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Revista Brasileira de Enfermagem 2017analyze scientific production on nursing practice in home care. (Review)
Review
OBJECTIVE:
analyze scientific production on nursing practice in home care.
METHOD:
integrative review employing databases LILACS, BDENF, IBECS, and MEDLINE. Studies in Spanish, English, and Portuguese were included, regardless of publishing date.
RESULTS:
after analyzing 48 articles, it was found that nursing practice in home care is complex, employing a multitude of actions by using three technologies: soft; soft-hard especially; and hard. Challenges related to the home-care training process are reported in the literature. Nurses use knowledge from their experience and scientific recommendations in conjunction with their reflections on the practice.
CONCLUSION:
home nursing practice is fundamental and widespread. Relational and educational actions stand out as necessary even in technical care, with a predominant need for home-care training.
Topics: Home Care Services; Home Health Nursing; Humans; Nurses, Community Health; Nursing Care
PubMed: 28226061
DOI: 10.1590/0034-7167-2016-0214 -
Frontiers in Public Health 2023
Topics: Humans; Home Care Services; Digital Health; Health Equity
PubMed: 38192562
DOI: 10.3389/fpubh.2023.1251154 -
JAMA Internal Medicine May 2019Use of postacute care is common and costly in the United States, but there is significant uncertainty about whether the choice of postacute care setting matters....
IMPORTANCE
Use of postacute care is common and costly in the United States, but there is significant uncertainty about whether the choice of postacute care setting matters. Understanding these tradeoffs is particularly important as new alternative payment models push patients toward lower-cost settings for care.
OBJECTIVE
To investigate the association of patient outcomes and Medicare costs of discharge to home with home health care vs discharge to a skilled nursing facility.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective cohort study used Medicare claims data from short-term acute-care hospitals in the United States and skilled nursing facility and home health assessment data from January 1, 2010, to December 31, 2016, on Medicare beneficiaries who were discharged from the hospital to home with home health care or to a skilled nursing facility. To address the endogeneity of treatment choice, an instrumental variables approach used the differential distance between the beneficiary's home zip code and the closest home health agency and the closest skilled nursing facility as an instrument.
EXPOSURES
Receipt of postacute care at home vs in a skilled nursing facility.
MAIN OUTCOMES AND MEASURES
Readmission within 30 days of hospital discharge, death within 30 days of hospital discharge, improvement in functional status during the postacute care episode, and Medicare payment for postacute care and total payment for the 60-day episode.
RESULTS
A total of 17 235 854 hospitalizations (62.2% women and 37.8% men; mean [SD] age, 80.5 [7.9] years) were discharged either to home with home health care (38.8%) or to a skilled nursing facility (61.2%) during the study period. Discharge to home was associated with a 5.6-percentage point higher rate of readmission at 30 days compared with discharge to a skilled nursing facility (95% CI, 0.8-10.3; P = .02). There were no significant differences in 30-day mortality rates (-2.0 percentage points; 95% CI, 0.8-10.3; P = .12) or improved functional status (-1.9 percentage points; 95% CI, -12.0 to 8.2; P = .71). Medicare payment for postacute care was significantly lower for those discharged to home compared with those discharged to a skilled nursing facility (-$5384; 95% CI, -$6932 to -$3837; P < .001), as was total Medicare payment within the first 60 days after admission (-$4514; 95% CI, -$6932 to -$3837; P < .001).
CONCLUSIONS AND RELEVANCE
Among Medicare beneficiaries eligible for postacute care at home or in a skilled nursing facility, discharge to home with home health care was associated with higher rates of readmission, no detectable differences in mortality or functional outcomes, and lower Medicare payments.
Topics: Aged; Aged, 80 and over; Female; Health Expenditures; Home Care Agencies; Home Care Services; Hospitalization; Humans; Male; Medicare; Mortality; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Retrospective Studies; Skilled Nursing Facilities; Subacute Care; United States
PubMed: 30855652
DOI: 10.1001/jamainternmed.2018.7998 -
Journal of Applied Gerontology : the... Feb 2023Disasters adversely affect individuals' mental health; yet, research is scant on the mental health needs of frontline workers during and immediately after disasters. Our...
