-
Ciencia & Saude Coletiva Mar 2016The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil...
The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil to consider Home Care (HC) as a care strategy. However, there is a gap between the supply of HC services, the demand for care and the health needs manifested by the population. Thus, this article analyzes scientific output regarding the status of the relation between supply, demand and the needs related to home health care. This work is based on an integrative review of the literature in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health and Science (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science. Despite the fact that few articles refer to the issue in question, there is evidence indicating that health demands and needs are seldom taken into account either in a quantitative or qualitative approach when developing the organization of HC services. The analysis would indicate that there is a national and international deficit in the supply of HC services considering the demand for health care and needs currently prevailing.
Topics: Brazil; Caribbean Region; Delivery of Health Care; Health Services Needs and Demand; Home Care Services; Humans; Latin America
PubMed: 26960102
DOI: 10.1590/1413-81232015213.11382015 -
International Journal of Environmental... Jan 2021In recent years, the management of health systems is a main concern of governments and decision-makers. Home health care is one of the newest methods of providing...
In recent years, the management of health systems is a main concern of governments and decision-makers. Home health care is one of the newest methods of providing services to patients in developed societies that can respond to the individual lifestyle of the modern age and the increase of life expectancy. The home health care routing and scheduling problem is a generalized version of the vehicle routing problem, which is extended to a complex problem by adding special features and constraints of health care problems. In this problem, there are multiple stakeholders, such as nurses, for which an increase in their satisfaction level is very important. In this study, a mathematical model is developed to expand traditional home health care routing and scheduling models to downgrading cost aspects by adding the objective of minimizing the difference between the actual and potential skills of the nurses. Downgrading can lead to nurse dissatisfaction. In addition, skillful nurses have higher salaries, and high-level services increase equipment costs and need more expensive training and nursing certificates. Therefore, downgrading can enforce huge hidden costs to the managers of a company. To solve the bi-objective model, an ε-constraint-based approach is suggested, and the model applicability and its ability to solve the problem in various sizes are discussed. A sensitivity analysis on the Epsilon parameter is conducted to analyze the effect of this parameter on the problem. Finally, some managerial insights are presented to help the managers in this field, and some directions for future studies are mentioned as well.
Topics: Costs and Cost Analysis; Home Care Services; Humans; Models, Theoretical
PubMed: 33494232
DOI: 10.3390/ijerph18030900 -
Atencion Primaria Nov 2019
Topics: Day Care, Medical; Health Transition; Home Care Services; Humans; Practice Guidelines as Topic; Primary Health Care
PubMed: 31594675
DOI: 10.1016/j.aprim.2019.07.005 -
International Journal of Environmental... Mar 2024Home health care companies provide health care services to patients in their homes. Due to increasing demand, the provision of home health care services requires...
Home health care companies provide health care services to patients in their homes. Due to increasing demand, the provision of home health care services requires effective management of operational costs while satisfying both patients and caregivers. In practice, uncertain service times might lead to considerable delays that adversely affect service quality. To this end, this paper proposes a new bi-objective optimization problem to model the routing and scheduling problems under uncertainty in home health care, considering the qualification and workload of caregivers. A mixed-integer linear programming formulation is developed. Motivated by the challenge of computational time, we propose the Adaptive Large Neighborhood Search embedded in an Enhanced Multi-Directional Local Search framework (ALNS-EMDLS). A stochastic ALNS-EMDLS is introduced to handle uncertain service times for patients. Three kinds of metrics for evaluating the Pareto fronts highlight the efficiency of our proposed method. The sensitivity analysis validates the robustness of the proposed model and method. Finally, we apply the method to a real-life case and provide managerial recommendations.
Topics: Humans; Uncertainty; Home Care Services; Time Factors; Medicine; Efficiency, Organizational
PubMed: 38541375
DOI: 10.3390/ijerph21030377 -
Health Services Research Dec 2020To examine the growth and evolution of the home health agency (HHA) market and to compare quality performance across HHA ownership categories.
OBJECTIVE
To examine the growth and evolution of the home health agency (HHA) market and to compare quality performance across HHA ownership categories.
DATA SOURCE
Agency characteristics were extracted from Medicare cost reports and Provider of Services file. Quality of care and patient characteristics were extracted from Quality of Patient Care Star Ratings and HHA Public Use File.
STUDY DESIGN
Agency- and state-level analyses were conducted to describe HHA market trends. Patient characteristics and quality measures were compared across ownership categories of interest.
DATA COLLECTION/EXTRACTION METHODS
All Medicare-certified HHAs in operation, 2005-2018.
