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Home Health Care (home + health_care)
Selected AbstractsMedicare-Certified Home Health Care: Urban-Rural Differences in UtilizationTHE JOURNAL OF RURAL HEALTH, Issue 3 2007Lacey Hartman MPP ABSTRACT:,Context:Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail.Purpose:To examine urban-rural differences in Medicare HHC utilization.Methods:The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes.Findings:Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas.Conclusions:Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies. [source] Community and Individual Race/Ethnicity and Home Health Care Use among Elderly Persons in the United StatesHEALTH SERVICES RESEARCH, Issue 5p1 2010James B. Kirby Objective. To investigate whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with health-related home care use among elderly persons in the United States. Data Sources. A nationally representative sample of community-dwelling elders aged 65+ from the 2000 to 2006 Medical Expenditure Panel Survey (N=23,792) linked to block group-level racial/ethnic information from the 2000 Decennial Census. Design. We estimated the likelihood of informal and formal home health care use for four racial/ethnic elderly groups (non-Hispanic [NH] whites, NH-blacks, NH-Asians, and Hispanics) living in communities with different racial/ethnic compositions. Principal Findings. NH-Asian and Hispanic elders living in block groups with ,25 percent of residents being NH-Asian or Hispanic, respectively, were more likely to use informal home health care than their counterparts in other block groups. No such effect was apparent for formal home health care. Conclusions. NH-Asian and Hispanic elders are more likely to use informal home care if they live in communities with a higher proportion of residents who share their race/ethnicity. A better understanding of how informal care is provided in different communities may inform policy makers concerned with promoting informal home care, supporting informal caregivers, or providing formal home care as a substitute or supplement to informal care. [source] Assessment and Interpretation of Comorbidity Burden in Older Adults with CancerJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Siran M. Koroukian PhD OBJECTIVES: To evaluate the associations between comorbidities, functional limitations, geriatric syndromes, treatment patterns, and outcomes in a population-based cohort of older patients diagnosed with colorectal cancer and receiving home health care. DESIGN: Retrospective study. SETTING: Data from the Ohio Cancer Incidence Surveillance System, Medicare claims and enrollment files, and the home health care Outcome and Assessment Information Set. PARTICIPANTS: Ohio residents diagnosed with incident colorectal cancer in 1999 to 2001 and receiving home health care in the 30 days before or after cancer diagnosis (N=957). MEASUREMENTS: Outcome measures included receipt of cancer treatment and survival through 2005. RESULTS: Not having surgery was associated negatively with comorbidities but positively with functional limitations and geriatric syndromes. Receipt of chemotherapy was negatively associated with comorbidities and functional limitations. The presence of two or more geriatric syndromes was significantly associated with unfavorable survival outcomes when analyzing overall survival and disease-specific survival (DSS). Having limitations in two or more activities of daily living was associated with unfavorable overall survival but not with DSS. Comorbity was associated with favorable DSS at borderline level of statistical significance but not with overall survival. CONCLUSION: The findings highlight the importance of incorporating functional limitations and geriatric syndrome data in geriatric oncology outcomes studies. [source] Quality and Outcomes of Heart Failure Care in Older Adults: Role of Multidisciplinary Disease-Management ProgramsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Ali Ahmed MD, FACP PURPOSE: To determine whether the management of heart failure by specialized multidisciplinary heart failure disease-management programs was associated with improved outcomes. BACKGROUND: The advent of angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone has revolutionized the management of heart failure. Randomized double-blind studies have demonstrated survival benefits of these drugs in heart failure patients. Nevertheless, in spite of these advances, heart failure continues to be a syndrome of poor outcomes.1,4 There is also evidence that a significant portion of heart failure patients does not receive this evidence-based therapy that reduces morbidity and mortality.5,7 Various disease-management programs have been proposed and tested to improve the quality of heart failure care. Most of these programs are specialized multidisciplinary heart failure clinics lead by cardiologists or heart failure specialists and conducted by nurses or nurse practitioners. Similar to the Department of Veterans Affairs (VA) multidisciplinary geriatric assessment clinics, these clinics also use many other