Need For Home Health Care Research Articles

Conducting Translation Research in the Home Care Setting: Lessons from a Just‐in‐Time Reminder Study

Home care organizations are relatively isolated from academic health centers, university-based schools of nursing, and centers of health services research that have advanced the knowledge base for quality improvement. Thus limited information exists about how best to promote evidence-based practice in this setting. This article examines research and translation issues posed by the decentralized home care setting and considers how these issues compare to issues in other settings. A case study approach is used to frame a discussion of the contextual and practical factors that can influence the design and future acceptance of different translation strategies in the home care setting. Use of a recently concluded randomized trial that tested the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses has been made to inform this discussion. Effective translation interventions in home health care need to address the unique nature of this setting including the dispersed, generalist workforce that serves a diverse patient population and lacks strong peer contact or on-site support and supervision. Proactive push translation strategies such as reminders that have been effective in other settings show promise in this service area but had a differential effect across conditions. Significantly, the cost-effectiveness analysis of this intervention showed that net patient care costs actually increased for one condition. The study described in this article demonstrates that rigorous translation research can be conducted in highly decentralized practice settings. It also points to the value of assessing different levels of intensity of interventions in a single study, looking at process measures and patient outcomes, and conducting a cost-effectiveness analysis. To encourage broader adoption of translation strategies, additional incentives from purchasing or regulatory agencies may be needed.

A Study on the Home Health Care Needs of Postpartum Women

This study was carried out to understand the home health care needs of postpartum women during the postpartum period. The goal of this study was to obtain data needed to develope postpartum home health care programs and to improve the nursing quality for postpartum women. A convenient sample of 105 healthy women who were discharged after delivery at a maternity hospital in Ulsan, Korea were studied from January 25 to April 15, 2001. Data collection was done with a structured questionnaire (maternal concerns questionnaire) by mailing. Data was collected from 1 to 4 weeks after delivery.The Results of this study were as follows: 1. The mean score of home health care need of postpartum women was 2.51. The degree of nursing need according to the category of home health care needs was 'concerns about the infant (2.91 +/- .68)', 'maternal physical and emotional concerns (2.62 +/- .52)', 'concerns related to the husband (2.45+/-73)', 'concerns related to the family (2.16+/-.64)', 'concerns related to the community (2.03+/-.60)' in rank. Among the items, 'recognizing illness in the newborn (3.36+/-.83)', 'normal growth and development (3.33+/-.92)' were high.2. Among items of concerns about infant (2.91+/-.68), 'recognizing illness in the newborn (3.36+/-.83)', 'normal growth and development (3.33+/-.52)' showed high nursing needs.3. Among items of maternal physical and emotional concerns (2.62+/-.52), 'being a good mother (3.31=/-.86)', 'return of their figures to normal (3.04+/-1.05) showed high nursing needs.4. Among items of concerns about husband (2.45+/-.73), 'husband being a good father (2.84+/-1.00) shows high nursing needs.5. Among items of concerns related to the community (2.03+/-.60), 'getting to health care facilities (2.69+/-.90) shows high nursing needs.6. On considering the relationship between the postpartum women s home health care needs and their general characteristics, parity (t=2.436, p=.017) and delivery type (t=2.074, p=.041) were statistically significant.

Predicting state Medicaid home and community based waiver participants and expenditures, 1992-1997.

The study examined trends and predictors of state Medicaid home and community based waiver participants and expenditures from 1992 to 1997 to identify factors of interest to policy makers and clinicians. HCFA Form 372 data were collected from state officials for each waiver for each year. Two separate regression analyses were conducted to examine the effects of sociodemographic, economic, political, policy, and health services on state waiver participants and expenditures. State waiver participants were positively associated with those aged 85 and over, personal income, residential care beds, and inpatient users and negatively with home health regulation and nursing home beds. State waiver expenditures were positively associated with democratic governors, personal income, home health reimbursement methods, Medicaid eligibility, home health agencies, and Medicare home health users. The factors policy makers might consider changing include increasing the number of residential care beds and home health agencies, removing certificate of need for home health care, using Medicare home health reimbursement methods for Medicaid, and raising the Medicaid eligibility criteria. In some states with low nursing home occupancy rates, reducing the supply of nursing home beds may also be considered. All of these approaches would be controversial and should be based on additional cost-effectiveness analysis.