PRINCIPAL FINDINGS
Over the study period, the HHA sector grew substantially, increasing from 7899 to 10 818 agencies, and chain-owned HHAs doubled in number from 903 (11.4% of all agencies) to 1841 (17.0%). In 2018, across agency types, for-profit nonchain agencies were the largest category both in the number of agencies (67.8%) and the number of Medicare enrollees served (40.7%). Additionally, for-profit nonchain agencies grew most in total number, from 4293 (54.3%) to 7337 (67.8%), while for-profit chain agencies grew most in the number of Medicare enrollees served, from 439 998 (12.9%) to 1 082 385 (28.3%). Regarding patient composition, for-profit nonchain agencies served the highest proportion of dual eligible beneficiaries (42.2%) and African-Americans (27.9%) among all agency types. Regarding quality performance, a higher star rating is significantly (P < .01) associated with chain agency status. Moreover, chain HHAs performed better on self-reported process measures, and risk-adjusted self-reported outcome measures; however, they performed worse on risk-adjusted claims-based outcome measures. These results were similar across for-profit and nonprofit chain agencies.
CONCLUSION
Chains play a growing role in the home health sector. Substantial differences in geographic distribution, patient composition, and quality performance were observed between chain- and nonchain HHAs. Examining the growth and performance of multi-agency chains can help inform quality reporting and monitoring, assess payment adequacy, and facilitate greater transparency and accountability within the HHA marketplace.
Topics: Health Services Research; Home Care Agencies; Home Care Services; Humans; Medicaid; Medicare; Ownership; Quality of Health Care; Socioeconomic Factors; United States
PubMed: 33284527
DOI: 10.1111/1475-6773.13597 -
Journal of the American Medical... Oct 2022Home health care agencies (HHAs) are skilled care providers for Medicare home health beneficiaries in the United States. Rural HHAs face different challenges from their... (Review)
Review
OBJECTIVE
Home health care agencies (HHAs) are skilled care providers for Medicare home health beneficiaries in the United States. Rural HHAs face different challenges from their urban counterparts in delivering care (eg, longer distances to travel to patient homes leading to higher fuel/travel costs and fewer number of visits in a day, impacting the quality of home health care for rural beneficiaries). We review evidence on differences in care outcomes provided by urban and rural HHAs.
DESIGN
Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the Newcastle-Ottawa Scale (NOS) for quality appraisal.
SETTING
Care provided by urban and rural HHAs.
METHODS
We conducted a systematic search for English-language peer-reviewed articles after 2010 on differences in urban and rural care provided by U.S. HHAs. We screened 876 studies, conducted full-text abstraction and NOS quality review on 36 articles and excluded 2 for poor study quality.
RESULTS
Twelve studies were included; 7 focused on patient-level analyses and 5 were HHA-level. Nine studies were cross-sectional and 3 used cohorts. Urban and rural differences were measured primarily using a binary variable. All studies controlled for agency-level characteristics, and two-thirds also controlled for patient characteristics. Rural beneficiaries, compared with urban, had lower home health care utilization (4 of 5 studies) and fewer visits for physical therapy and/or rehabilitation (3 of 5 studies). Rural agencies had lower quality of HHA services (3 of 4 studies). Rural patients, compared with urban, visited the emergency room more often (2 of 2 studies) and were more likely to be hospitalized (2 of 2 studies), whereas urban patients with heart failure were more likely to have 30-day preventable hospitalizations (1 study).
CONCLUSION AND IMPLICATIONS
This review highlights similar urban/rural disparities in home health care quality and utilization as identified in previous decades. Variables used to measure the access to and quality of care by HHAs varied, so consensus was limited. Articles that used more granular measures of rurality (rather than binary measures) revealed additional differences. These findings point to the need for consistent and refined measures of rurality in studies examining urban and rural differences in care from HHAs.
Topics: Aged; Home Care Agencies; Home Care Services; Hospitalization; Humans; Medicare; Rural Population; United States
PubMed: 36108785
DOI: 10.1016/j.jamda.2022.08.011 -
Journal of the American Medical... May 2021Patients who are referred to home health care after an acute care hospitalization may not receive home health care, resulting in incomplete home health referrals. This...
OBJECTIVES
Patients who are referred to home health care after an acute care hospitalization may not receive home health care, resulting in incomplete home health referrals. This study examines the prevalence of incomplete referrals to home health, defined as not receiving home health care within 7 days after an initial hospital discharge, and investigates the relationship between home health referral completion and patient outcomes.