services, including pharmacists, dietitians, physical therapists, and social workers. Some of these programs also have an affiliated home health service. Several observation studies, using mostly pre- and postcomparison designs, have demonstrated the effectiveness of these programs in the process of care, resource use, healthcare costs, and clinical outcomes in patients with heart failure.8 Risk of hospitalization was reduced by 50% to 85% in six of the studies.8 Subsequently, several randomized trials were conducted to determine the effectiveness of these programs. The purpose of this systematic review was to determine the effectiveness of these programs on mortality and hospitalization rates of heart failure patients. METHODS: Published articles on human randomized trials involving specialized heart failure disease-management programs in all languages were searched using Medline from 1966 to 1999 and other online databases using the following terms and Medical Subject Headings: case management (exp); comprehensive health care (exp); disease management (exp); health services research (exp); home care services (exp); clinical protocols (exp); patient care planning (exp); quality of health care (exp); nurse led clinics; special clinics; and heart failure, congestive (exp). In addition, a manual search of the bibliographies of searched articles was performed to identify articles otherwise missed in the above search. Personal communications were made with three authors to obtain further data on their studies. Using a data abstraction tool, two of the investigators separately abstracted data from the selected articles. Data from the selected studies were combined using the DerSimonian and Laird random effects model and the Mantel-Haenszel-Peto fixed effects model. Meta-Analyst 0.998 software (J. Lau, New England Medical Center, Boston, MA) was used to determine risk ratios (RRs) with 95% confidence intervals (CIs) of mortality and hospitalization for patients receiving care through these specialized programs compared with those receiving usual care. The Cochran Q test was used to test heterogeneity among the studies, and sensitivity analyses were performed to examine the effect of various covariates, such as duration of intervention, and other characteristics of the disease-management programs. RESULTS: The original search resulted in 416 published articles, of which 35 met preliminary selection criteria. Of these, 11 were randomized trials and were selected for the meta-analysis. Studies that were not randomized trials, did not involve heart failure patients or disease-management programs, or had missing outcomes were excluded. Of the 11 studies selected, nine involved specialized follow-up using multidisciplinary teams and the remaining two involved follow-up by primary care physicians and telephone. These studies involved 1,937 heart failure patients with a mean age of 74. The follow-up period ranged from no follow-up (one study) to 1 year (one study). Patients receiving care from specialized heart failure disease-management programs had a 13% lower risk of hospitalization than those receiving usual care (summary RR = 0.87; 95% CI = 0.79,0.96), but the Cochran Q test demonstrated significant heterogeneity among the studies (P = .003). Subgroup analysis of the nine studies using specialized follow-up by a multidisciplinary team showed similar results (summary RR = 0.77, 95% CI = 0.68,0.86; test of heterogeneity, P> .50). Seven of the nine studies did not show any significant association between intervention and reduced hospitalization, but the two studies that used follow up by primary care physicians and telephone failed to show any significant reduction in hospitalization (summary RR = 0.94, 95% CI = 0.75,1.19). In fact, one of the studies demonstrated a higher risk of hospitalization for patients receiving intervention (RR = 1.26, 95% CI = 1.04,1.52). Of the 11 studies, only six reported mortality as an outcome. None of these studies found any association between intervention and mortality (summary RR = 1.15, 95% CI = 0.96,1.37; test of heterogeneity, P> .15). Five of the studies used quality of life or functional status as outcomes, and, of them, only one demonstrated significant positive association. The results of the sensitivity analyses were negative for any significant association with duration of intervention or follow-up or year of study. Eight studies performed cost analyses and seven demonstrated cost-effectiveness of the intervention. CONCLUSIONS: The authors concluded that specialized disease-management programs were cost-effective, and heart failure patients cared for by these programs were more likely to undergo fewer hospitalizations, but the study did not provide any conclusive association between these programs and quality of care or mortality. The authors recommend that disease-management programs involve patient education and specialized follow-up by a multidisciplinary team including home health care. [source] Older patients with chronic heart failure within Swedish community health care: a record review of nursing assessments and interventionsJOURNAL OF