Receiving Home Health Care Research Articles

Long-term Monitoring of Changes in Blood Pressure, Blood Glucose, and Total Cholesterol Levels among Frail Older Individuals Receiving Home Health Care Nursing in South Korea

ABSTRACT This study identified changes in blood pressure, blood glucose, and cholesterol levels in frail elderly adults who received home health care nursing over 8 years in Korea. Secondary data extracted from nursing records (2010–2018) of a public health center were analyzed using a mixed model of repeated measure. Study participants were elderly people (n = 499) with a mean age of 81.9 ± 5.56 years. Systolic and diastolic blood pressure decreased by 8.97 and 15.78 mmHg, and by 2.92 and 5.01 mmHg, respectively, at 4-year and 8-year monitoring. This demonstrates that home health care nursing is effective and has both short- and long-term benefits.

Evde Sağlık Hizmeti Alan Hastaların Profillerinin İncelenmesi: Batman İli Örneği

Evde Sağlık Hizmeti Alan Hastaların Profillerinin İncelenmesi: Batman İli Örneği

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations.

Home health (HH) is a major type of home-based skilled care available to Medicare beneficiaries. We examined the association between living situation (home alone, home with others, and assisted living (AL) residence) and utilization and functional outcomes among Medicare HH recipients. Analysis of national data from the Outcome and Assessment Information Set, HH Compare, Medicare claims, and Area Health Resource Files. Medicare-certified HH agencies in the United States. National population of Medicare beneficiaries ≥65 years old who received HH care in CY 2017 (N = 6,637,496). Outcomes included time-to-event measures of hospitalization and emergency department (ED) visits, and improvement in activities of daily living (ADL) from the start to the end of the HH admission. AL residents (12%) and patients living alone at home (24%) had longer survival time without hospitalization and ED visits than patients living with others at home (64%). Adjusting for covariates and HH agency-level random effects, and compared with patients living with others, AL residents had lower risk of hospitalization (hazard ratio (HR) = 0.85, P < .001) and ED visit (HR = 0.92, P < .001); however, less ADL improvement (β = 0.29 (29% less of total independence in one ADL)); and patients living alone had lower risk of hospitalization (HR = 0.94, P < .001) and ED visit (HR = 0.93, P < .001), yet more ADL improvement (β = -0.15 (15% more of total independence in one ADL)). In the national population of Medicare HH recipients, patients living with others at home had the highest risk of hospitalization and ED visits, whereas AL residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits, meaning that combined support from HH and AL reduces acute care admissions. Evidence-based interventions are needed for HH patients living with others at home to avoid unnecessary acute care use.

Self-Care for Caregivers of Individuals Living With Multiple Sclerosis: Testing Mediation Models of Caregiver Stress, Health, and Self-Care

Individuals with Multiple Sclerosis (MS) often receive home health care, yet little research investigates the health of informal caregivers of individuals with MS. We tested a mediation model in which associations between caregiver stress and caregiver self-care were explained by each of four a priori caregiver health factors—caregiver negative affect, pain, tiredness, and functional limitations. Participants ( n = 60 informal caregivers) were recruited online or in-person from March—July 2018, and completed an online survey assessing demographics and their caregiving experience. After controlling for demographics, only caregiver tiredness mediated the association between caregiver stress and caregiver self-care. Therefore, caregiver tiredness may be an important construct for assessment, intervention, and future research, among caregivers of individuals with MS, and among anyone providing home health care. These findings have research, clinical, and policy implications.

Team Members' Roles in Home Healthcare: Evidence From the "AKEΣΩ-1" Project in Greece.

Home healthcare has just recently won the interest of policy decision makers in Greece and there is a lack of knowledge regarding the contributions provided by each team member. The aim of this study was to describe the home care interventions carried out by nurses, physicians, and physiotherapists during the AKEΣΩ-1 project. We examined the data from 1,094 patients who received home healthcare (HHC) from an interdisciplinary team from the Hellenic Red Cross HHC services in three major cities in Greece during a 20-month period. The visits and interventions by nurses, physicians, and physiotherapists were grouped and measured. Patients were mostly older adults (80.73%), women (68.37%) with medical problems (46.8%). Nurses conducted 70.76% of the visits, and provided 21,017 interventions. Physiotherapists conducted 22.83% of the visits and 4,627 interventions, and physicians conducted 6.4% of the visits and 2,117 interventions. Nurses provided a wide range of complex skilled nursing interventions that required knowledge of the community and ability to network. Physiotherapy and educating patients and caregivers were the most frequent interventions of physiotherapists. The main role of physicians was to conduct clinical exams. The Greek healthcare system is hospital- and physician-oriented. We documented that in HHC, nurses take a lead role in providing care, organizing services, and collaborating with other community services. From a health and social policy perspective, proper planning and staffing of HHC services are required. From an academic and licensing perspective, it is important to ensure that nurses working in the community have appropriate preparation.