DESIGN
Retrospective cohort study.
SETTING AND PARTICIPANTS
Medicare beneficiaries who are discharged from short-term acute care hospitals between October 2015 and December 2016 with a discharge status code on the hospital claim indicating home health care.
METHODS
Patient characteristics and outcomes were compared between Medicare beneficiaries with complete and incomplete home health referrals after hospital discharge. The outcomes included mortality, readmission rate, and total spending over a 1-year episode following hospitalization. These outcomes were risk-adjusted using patient demographic, socioeconomic, clinical characteristic, hospital characteristic, and state fixed effects.
RESULTS
Approximately 29% of the 724,700 hospitalizations in the analytic dataset had incomplete home health referrals after discharge. The rate of incomplete home health referrals varied among clinical conditions, ranging from 17% among joint/musculoskeletal patients and 38% among digestive/endocrine patients. Risk-adjusted 1-year mortality and readmission rates were 1.4 and 2.4 percentage points lower and total spending was $1053 higher among patients with complete home health referrals as compared with those with incomplete home health referrals after hospital discharge.
CONCLUSIONS AND IMPLICATIONS
The analysis revealed that almost 1 in 3 patients discharged from a hospital with a discharge status of home health does not receive home health care. In addition, complete home health referrals are associated with lower mortality and readmission rates and higher spending. As home health care utilization increases, policymakers should pay attention to the tradeoff between quality and cost when implementing alternative policies and payment models.
Topics: Aged; Home Care Services; Hospitalization; Humans; Medicare; Patient Discharge; Patient Readmission; Referral and Consultation; Retrospective Studies; United States
PubMed: 33417841
DOI: 10.1016/j.jamda.2020.11.039 -
Current Environmental Health Reports Sep 2021To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC... (Review)
Review
PURPOSE OF REVIEW
To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research?
RECENT FINDINGS
HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.
Topics: Aged; Healthy Aging; Home Care Services; Home Health Aides; Humans; Occupational Health; Workforce
PubMed: 33982149
DOI: 10.1007/s40572-021-00315-7 -
International Journal of Older People... Jan 2022Due to the rapid ageing of the population, there is increasing demand for long-term care in the people's home environment. Such care aims to allow the people to stay at...
BACKGROUND
Due to the rapid ageing of the population, there is increasing demand for long-term care in the people's home environment. Such care aims to allow the people to stay at home and avoid hospitalisation or other institutional care. In home health care, care must be provided at the highest possible quality, with the focus on the people's needs and experiences.
OBJECTIVES
This study explores the experiences and needs of frail older people receiving home health care.
DESIGN AND METHODS
An exploratory descriptive qualitative approach was chosen. Audio-taped semi-structured interviews were conducted with fifteen older people receiving home health care. A content analysis was used to analyse the data collected.
RESULTS
The content analysis identified one main theme, three categories and seven subcategories related to frail older people's needs and experiences of home health care. The main theme was quality of care. The first category, Safe and Secure Care, consisted of three subcategories: Education and Experience of Nurses, Information, and Continuity of Care in terms of personnel continuity and regular care. The second category, Autonomy, contained two subcategories: Decision-making and Self-sufficiency. The last category, Relationship with Professionals, consisted of two subcategories: Personality of Nurse and Partnerships.
CONCLUSION
Older people are able to express their satisfaction or dissatisfaction with home health care. The results of this study revealed that the quality of care is crucial for frail older people.
IMPLICATION FOR PRACTICE
The provision of home health care is inherently highly specific; home care nurses should work to provide the highest possible quality of care. In particular, nurses should focus on ensuring that the care they provide is safe, effective, timely, efficient and person-centred.
Topics: Aged; Frail Elderly; Health Services Needs and Demand; Home Care Services; Home Environment; Humans; Patient Satisfaction; Qualitative Research
PubMed: 34418315
DOI: 10.1111/opn.12418 -
Journal of the American Geriatrics... Jul 2017To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated... (Observational Study)
Observational Study
OBJECTIVES
To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care.
DESIGN
Observational study.
SETTING
All counties in the United States.
PARTICIPANTS
All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system.
MEASUREMENTS
County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years.
RESULTS
The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care.
CONCLUSION
The availability of home health care increased nationwide during the study period, but there was much geographic variation.
Topics: Ethnicity; Geography, Medical; Health Services; Health Services Accessibility; Home Care Services; Humans; Income; Medicare; United States
PubMed: 28322441
DOI: 10.1111/jgs.14811