a worse health status than the group without missing data. Persons with missing data at 6-month follow-up had a 3.63 higher chance of dying between 6 and 12 months after baseline, a 3.43 higher chance for institutionalization at 6 months, and a 2.87 higher chance for institutionalization at 12 months. ConclusionIn this study, missing data at follow-up is not a random occurrence. The findings are important for healthcare professionals and for researchers working with longitudinal data. Further study is required to research possible solutions.

Abstract TP381: Evaluation Of A Modified Home Care Intervention For Stroke Patients In Transition From Hospital To Home

Introduction: In the past two decades, there has been 84% increase of stroke prevalence in China. Since transitional care facilities are lacking in China, most of the stroke survivors return home after discharged from acute hospital setting. Routine disease-oriented discharge planning does not match individual home care needs. Objective: To evaluate the effectiveness of a modified home care (HC) intervention to facilitate the transition of care for stroke survivors from hospital to home. Methods: Using a quasi-experimental study design, stroke survivors from a 115-bed stroke unit in teaching hospital in China were recruited. HC subjects (n=168) received nurse-led pre-discharge preparation and post-discharge follow-ups, which beganon admission until 30-days post hospital discharge(a total of 4 hours,5 sessions,48 minutes on average). Hospital length of stay (LOS), stroke-related readmission rates, ability to perform activities of daily living (ADLs), and medication adherence were assessed at 30-days post-discharge. Historical controls (n=173)that received routine discharge planning, including standardized patient education about stroke and one telephone follow-up, were used as the comparison group (CG). Results: Subjects were on average 65.10 years old, 51% women, 74% ischemic stroke, 26% hemiparesis. The HC group had significantly better outcomes with a reduced hospital LOS(HC=11.3±2.2days vs.CG=12.4±4.3 days, p = 0.03), decreased stroke-related readmission rate(HC=1.2% vs.CG=6.4%, p = 0.02), increased ability to perform ADLs observed by Barthel Index. (HC=38.3±10.2vs.CG=32.1±10.3, p = 0.03) and medication adherence (HC=95.8%vs.CG=53.2%, p = 0.004), compared to CG. Conclusions: Our findings suggest that the modified HC intervention, incorporating nursing care planning and follow-ups across care settings, is effective in enhancing the transition from hospital to home, in terms of hospital care utilization and patient outcomes.

Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale.

Introduction:Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale.Methods:Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4–6), and low (Group 3 - ESAS scores 0–3) priority based on ESAS scores. In high priority group, patients received home visit in 0–3 working days; medium priority group, patients received home visit in 0–10 working days; and low priority group, patients received home visit in 0–15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care.Results:“High priority” patients were visited in 2.63 ± 0.75 days; “medium priority” patients were visited in 7.00 ± 1.5 days, and “low priority” patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (χ2 = 27.3, P < 0.001) compared to Group 2 (28.6%) and Group 3 (15.4%). Group 2 had more hospital deaths. Interval duration from triaging to first intervention was a significant predictor of survival with odds ratio 0.75 indicating that time taken for intervention from triaging was more significantly affecting survival than group triaging.Conclusion:Pilot study of testing triaging coding system in home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group, and (d) time taken for intervention from triaging was a significant predictor of survival.

A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial

Background: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. Aim: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. Design: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument. Setting/participants: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. Results: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. Conclusion: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.

Recruitment and Reasons for Non-Participation in a Family-Coping-Orientated Palliative Home Care Trial (FamCope)

Cancer patients and their family caregivers need support to cope with physical, psychosocial, and existential problems early in the palliative care trajectory. Many interventions target patient symptomatology, with health care professionals acting as problem-solvers. Family coping, however, is a new research area within palliative care. The FamCope intervention was developed to test if a nurse-led family-coping-orientated palliative home care intervention would help families cope with physical and psychosocial problems at home—together as a family and in interaction with health care professionals. However, an unexpectedly high number of families declined participation in the trial. We describe and discuss the recruitment strategy and patient reported reasons for non-participation to add to the knowledge about what impedes recruitment and to identify the factors that influence willingness to participate in research aimed at family coping early in the palliative care trajectory. Patients with advanced cancer and their closest relative were recruited from medical, surgical, and oncological departments. Reasons for non-participation were registered and characteristics of participants and non-participants were compared to evaluate differences between subgroups of non-participants based on reasons not to participate and reasons to participate in the trial. A total of 65.9% of the families declined participation. Two main categories for declining participation emerged: first, that the “burden of illness is too great” and, second, that it was “too soon” to receive this kind of support. Men were more likely to participate than women. Patients in the “too soon” group had similar characteristics to participants in the trial. Timing of interventions and readiness of patients and their relatives seems to affect willingness to receive a family-coping-orientated care approach and impeded recruitment to this trial. Our findings can be used in further research and in clinical practice in order to construct interventions and target relevant populations for early family-coping-orientated palliative care.