Intervenciones desde la farmacia comunitaria en los pacientes adultos que reciben atención de la salud a domicilio: revisión exploratoria

Objetivos: Revisar la literatura científica relacionada con las intervenciones desde la farmacia comunitaria en los pacientes adultos que recibieron atención de la salud a domicilio.Métodos: Revisión exploratoria de los artículos recuperados de las bases de datos bibliográficas MEDLINE (PubMed), Embase, Cochrane Library, Scopus y Web of Science hasta marzo de 2020. La ecuación de búsqueda se formuló́ mediante los descriptores “Home Care Services” y “Pharmacies” o “Community Pharmacy Services”, utilizando también los Entry Terms relacionados y los filtros: «Humans» y «Adult: 19+ years». La calidad de los artículos se evaluó́ mediante el cuestionario STROBE.Resultados: De las 307 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron 44 artículos: 11 estudios descriptivos transversales y 10 ensayos aleatorizados controlados. En 19 (43%) de estos se observó que las intervenciones realizadas desde la farmacia comunitaria aumentaron la adherencia fármaco-terapéutica. También, un mejor conocimiento sobre los medicamentos (administración, seguridad, dosis, posología) en 17 (38,6%) trabajos y en 13 (29,5%) estudios se consiguió la prevención o resolución de los PRM. Al evaluar la calidad de los artículos seleccionados para la revisión mediante el cuestionario STROBE, las puntuaciones oscilaron entre un mínimo de 11 y un máximo de 20,8 sobre una puntuación máxima de 22.Conclusiones: La intervención farmacéutica, a través de la farmacia comunitaria, aportó beneficios en la población más adulta, mediante el aumento de la adherencia farmacoterapéutica, la disminución de los problemas relacionados con los medicamentos y la mejora en el almacenamiento y conservación de los mismos.

Quality of Life of Older People Receiving Home Health Care Services: An Example From Turkey

Advanced age, restrictions on daily life activities, increased disability, and chronic diseases negatively affect the quality of life of older individuals. The aim of the present study was to investigate the quality of life of older patients receiving home health care services (HHCS) in Samsun province, Turkey. The population of this cross-sectional study comprised 489 individuals aged 65 years and older. Patient selection was performed using the stratified randomized sampling method. A total of 183 patients were included in the study. Data were collected using a questionnaire and face-to-face interviews. The Mann-Whitney U and Kruskal–Wallis tests were used in the statistical evaluation of data, and significance was regarded as p &lt; .05 for all tests. Some 75.4% of the patients were women, and the average age was 82 years. Eighty-three percent of the participants were semi-dependent or completely dependent in the activities of daily living (ADL); however, in the instrumental activities of daily living (IADL), 96.0% were semi-dependent or completely dependent. The quality of life of the older people receiving HHCS was identified as low both in the physical and mental health components. However, physical quality of life was statistically higher in men, in graduates of primary school or above, and in patients with no decubitus ulcers compared with the others. We found that the older individuals receiving HHCS had a lower quality of life due to their chronic diseases and high dependency compared with the general population and their contemporaries.

Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults

Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Hospital referral to home health care. Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.

Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations

ObjectivesThis study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates. BackgroundAfter hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied. MethodsThis study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes. ResultsFrom 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC. ConclusionsUse of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.

Study protocol for assessing the user acceptance, safety and efficacy of a tablet-based workflow and decision support system with incorporated basal insulin algorithm for glycaemic management in participants with type 2 diabetes receiving home health care: A single-centre, open-label, uncontrolled proof-of-concept study