CLINICAL NURSING, Issue 1 2004Anna Ehrenberg PhD Background., Older patients with chronic heart failure constitute a large group within community home care that is at high risk for re-hospitalization. However, hospital readmission can be prevented if early signs of deterioration are recognized and proper interventions applied. Aims and objectives., The aim of the study was to audit nursing care for older chronic heart failure patients within the Swedish community health care system. Design., The study adopted a retrospective descriptive design. Methods., In a Swedish urban municipality nursing documentation from 161 records on patients diagnosed with chronic heart failure was collected retrospectively from community nursing home care units. Patient records were reviewed for characteristics of nursing care and assessed for comprehensiveness in recording. Results., The main results showed that medical care of patients with chronic heart failure was poorly recorded, making it possible only to follow fragments of the care process. The nursing notes showed poor adherence to current clinical guidelines. Only 12% of the records contained notes on patients' body weight and only 4% noted patients' knowledge about chronic heart failure. When interventions did occur, they largely consisted of drug administration. Conclusions., The findings revealed flaws in the recording of specific assessment and interventions as well as poor adherence to current international clinical guidelines. Relevance to clinical practice., Supportive guidelines available at the point of care are needed to enhance proper community-based home health care for older patients with chronic heart failure. [source] Priorities for Nursing Research in KoreaJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2002Mi Ja Kim Purpose: To identify priorities for nursing research in Korea. Methods: A national sample of nurses in academic and clinical settings, representing varied clinical specialties, participated in two rounds of a Delphi survey. Participants listed five most important nursing research problems rated on three dimensions: the degree of nurses' lead role, contribution to nursing profession, and nurses' contribution to health and welfare of patients and clients. A total of 29 research areas were derived from 1,013 research problems identified from the Delphi surveys, and 26 expert panel members who participated in a 1-day workshop to determine the priority of these areas. Key words of 706 research articles published in the major nursing research journals in Korea were analyzed to identify priorities. Results: In the two rounds of Delphi surveys 347 of 1,047 nurses participated (31%,33% response rates respectively). Top three research areas common to both Delphi survey and literature analysis were: clinical nursing practice, nursing education, and nursing research. Cultural nursing was rated the lowest in the Delphi survey but was rated third by the expert panel members. Conclusions: In the clinical practice area, research on the advanced practice nursing system was the first priority research problem followed by development of nursing interventions, clinical competency, quality and effectiveness of nursing care, and standardized nursing tasks. Research on home health care, nursing education, utilization of nursing research, and geriatric nursing were other areas of priority. Nurses around the world are encouraged to develop collaborative research projects based on common priority areas. [source] Economic burden associated with Parkinson's disease on elderly Medicare beneficiariesMOVEMENT DISORDERS, Issue 3 2006Katia Noyes PhD Abstract We evaluated medical utilization and economic burden of self-reported Parkinson's disease (PD) on patients and society. Using the 1992,2000 Medicare Current Beneficiary Survey, we compared health care utilization and expenditures (in 2002 U.S. dollars) of Medicare subscribers with and without PD, adjusting for sociodemographic characteristics and comorbidities. PD patients used significantly more health care services of all categories and paid significantly more out of pocket for their medical services than other elderly (mean ± SE, $5,532 ± $329 vs. $2,187 ± $38; P < 0.001). After adjusting for other factors, PD patients had higher annual health care expenses than beneficiaries without PD ($18,528 vs. $10,818; P < 0.001). PD patients were more likely to use medical care (OR = 3.77; 95% CI = 1.44,9.88), in particular for long-term care (OR = 3.80; 95% CI = 3.02,4.79) and home health care (OR = 2.08; 95% CI = 1.76,2.46). PD is associated with a significant economic burden to patients and society. Although more research is needed to understand the relationship between PD and medical expenditures and utilization, these findings have important implications for health care providers and payers that serve PD populations. © 2005 Movement Disorder Society [source] Accuracy in the outcomes and assessment information set (OASIS): Results of a video simulationRESEARCH IN NURSING & HEALTH, Issue 4 2003Elizabeth A. Madigan Abstract There is little information regarding the accuracy of the Outcomes