Helping staff to implement psychosocial interventions in care homes: augmenting existing practices and meeting needs for support.

To contribute to an optimised training programme for care staff that supports the implementation of evidence-based psychosocial interventions in long-term care. Qualitative study that involved focus group discussions with 119 care home staff within 16 care homes in the UK. Part of wider clinical trial aimed at developing and evaluating an effective and practical psychosocial intervention and implementation approach for people with dementia in long-term care. Inductive thematic analysis was used to identify themes and interpret the data. The findings highlighted that successful training and support interventions must acknowledge and respond to 'whole home' issues. Three overarching themes emerged as influential: the importance of contextual factors such as staff morale, interpersonal relationships within the home, and experience and perceived value of the proposed intervention. Priority must be given to obtain the commitment of all staff, management and relatives to the training programme and ensure that expectations regarding interaction with residents, participation in activities and the reduction of medication are shared across the care home.

Effect of home-care intervention on drug safety for first-episode patients with schizophrenia

Objective To explore the effect of home-care intervention on drug safety for first-episode patients with schizophrenia. Methods 84 cases of first-episode schizophrenics were randomly divided into control and intervention groups, 42 cases in each group. A-bility to use drugs was evaluated and nursing problem was made. Discharged patients were given antipsychotics therapy and regular medication guidance. Patients in intervention group were given telephone follow-up every 1 month, patients and family members accepted home-care intervention every 3 months follow-up. Results Patients and families of intervention group about the adverse drug reactions understanding and coping, drug adherence, mental symptoms control were markedly higher than those of control group. Conclusion Family nursing intervention could establish a good nurse-patient relationship, paying attention to medication guidance and medicine knowledge education could help to improve patients'safety and compliance medicine, reduce the recurrence rate. Key words: Home-care intervention; Schizophrenia; Drug safety

A Hybrid Process Fidelity Assessment in a Home-Based Randomized Clinical Trial

A process fidelity assessment was conducted as a nested study within a home-based randomized clinical trial teaching self-management to 101 long-term indwelling urinary catheter users in the treatment group. Our hybrid model combined external assessments (outside observations and tape recordings) with internal evaluation methods (through study nurse forms and notes) for a comprehensive process fidelity assessment. Barriers, patient-related issues, and nurse perspectives were identified demonstrating the complexity in home care intervention research. The complementary and synergistic approaches provided in-depth information about the context of the delivery and the impact of the intervention on study outcomes.

Application of Friedman family assessment model on home care of patients with depression

Objective To evaluate the application of Friedman family assessment model in home care patients with depression. Methods A total of 80 patients with depression were treated by their visit serial number, and the Single numbers were arranged into the intervention group, the even numbers were arranged into the control group, each of 40 cases. In the control group, patients were used conventional drug therapy and made an appointment in the outpatient. On this basis, patients in the intervention group were utilized the Friedman family assessment model as a guide for home care intervention. Before and after the intervention, patients were applied the Hamilton depression scale 17 (HAMD 17) to evaluate the extent of the patients′ depression. We used generic quality of life Inventory-74 (GQOLI-74) assessed the depressed patients′ life quality. Results After 16 weeks the results showed the HAMD17 score of the intervention group point was (6.82±2.49) lower than that of the control group (8.26±2.01)(t=2.82, P<0.01). The total score of GQOLI-74 in the intervention group was (230.00±20.65), and its three dimensional points were as follows: physical function (65.73±8.26), psychological functioning (59.87±8.92), social functioning (56.13±10.26), which were significantly higher than that of the control group (213.94±19.28) points, (60.06±9.19) points, (53.63±8.44) points, (49.76±9.72 ), with the statistical difference (t=-3.65, -2.91, -3.22, -2.86, respectively; P<0.01). Conclusions Friedman family assessment model is a more effective rehabilitation methods, especially on reducing the extent of home care patients with depression, promoting the rehabilitation of the disease and improving the quality of life of patients. Key words: Depression; Home care; Friedman family assessment model

A Clinical Trial of Translation of Evidence Based Interventions to Mobile Tablets and Illness Specific Internet Sites.