IntroductionDiabetes management can be especially complex for older adults who receive health care at home. Thus, international guidelines recommend basal-insulin regimens due to simpler handling and low hypoglycaemia risk. A basal-insulin algorithm (including basal-plus) was developed to also include participant's health status and subsequently implemented into a tablet-based workflow and decision support system, GlucoTab@MobileCare. This study protocol describes a proof-of-concept study to investigate user acceptance, safety and efficacy of the GlucoTab@MobileCare system in participants receiving home health care. MethodsThe open-label, single-centre, uncontrolled study will recruit a maximum of ten participants with insulin treated type-2-diabetes (age ≥18 years) who receive home health care. During a three month study period participants will receive basal- or basal-plus-insulin therapy once daily as suggested by the GlucoTab@MobileCare system. Statistical analysis will be conducted on an intention-to-treat basis. The primary endpoint is the percentage of tasks (BG measurements, insulin dose calculations, insulin injections) that were performed according to GlucoTab@MobileCare suggestions relative to the total of suggested tasks. Secondary endpoints include user acceptance, safety and efficacy parameters. The study was approved by the ethics committee and regulatory authorities. Before obtaining written informed consent, all participants will receive oral and written information about all aspects of the study. Results will be published in a peer-reviewed journal and at diabetes and geriatric conferences. DiscussionPotential implications may be improved quality and safety of basal-insulin therapy in older adults as well as support for health-care-providers in daily routine including evidence-based knowledge. Trial registrationGerman Clinical Trials Register (DRKS00015059);

Sağlık Hizmetlerinde Memnuniyeti Etkileyen Faktörler: Güven ve Kalite

In this study, we investigated the effect of the perceived trust and quality of health personnel providing home health services on the satisfaction of individuals receiving home health care. Individuals who receive free home health care constitute the universe of our research. The sample of the study consisted of 151 patients with health conditions who could participate in the survey. To collect data in this study, we applied the “Trust” Scale developed by Oly Ndubisi (2007), the “Satisfaction” Scale developed by Sevilmiş (2015) and the “Staff Quality” Scale developed Yıldırım (2017). The SPSS 21 Package Program was used to analyze the data obtained from the study. As a result of the regression analysis, the quality of staff (R2=0,234) and trust (R2=0,345) have a profound effect on patient satisfaction. Quality of staff and trust affect have a middle level (R2=0,420) positive effect on patient satisfaction. The research has limitations in terms of the fact that patients are not healthy enough to answer multi-item questionnaires, not all factors affecting patient satisfaction are included in the model, the results obtained from the research are about people who benefit from home health services, the size of samples and the sampling technique. The literature on home healthcare services has a very narrow scope. In the literature, no studies regarding personnel reliability and personnel quality affecting the satisfaction of patients benefiting from home health services have been encountered. In this context, our research differs from similar research in the literature.

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

Abstract 107: Home Health Care After Discharge is Associated With Less Early Readmissions for Patients With Acute Myocardial Infarction

Objective: Home health care (HHC) is a support tool to transition patients after discharge and acute myocardial infarction (AMI) is a significant cause of morbidity and mortality in the U.S. However, little is known regarding the impact of HHC on AMI patients. We sought to identify predictors of readmissions among AMI patients, characteristics of those who receive HHC and investigate the association of HHC with readmission. Methods: We queried the National Readmission Database (NRD) (January 2012 - December 2014), to identify patients discharged after AMI and selected patients who were discharged home with (HHC+) and without HHC (HHC-). We reported national estimates with survey methods with weights provided in our data. After univariate exploratory analyses, we developed a regression model to identify the probability of each patient to receive HHC. From the propensity score, we calculated average treatment on the treated (ATT) weights. These ATT weights were included in the logistic regression model to determine the impact of HHC on readmission after adjusting for available clinical confounders. We considered post-weighting standardized differences &lt;10% as appropriate for our ATT model. To determine clinical factors associated with readmission, we also performed a multi-variable logistic regression with readmission as the end-point. All results were reported as risk ratios (RR) with their 95% confidence intervals (CI). Results: Between January 2012 to December 2014, 406,237 patients were treated for AMI and discharged home with or without HHC. Among these 9.4% (38,215) received HHC. HHC+ patients were older (mean age 77 ± 11 vs 60 ±12 years p&lt;0.001), more likely to be female (53.6% vs. 26.9%, p &lt;0.001), and have cancer (3.7% vs 1.3%, p &lt;0.001), congestive heart failure (5.7% vs. 0.5%, p &lt;0.001), chronic pulmonary disease (23.2% vs. 12.7%, p &lt;0.001), chronic kidney disease (26.9% vs 6.9%, p &lt;0.001), diabetes (35.6% vs. 26.7%, p &lt;0.001), hypertension (70.7% vs. 64.8%, p &lt;0.001) and peripheral vascular disease (14.6% vs 6.4%, p &lt;0.001). Patients readmitted after MI were more likely to be older and have diabetes (RR 1.42, 95% CI 1.37-1.48), CHF (RR 5.89, CI 5.55-6.26) or COPD (RR 1.59, 1.52-1.65). Unadjusted 30-day readmission rate was 20.9% for HHC+ and 8.2% for HHC- patients. Propensity-weighted adjustment for covariates yielded 36,979 HHC+ patients and 37,785 HHC- patients. Adjusted risk rations (RR) for 30-day readmission were computed using ATT weights, and HHC+ patients had significantly lower readmission risk (RR 0.89, 95% CI 0.82 - 0.96) compared to HHC- (RR 1.12, 95% CI 1.04 - 1.21; p &lt; 0.001) Conclusion: In the United States, a small proportion of patients receive home health care after discharge post-AMI. Older, females and those with diabetes or heart failure are more likely to receive home health care. Use of home health care may be associated with lower 30-day readmission rates after AMI.