and Assessment Information Set (OASIS), the patient assessment tool mandated for use in Medicare-funded home health care. The purposes of this study were to evaluate the accuracy of OASIS completion by home health nurses and rehabilitation therapists, to compare responses of nurses and therapists, and to determine whether dispersion of answers would affect the home health resource group (HHRG) to which patients were assigned for Medicare home health care payments to agencies. Using a video simulation of admission and discharge visits, 436 clinicians from 29 Ohio home health care agencies scored selected OASIS items. Although the majority of the items were rated accurately, discrepancies were found between clinician responses and the "correct" answer on several items. Nurses and therapists provided similar ratings on most items studied, but for most cases in which discrepancies were found, nurses were more likely to agree with the "correct" answer. Discrepancies most often led to patients being assigned to lower-payment HHRGs. Continued monitoring of OASIS data collection accuracy is recommended to maximize the value of the OASIS instrument in home health care research, practice, and policy. © 2003 Wiley Periodicals, Inc. Res Nurs Health 26:273,283, 2003 [source] Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban LocationTHE JOURNAL OF RURAL HEALTH, Issue 1 2008William J. McAuley PhD ABSTRACT:,Context:The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. Purpose: We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Methods: Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. Findings: All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. Conclusions: The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff. [source] Medicare-Certified Home Health Care: Urban-Rural Differences in UtilizationTHE JOURNAL OF RURAL HEALTH, Issue 3 2007Lacey Hartman MPP ABSTRACT:,Context:Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail.Purpose:To examine urban-rural differences in Medicare HHC utilization.Methods:The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes.Findings:Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas.Conclusions:Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies. [source] Medicare and Medicaid: Conflicting Incentives for Long-Term CareTHE MILBANK QUARTERLY, Issue 4 2007DAVID C. GRABOWSKI The structure of Medicare and Medicaid creates conflicting incentives regarding dually eligible beneficiaries without coordinating their care. Both Medicare and Medicaid have an interest in limiting their costs, and neither has an incentive to take responsibility for the management or quality of care. Examples of misaligned incentives are Medicare's cost-sharing rules, cost shifting within home health care and nursing homes, and cost shifting across chronic and acute care settings. Several policy initiatives,capitation, pay-for-performance, and the shift of the dually eligible population's Medicaid costs to the federal government,may address these conflicting incentives, but all have strengths and weaknesses. With the aging baby boom generation and projected federal and state budget shortfalls, this issue will be a continuing focus of policymakers in the coming decades. [source] Gerontological home health care , A guide for the social work practitionerAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2009Elizabeth Ozanne No abstract is available for this article. [source] Application of mobile-phone cameras to home health care and welfare in the elderly: Experience in a rural practiceAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2005Kazuhiko Kotani No abstract is available for this article. [source] Network and service architecture for emerging services based on home sensor networksBELL LABS TECHNICAL JOURNAL, Issue 2 2009Harish Viswanathan Sensor networks in the home can enable a variety of applications such as home monitoring and control, home security, home energy management, and home health care. Current state-of-the-art solutions typically target a single sensor application and do not take advantage of the established infrastructure of the broadband service provider, such as a telco operator or cable provider. In this paper, we propose an alternative solution that provides a comprehensive and scalable service platform for multiple parallel home sensor applications, even from third party providers. We highlight the advantages that a broadband service provider holds for providing these emerging high margin services, and derive a suitable end-to-end network architecture. We describe the functions of each of the main components and some of their interfaces, and pay particular attention to one of the key technological challenges: the commissioning and management of the home sensor network. In particular, we describe a laboratory implementation that demonstrates the feasibility of automatic commissioning and remote management of the sensor network. © 2009 Alcatel-Lucent. [source] Guidelines for pediatric home health careACTA PAEDIATRICA, Issue 7 2009Emma Rylander No abstract is available for this article. [source] | ||||||||||||||||||||||