Disasters adversely affect individuals' mental health; yet, research is scant on the mental health needs of frontline workers during and immediately after disasters. Our study explored this gap through the perspectives of home-based care providers (HBCP) who provided care during and after Hurricanes Irma and Harvey. In this qualitative study, five in-person focus groups were held between January and November 2019 with 25 HBCP drawn from home health care agencies in southern Florida and the Greater Houston Area. Four themes were identified using an abductive analytic approach: HBCPs' disaster-related mental health needs; HBCP resilience in the context of disaster; psychological tensions associated with simultaneously caring for self, family, and patients; and supporting patients' mental health needs during and after disaster. Our data suggest that HBCP may benefit from formal training and interventions to support their own mental health as well as that of their patients in the context of disasters.
Topics: Humans; Mental Health; Disasters; Home Care Services; Florida; Focus Groups
PubMed: 36134693
DOI: 10.1177/07334648221128559 -
Journal of the American Medical... Nov 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Home Care Services; Pandemics; Pneumonia, Viral; SARS-CoV-2; United States
PubMed: 33138933
DOI: 10.1016/j.jamda.2020.09.018 -
Health Services Research Apr 2018To evaluate whether communication failures between home health care nurses and physicians during an episode of home care after hospital discharge are associated with...
OBJECTIVE
To evaluate whether communication failures between home health care nurses and physicians during an episode of home care after hospital discharge are associated with hospital readmission, stratified by patients at high and low risk of readmission.
DATA SOURCE/STUDY SETTING
We linked Visiting Nurse Services of New York electronic medical records for patients with congestive heart failure in 2008 and 2009 to hospitalization claims data for Medicare fee-for-service beneficiaries.
STUDY DESIGN
Linear regression models and a propensity score matching approach were used to assess the relationship between communication failure and 30-day readmission, separately for patients with high-risk and low-risk readmission probabilities.
DATA COLLECTION/EXTRACTION METHODS
Natural language processing was applied to free-text data in electronic medical records to identify failures in communication between home health nurses and physicians.
PRINCIPAL FINDINGS
Communication failure was associated with a statistically significant 9.7 percentage point increase in the probability of a patient readmission (32.6 percent of the mean) among high-risk patients.
CONCLUSIONS
Poor communication between home health nurses and physicians is associated with an increased risk of hospital readmission among high-risk patients. Efforts to reduce readmissions among this population should consider focusing attention on this factor.
Topics: Adult; Age Factors; Communication; Fee-for-Service Plans; Female; Home Care Services; Humans; Insurance Claim Review; Interprofessional Relations; Linear Models; Male; Medicare; Middle Aged; Natural Language Processing; Nurses, Community Health; Patient Readmission; Physicians; Propensity Score; Risk Factors; Severity of Illness Index; Sex Factors; Socioeconomic Factors; United States
PubMed: 28217974
DOI: 10.1111/1475-6773.12667 -
PloS One 2022This article proposes a novel dynamic objective function in a multi-period home health care (HHC) problem, known as the nurse-patient relationship (NPR). The...
This article proposes a novel dynamic objective function in a multi-period home health care (HHC) problem, known as the nurse-patient relationship (NPR). The nurse-patient relationship score indicating the trust a patient has for his or her care worker increases when the same people meet regularly and decreases when they are apart. Managing human resources in HHC is a combination of routing and scheduling problems. Due to computational complexity of the HHC problem, a 28-day home health care problem is decomposed into daily subproblems, and solved sequentially with the tabu search. The solutions are then combined to give a solution to the original problem. For problems with less complex constraints, the NPR model can also be solved using exact methods such as CPLEX. For larger scale instances, however, the numerical results show that the NPR model can only be solved in reasonable times using our proposed tabu search approach. The solutions obtained from the NPR models are compared against those from existing models in the literature such as preference and continuity of care. Essentially, the analysis revealed that the proposed NPR models encouraged the search algorithm to assign the same care worker to visit the same patient. In addition, it had a tendency to assign a care worker on consecutive days to each patient, which is one of the key factors in promoting trust between patients and care workers. This leads to the efficacy of monitoring patient's disease progression and treatment.