Prioritizing Ergonomic Research in Aging for the 21st Century American Workforce

The Bureau of Labor Statistics predicts that by 2006 Americans aged 55 and over will represent the greatest annual growth rate and will occupy nearly 30% of the American population. Additionally, by 2006 civilian labor force participation rates for the 55 and older group will grow to 36.8%, a 6.5% increase over the participation rates for this group for 1996, and over three times the percent increase of the next highest group (25 to 54 years; 1.7%). The predicted median age of the labor force for 2006 is estimated at 40.6 years, an age not approached since the median age rose to 40.5 years in 1962. Coupled with this aging profile, professional specialty occupations and service occupations are expected to provide nearly half of the total job growth during the decade leading to 2006. Within the professional specialty professions, nearly 90% of the employment increases are expected to occur in the service industry division, led by educational services and health services. The four industry sectors projected to produce the largest job growth are retail trade, business services, health services, and educational services. In contrast to the increases in the service and business sector, the manufacturing sector is expected to experience a loss of jobs, particularly for operators, fabricators, and laborers. The purpose of this paper is to merge demographic data with ergonomic and human factors data and predictions to explore areas of ergonomic research that will aid in keeping the aging workforce, and those with whom they interact, healthy in their jobs and keep the companies for whom they are employed competitive. Although some ergonomics research has been conducted in all the listed areas of expected growth, a return to the examination of the job demands in each sector, with an eye to particular application to the aging workforce, is important. The retail trade sector requires of the employee cognitive and visual skills, processing skills, and VDT work. It is expected that displays will continue to be studied to improve interaction and reduce glare. In addition, the increase in transportation jobs associated with business and trade, and the inclination for older baby boomer generation to continue driving will spur research on glare, displays, vibration, temperature, cognition, and psychomotor skills. Within the health services sector, the increase in the need for home health care will increase the number of older workers employed in this area, a change that will necessitate building upon the research already conducted on individual health and the ergonomics of work and the work environment in home settings. Educational services, especially for the changing workforce and the young workforce, will entice the aging into this field and promulgate new paradigms for training and work organization.

Prevalence and predictors of unmet need for supportive services among HIV-infected persons: impact of case management.

Previous research has indicated that the needs of persons infected with human immunodeficiency virus (HIV) for supportive services often go unmet. Although case management has been advocated as a method of decreasing unmet needs for supportive services, its effectiveness is poorly understood. To assess the prevalence of need and unmet need for supportive services and the impact of case managers on unmet need among HIV-infected persons. National probability sample. A total of 2,832 HIV-infected adults receiving care. Need and unmet need for benefits advocacy, housing, home health, emotional counseling, and substance abuse treatment services. Sixty-seven percent of the sample had a need for at least one supportive service, and 26.6% had an unmet need for at least one service in the previous 6 months. Contingent unmet need (unmet need among persons who needed the service) was greatest for benefits advocacy (34.6%) and substance abuse treatment (27.6%). Fifty-seven percent of the sample had had contact with their case manager in the previous 6 months. In multiple logistic regression analysis, with adjustment for covariates, having a case manager was associated with decreased unmet need for home healthcare (OR =0.39; 95% CI = 0.25-0.60), emotional counseling (OR = 0.54; 95% CI = 0.38-0.78), and any unmet need (OR = 0.70; 95% CI = 0.54-0.91). An increased number of contacts with a case manager was significantly associated with lower unmet need for home health care, emotional counseling, and any unmet need. Need and unmet need for supportive services among HIV-infected persons is high. Case management programs appear to lower unmet need for supportive services.

The Conceptual and Empirical Link Between Health Behaviors, Self Reported Health, and the Use of Home Health Care in Later Life

ABSTRACT The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.

A study on home health care support information system for health evaluation.

The need for home health care has been increasing in Japan and the application of various techniques such as medical informatics are desired to support home health care services. Therefore, we developed an information system for health evaluation of the elderly including patients at home by applying multifunctional telephone set and an IC memory card, by which complaints, symptoms, and conditions by them can be collected, recorded, and transmitted to medical facilities. We also conducted an experiment for trial use of the system with the cooperation of elderly female volunteers. It was recognized that the elderly volunteers could operate the system with the help of public health nurses and their health information could be collected by the system. Although the developed system has some problems, it was suggested that the system would be useful for the support of health evaluation of elderly at home.

Lyme Disease

The 11,424 cases of Lyme disease reported in 1994 represented a nearly 40% increase from the previous year. The dramatic increase of Lyme disease in the United States points to the need for home healthcare nurses to review their knowledge of the clinical manifestations, treatment, and prevention measures for this emerging infection.

A Survey on Home Health Care Needs in Youn-Cheon County in Korea

A Survey on Home Health Care Needs in Youn-Cheon County in Korea

Determinants of subsequent home health care nursing service use by hospitalized patients with cancer.

The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.

The challenge of marketing home health care in the nineties.

This paper explores the recent growth and development of home health care services. Rising medical costs and technological and social changes have made home care a competitive alternative to hospitalization and other forms of institutionalization. Providers of home health care need to familiarize themselves with the demographic trends affecting their customer base. A strategic marketing orientation is suggested for future growth and profitability.

A checklist to assess the need for home health care: instrument development and validation.

AbstractThe development of a one‐page checklist is described, and results of validity and reliability studies are reported. The purpose of the checklist is to help practitioners assess the health status of patients upon discharge from adult or pediatric stations. The form was designed and validated for routine use by nurses on in‐patient stations. A pre‐post study of the effect of the prospective reimbursement plan on a teaching hospital‐based home health service in which the instrument is being used is described.

An analysis of non-institutional long-term care planning methods for care in the home.

This article provides a comparative analysis of planning methods used by health planners and other policy analysts to determine the need for home health care, personal care, and home maintenance services. The analysis focuses primarily on approaches used to estimate the population risk, but also examines techniques used to determine the service requirements of that population. The article reviews two approaches which use indicators of demand (i.e., population case rates and referral rates) and a third approach which relies on health status measures (e.g., functional capacity, existence of chronic conditions, ability to perform activities of daily living). The author concludes that a definitive methodology has not yet been developed and makes suggestions for future research.