This article describes a method to translate an evidence based health care intervention to the mobile environment. This translation assisted patient participants to: avoid life threatening infections; monitor emotions and fatigue; keep involved in healthy activities. The mobile technology also decreased costs by reducing for example travel to visit health care providers. Testing of this translation method and its use by comparison groups of patients adds to the knowledge base for assessing technology for its impact on health outcome measures. The challenges and workflow of designing materials for the mobile format are described. Transitioning clinical trial verified interventions, previously provided in person to patients, onto tablet and internet platforms is an important process that must be evaluated. In this study, our evidence based guide's intravenous (IV) homeCare interventions (IVhomeCare) were delivered via Apple iPad mini™ tablet audiovisual instruction / discussion sessions and on a website. Each iPad audiovisual session (n = 41), included three to five families, a mental health specialist, and healthcare professionals. Patients and their family caregivers readily learned to use the wireless mobile tablets, and the IVhomeCare interventions, as described here, were successfully translated onto these mobile technology platforms. Using Likert scale responses on a questionnaire (1 = not helpful and 5 = very helpful) participants indicated that they gained problem solving skills for home care through iPad group discussion (M = 4.60, SD = 0.60). The firewall protected videoconferencing in real time with multiple healthcare professionals effectively allowed health history taking and visual inspection of the patient's IV insertion site for signs of infection. Supportive interactions with peer families on videoconferencing were documented during discussions. Discussion topics included low moods, fatigue, infection worry, how to maintain independence, and need for support from others with their same lifelong IV experiences. The visual family interactions, discussions with professionals, and the iPad internet links were highly rated. Mobile distance care delivery can result in saved time and money for both healthcare professionals and families.

Evidence-based nurse case management practice in community health.

The purpose of this study was to investigate and compare the type of nurse case managers' (NCMs') practice on patients' quality outcomes in community settings. Nurse case management (CM) practice with NCMs in community-based settings. The design of this study was an exploratory, descriptive secondary analysis of 4 types of service by 11 NCMs, delivered to selected Medicare beneficiaries in community settings. Descriptive statistics and ANOVA tests were calculated. The majority of CM services were delivered in home care services in the community. Most of the 4 types of services-home, telephone, clinic, and mixed care-positively changed patients' quality measure outcomes-self-care activities of daily life, quality of life, and well-being. However, there were no modes that were statistically significant in patients' quality measure outcomes at the p < .05 level in the 2-year time frame. It is imperative to know the most effective and efficient types of CM services in community health for evidence-based NCMs practice. The results contribute to understanding how community health nurses may choose to select home care interventions for effectiveness. Thus, NCMs' practice needs to be capitalized on by practicing health administrators for health care management services within the current dynamic health policy environment.

Can case management be an asset to home care interventions in order to delay institutionalization of frail older persons? A Belgian longitudinal study

Background / Objective: In the international literature, case management is often found to be a valuable way of organizing home care services and providing continuity of care. However, not many studies have provided evidence that case management can be effective in delaying institutionalization of older persons. The Belgian federal government is interested in funding home care projects that attain this goal. Twenty two case management projects will be analyzed during a 4-year period to reach a policy decision. Methods: Professional caregivers are asked to fill out the comprehensive geriatric assessment interRAI Home Care (HC) and an ad-hoc economic questionnaire describing the social services use and the time of informal care Informal caregivers also fill out the Zarit Burden scale 12 items and older persons fill out the WHOQOL-8. After descriptive statistics, the study population is stratified according to impairment levels (ADL, depression and cognition). Multivariate analyses are performed to identify significant associations and the effect of case management on the delay of institutionalization. Results: The study population consists of frail older persons in 21 case management projects (n=8534, average age: 79.7 median age 81.0, 67.6% women. The total of older persons in case management projects is 5004. This population shows moderate to high ADL impairment (47% CI(0.45 - 0.48)), moderate to high cognitive problems (27% CI(0.25 - 0.27)) and daily depression symptoms (27% CI(.25 - .28). These clients will be compared to a population not receiving any case management. International Journal of Integrated Care – Volume 14, 01 October – URN:NBN:NL:UI:10-1-116159– http://www.ijic.org/ Conclusion: This research will show the effect of case management combined with home care interventions in order to delay institutionalization of older persons. This information can help home care providers to adapt their services into a more integrated form of care model where case management will bring different types of services together. The results will also help policy makers to decide whether case management should be funded or not.