Topics: Algorithms; Home Care Services; Humans; Nurse-Patient Relations
PubMed: 35622818
DOI: 10.1371/journal.pone.0268517 -
International Journal of Environmental... Nov 2022Health care facilities have not increased in response to the growing population. Therefore, government and health agencies are constantly seeking cost-effective...
Health care facilities have not increased in response to the growing population. Therefore, government and health agencies are constantly seeking cost-effective alternatives so they can provide effective health care to their constituents. Around the world, health care organizations provide home health care (HHC) services to patients, especially the elderly, as an efficient alternative to hospital care. In addition, recent pandemics have demonstrated the importance of home health care as a means of preventing infection. This study is the first to simultaneously take into account nurses' working preferences and skill levels. Since transferring samples from the patient's home to the laboratory may affect the test results, this study takes into account the time it takes to transfer samples. In order to solve large instances, two metaheuristic algorithms are proposed: Genetic Algorithms and Particle Swarm Optimization. Nurses are assigned tasks according to their time windows and the tasks' time windows in a three-stage scheduling procedure. Using a case study set in Tehran, Iran, the proposed model is demonstrated. Even in emergencies, models can generate effective strategies. There are significant implications for health service management and health policymakers in countries where home health care services are receiving more attention. Furthermore, they contribute to the growing body of knowledge regarding health system strategies by providing new theoretical and practical insights.
Topics: Humans; Aged; Iran; Home Care Services; Algorithms
PubMed: 36429755
DOI: 10.3390/ijerph192215036 -
BMC Palliative Care May 2022The role of the resource nurse aims at bridging the gap between the specialist nurses and the nurses who work in non-specialist wards. The role is established...
BACKGROUND
The role of the resource nurse aims at bridging the gap between the specialist nurses and the nurses who work in non-specialist wards. The role is established internationally and used in a wide area of clinical settings. The resource nurse is promoting evidence-based practice. Patients with life limiting conditions including cancer and other chronic diseases will likely need palliative care during the trajectory of illness. Due to the complexity of palliative care, both interprofessional help and cooperation between levels of healthcare are considered necessary.
AIM
The aim of this study was to explore the perceptions and experiences related to the role of the resource nurse in palliative care in the setting of home health care services and hospitals in Norway, from the perspectives of the resource nurses and the ward nurses.
DESIGN
The study has an explorative design with a qualitative approach.
METHODS
Eight individual interviews were conducted. Audiotaped interview material was transcribed verbatim and the data were analysed using systematic text condensation. The encoded data material provided the basis for writing analytical texts that in turn resulted in meaningful descriptions of the different categories.
RESULTS
Four resource nurses and four ward nurses participated in individual interviews. Analysis of the data yielded three categories: 1. Expectations of better competence in the ward. 2. Expectations of better cooperation between professions and different levels of healthcare services. 3. Improvements and hindrances.
CONCLUSION
The resource nurse role is underutilized due to heavy workload and inefficient organization of care. Improvements such as sufficient time resources, support from the ward nurse and cooperation with staff nurses, the resource nurses' role could contribute to increased competence and cooperation interprofessionally and between levels of healthcare.
Topics: Home Care Services; Hospitals; Humans; Nurse's Role; Palliative Care; Qualitative Research
PubMed: 35501848
DOI: 10.1186/s12904-022-00956-x -
Health Economics Mar 2014Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We...
Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition.
Topics: Economic Competition; Health Care Costs; Home Care Services; Humans; Models, Theoretical; Quality Indicators, Health Care; Quality of Health Care
PubMed: 23670849
DOI: 10.1002/hec.2938