The Ventilator-Dependent Child: Best Practices for Educating Home Care Nurses.

Pediatric Home Service (PHS) in Roseville, Minnesota, has provided home care for children with medical complexity for over 30 years. This article describes the PHS program for educating and training home care nurses (HCNs). Since the inception of the company, advanced training for family and professional caregivers of ventilator-dependent children has been an important focus. The current program for HCN has three components and incorporates simulation and in-home training. Standardizing educational requirements and competencies for pediatric HCNs across nursing agencies has the potential to improve outcomes for children with medical complexity receiving home healthcare services.

Does Home Health Care Increase the Probability of 30-Day Hospital Readmissions? Interpreting Coefficient Sign Reversals, or Their Absence, in Binary Logistic Regression Analysis

Data for 30-day readmission rates in American hospitals often show that patients that receive Home Health Care (HHC) have a higher probability of being readmitted to hospital than those that did not receive such services, but it is expected that when control variables are included in a regression we will obtain a “sign reversal” of the treatment effect. We map the real-world situation to the binary logistic regression model, and we construct a counterfactual probability metric that leads to necessary and sufficient conditions for the sign reversal to occur, conditions that show that logistic regression is an appropriate tool for this research purpose. This metric also permits us to obtain evidence related to the criteria used to assign HHC treatment. We examine seven data samples from different USA hospitals for the period 2011–2017. We find that in all cases the provision of HHC increased the probability of readmission of the treated patients. This casts doubt on the appropriateness of the 30-day readmission rate as an indicator of hospital performance and a criterion for hospital reimbursement, as it is currently used for Medicare patients.

Evde Sağlık Hizmeti Alan Hastaların Bakım Verenlerinde Bakım Yükü

Giriş: Bu çalışma Evde Sağlık Hizmeti (ESH) alan hastalara bakım verenlerin bakım yükünü ve etkileyen faktörleri değerlendirmeyi amaçlamıştır. Yöntem: Kesitsel tipteki çalışmaya evde sağlık hizmeti alan hastaların bakım hizmeti verenleri dahil edilmiştir. Bakım verenlerin bakım yükünü değerlendirmek amacıyla Zarit Bakım Yükü Ölçeği (ZBYÖ), bakım yüküne etki eden değişkenleri belirlemek amacıyla veri toplama formu kullanılmıştır. Bulgular: Çalışmaya ESH’den faydalanan 80 hastaya primer bakım verenler dâhil edilmiştir. Bakım verenlerin ZBYÖ puan ortalaması 38,4 olarak belirlenirken, bunların %43,8’inin ZBYÖ puanının yüksek, %2,5’inin ise çok yüksek olduğu tespit edilmiştir. Bakım yükü yüksek olanların %74,3’ü, baktıkları hastalara bakacak başka kimsenin bulunmamasından dolayı bakım verdiklerini belirtmiştir. Bakım verenlerin bakım yükü düzeyleri ile tükenmişlik, güçsüzlük-çaresizlik hissetme ve hastayla iletişim kurma sıkıntısı yaşama durumları arasında anlamlı ilişki saptanmıştır (p=0,001). Bakım yükü çok yüksek olanların tamamının anti-depresan kullandığı ve kendisini tükenmiş hissettiği tespit edilmiştir. Bakım verenlerin depresyon ve uyku ilacı kullanma durumları ve uyku kaliteleriyle bakım yükü düzeyleri arasında anlamlı bir ilişkinin olduğu ortaya konmuştur (p&amp;lt;0,05). Sonuç: Bakım verenlerin çoğunun bakım yükü düzeyi yüksek olarak saptanmış olup bu kişilerin tükenmişlik ve güçsüzlük-çaresizlik hissettiği, ayrıca bakımla ilgili eğitim-danışmanlık ve yardım gereksinimi duyduğu belirlenmiştir. Bu sonuçlar ışığında, ESH kapsamının, bakım verenlerin çeşitli gereksinim ve taleplerini de göz önünde bulunduracak şekilde genişletilmesinin ve bakım verenlere özellikle psikolojik ve sosyal destek alanlarında yardımcı olunmasının, bakım yükünün hafifletilmesi açısından faydalı olabileceği düşünülmektedir.