P497: A feasibility study of a cluster randomised controlled trial to evaluate a falls prevention intervention in care homes for older people

P497: A feasibility study of a cluster randomised controlled trial to evaluate a falls prevention intervention in care homes for older people

Chronic kidney disease and support provided by home care services: a systematic review.

BackgroundChronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients.MethodsA systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients’ homes were included. Studies with only a home training intervention and those without an applied research component were excluded.ResultsSeventeen studies (10 cohort, 4 non-comparative, 2 cross-sectional, 1 randomized) examined the support provided by home care services in 15,058 CKD patients. Fourteen studies included peritoneal dialysis (PD), two incorporated hemodialysis (HD) and one included both PD and HD patients in their treatment groups. Sixteen studies focused on the dialysis phase of care in their study samples and one study included information from both the dialysis and pre-dialysis phases of care. Study settings included nine single hospital/dialysis centers and three regional/metropolitan areas and five were at the national level. Studies primarily focused on nurse assisted home care patients and mostly examined PD related clinical outcomes. In PD studies with comparators, peritonitis risks and technique survival rates were similar across home care assisted patients and comparators. The risk of mortality, however, was higher for home care assisted PD patients. While most studies adjusted for age and comorbidities, information about multidimensional prognostic indices that take into account physical, psychological, cognitive, functional and social factors among CKD patients was not easily available.ConclusionsMost studies focused on nurse assisted home care patients on dialysis. The majority were single site studies incorporating small patient populations. There are gaps in the literature regarding the utility of providing home care to CKD patients and the impact this has on healthcare resources.

Improving Well-being and Health for People with Dementia (WHELD): study protocol for a randomised controlled trial.

BackgroundPeople with dementia living in care homes often have complex mental health problems, disabilities and social needs. Providing more comprehensive training for staff working in care home environments is a high national priority. It is important that this training is evidence based and delivers improvement for people with dementia residing in these environments. Well-being and Health for People with Dementia (WHELD) combines the most effective elements of existing approaches to develop a comprehensive but practical staff training intervention. This optimised intervention is based on a factorial study and qualitative evaluation, to combine: training on person-centred care, promoting person-centred activities and interactions, and providing care home staff and general practitioners with updated knowledge regarding the optimal use of psychotropic medications for persons with dementia in care homes.DesignThe trial will be a randomised controlled two-arm cluster single blind trial that will take place for nine months across 80 care homes in the United Kingdom.DiscussionThe overarching goal of this trial is to determine whether this optimised WHELD intervention is more effective in improving the quality of life and mental health than the usual care provided to people with dementia living in nursing homes. This study will be the largest and best powered randomised controlled trial (RCT) evaluating the benefits of an augmented person-centred care training intervention in care homes worldwide.Trial registrationCurrent controlled trials ISRCTN62237498Date registered: 5 September 2013

Pilot Testing of the Home Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities Intervention

The primary aim of this pilot study was to develop, implement, and test the feasibility and efficacy of the Home Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. A total of 50 patients with a primary diagnosis of heart failure (HF) were assigned to the intervention ( n = 26) or control group ( n = 24) according to geographical location in a large multibranch Medicare-certified home health agency. Forty-six patients completed the study. Patients participating in the HEART intervention demonstrated significantly improved HF knowledge ( F = 1.31, p &lt; .001) in comparison with control group patients’ at the study endpoint. There was a non-significant trend toward improved quality of life (QOL) and lower hospital readmission rates (6 patients vs. 9 patients) in the intervention group.