Direct and indirect costs of home healthcare in Japan: A cross-sectional study.

To tackle the rising healthcare expenditure in an ageing society in Japan, home healthcare has been promoted over the past several years. However, there is a dearth of literature on total costs incurring for home healthcare. In this study, we conducted a cross-sectional study among patients, who received home healthcare in the month of May, 2018. Direct healthcare costs and patients' clinical characteristics were collected from medical records and long-term care databases (n=166). Indirect costs were estimated using a questionnaire survey which obtained information on job absenteeism and care time from the caregiver. A total of 112 patients responded to the survey. The median age was 82years (interquartile range: 74-88). Total per-person per month home-care costs averaged USD 6,163 with direct costs (USD 2,547) and indirect costs (USD 3,596) accounted for 41.3% and 58.3% of the total costs, respectively. The largest components of direct costs were long-term care costs (48%) and medical costs (47%). Multivariable adjusted model showed that those with heavy healthcare were more likely to incur higher total as well as direct and indirect home healthcare cost (p<.05 for each). Patients aged>75years (p=.041) were less likely and those who used oxygen at home were more likely to incur direct home healthcare cost (p=.001) than their counterpart. Our study findings show that indirect cost is a major contributor to total home healthcare costs in Japan. Also for patients who need heavy healthcare, both direct and indirect costs are large burden.

Medication Discrepancies in Older Veterans Receiving Home Healthcare.

In a prospective cohort study of Veterans and community health nurses, we enrolled hospitalized older Veterans referred to home care for skilled nursing and/or physical or occupational therapy for posthospitalization care. We assessed preadmission activities of daily living and instrumental activities of daily living, health literacy, numeracy, and cognition. Postdischarge phone calls identified medication errors and medication reconciliation efforts by home healthcare clinicians. Veterans Administration-based community health nurses completed surveys about content and timing of postdischarge interactions with home healthcare clinicians. We determined the types and frequency of medication errors among older Veterans receiving home healthcare, patient-provider communication patterns in this setting, and patient characteristics affecting medication error rates. Most Veterans (24/30, 80%) had at least one discordant medication, and only one noted that errors were identified and resolved. Veterans were asked about medications in the home healthcare setting, but far fewer were questioned about medication-taking details, adherence, and as-needed or nonoral medications. Higher numeracy was associated with fewer errors. Veterans Administration community health nurses reported contact by home healthcare clinicians in 41% of cases (7/17). Given the high rate of medication errors discovered, future work should focus on implementing best practices for medication review in this setting, as well as documenting barriers/facilitators of patient-provider communication.

Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain.

Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL), and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome and Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, whereas patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p value = 0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.

Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors

ObjectiveTo profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission. DesignCross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data. Setting and ParticipantsNational sample of Medicare beneficiaries hospitalized for sepsis who were discharged to HHC between July 1, 2013 and June 30, 2014 (N = 165,228). MethodsWe used an indicator distinguishing among 3 types of sepsis: explicitly coded sepsis diagnosis without organ dysfunction; severe sepsis with organ dysfunction; and septic shock. We compared these subgroups' demographic, clinical and functional characteristics, comorbidities, risk factors for rehospitalization, characteristics of the index hospital stay, and predicted 7-day hospital readmission. ResultsThe majority (80.7%) had severe sepsis, 5.7% had septic shock, and 13.6% had sepsis without acute organ system dysfunction. The medical diagnoses recorded at HHC admission identified sepsis or blood infection only 7% of the time, potentially creating difficulty identifying the sepsis survivor in HHC. Among sepsis types, septic shock survivors had the greatest illness burden profile. This study describes 12 key variables, each of which individually raises the relative 7-day readmission risk by as much as 60%. Increased risk of 7-day rehospitalization was found among those with septic shock, 3 or more previous inpatient stays, index hospital length of stay of >8 days, dyspnea, >6 functional dependencies, and other risk factors. Conclusions and ImplicationsImplications for practice include using our findings to identify sepsis survivors who are at risk for early readmission. Assessment for these factors may profile the at-risk patient, thereby triggering the call for additional acute care intervention such as delayed discharge, or post-acute intervention such as early home visit and outpatient follow-up.