Developing integrated person-centered care quality indicators for home health agencies in Shanghai, China: A modified Delphi-analytic hierarchy process study.

OBJECTIVES: To develop person-centered integrated care quality indicators for home health agencies in Shanghai, China. DESIGN: The study combined the Delphi method and the analytic hierarchy process (AHP). MATERIAL AND METHODS: The Delphi consultation questionnaire was distributed to experts in home healthcare in Shanghai, China. A panel of experts with experience in home healthcare in Shanghai, China, was selected. Purposive sampling was used to choose experts. In this study, ten experts were selected from within sub-fields of home healthcare, including nursing, health policy, quality improvement, person-centered care (PCC), and integrated care. RESULTS: The authority coefficient (Cr) in this study was 0.835. The coordination degree of experts' opinions, which is expressed by Kendall coordination coefficient W (a higher value, better coordination of the item), ranged from 0.352 to 0.386 (p < 0.001). The consistency ratio (CR) values for each level were less than 0.1. The quality indicator system included three first-level indicators, 15 second-level indicators, and 56 third-level indicators. CONCLUSIONS: A person-centered integrated care quality indicator system was developed for home health agencies. The findings from this study enable nurses, managers, and policymakers in home and community-based settings to evaluate person-centered integrated care quality using a robust framework. In addition, these indicators can also be used as a standardized tool to guide the development of long-term care services and supports (LTSS) for home-bound elderly.

Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019.

Importance: Given the growth of home health agency (HHA) care, it is important to understand whether quality reporting programs, such as star ratings, are associated with improved patient outcomes. Objective: To assess the immediate and long-term association of the introduction of HHA star ratings with patient-level quality outcomes, comparing claims-based and agency-reported measures. Design, Setting, and Participants: This cross-sectional study used Medicare HHA claims and agency-reported assessments to identify sequential patient episodes (ie, spells) among US adults with traditional Medicare who received HHA care (2013-2019). An interrupted time series (ITS) model was used to measure changes in trends and levels before and after the introduction of star ratings. Statistical analysis was performed from November 2022 to September 2023. Exposure: The exposure was the introduction of HHA star ratings. The postexposure period was set as starting January 1, 2016, to account for the period when both star ratings (quality of patient care and patient satisfaction rating) were publicly reported. Main Outcomes and Measures: The main outcomes included claims-based hospitalization measures (both during the patient spell and 30 days after HHA discharge) and agency-reported functional measures, such as improvement in ambulation, bathing, and bed transferring. There was also a measure to capture timely initiation of care among post-acute care HHA users, defined as HHA care initiated within 2 days of inpatient discharge. Results: This study identified 22 958 847 patient spells to compare annual changes over time; 9 750 689 patient spells were included during the pre-star ratings period from January 1, 2013, to December 31, 2015 (6 067 113 [62.2%] female; 1 100 145 [11.3%] Black, 512 487 [5.3%] Hispanic, 7 845 197 [80.5%] White; 2 656 124 [27.2%] dual eligible; mean [SD] patient spell duration, 70.9 [124.9] days; mean [SD] age, 77.4 [12.0] years); 13 208 158 patient spells were included during the post-star ratings period from January 1, 2016, to December 31, 2019 (8 104 69 [61.4%] female; 1 385 180 [10.5%] Black, 675 536 [5.1%] Hispanic, 10 664 239 [80.7%] White; 3 318 113 [25.1%] dual eligible; mean [SD] patient spell duration, 65.3 [96.2] days; mean [SD] age, 77.7 [11.6] years). Results from the ITS models found that the introduction of star ratings was associated with an acceleration in the mean [SE] hospitalization rate during the spell (0.39% [0.05%] per year) alongside functional improvements in ambulation (2.40% [0.29%] per year), bed transferring (3.95% [0.48%] per year) and bathing (2.34% [0.19%] per year) (P < .001). This occurred alongside a 1.21% (0.12%) per year reduction in timely initiation of care (P < .001). Conclusions and Relevance: This cross-sectional study found an observed improvement in agency-reported functional measures, which contrasted with slower increases in more objective measures such as hospitalization rates and declines in timely initiation of care. These findings suggest a complex picture of HHA quality of care after the introduction of star ratings.

Home Health Nursing Agencies' Services for Children With Medical Complexity: Parent and Nurse Perspectives.

OBJECTIVE: Many children with medical complexity (CMC) require the services of home health nurses (HHNs). Home health agencies (HHAs) hire, train, and manage nurses. For children to flourish, families, nurses, and HHAs must establish successful working relationships. Our objective was to understand the perspectives of parents and nurses about HHAs. METHODS: In Illinois (IL) from 2019 to 2022, HHNs for and parents of children with invasive mechanical ventilation were interviewed. In North Carolina (NC) from 2012 to 2013, parents of CMC were interviewed, and from 2013 to 2014 HHNs participated in focus groups. Each dataset was initially analyzed separately for main themes relating to HHAs. Using collaborative thematic analysis, we determined themes common across datasets. RESULTS: In IL, 23 mothers, 12 fathers, and 20 nurses were interviewed. In NC, 19 mothers, 6 fathers, and 1 grandmother were interviewed; and 4 focus groups of 18 nurses were conducted. Four common themes were identified. 1) HHAs do not have a uniform process for hiring and assigning nurses to cases. 2) HHAs have marked variability in training offered to nurses. 3) Shift scheduling, notifications, and communications with the HHAs frustrate parents and nurses. 4) Nurses and parents have little allegiance to specific HHAs; they frequently change agencies or work with several simultaneously. CONCLUSIONS: Parents and nurses perceive practices for hiring, training, and staffing as inconsistent, and experience communication challenges. HHA-level problems may contribute to issues with HHN retention and complicate the lives of the families of CMC. Further research about this critical health care sector is needed.

Identifying the process and agency characteristics associated with poor utilization outcomes in home healthcare.

This study identified the process and agency characteristics associated with poor utilization outcomes - higher percentages of patients (i) admitted to an acute care organization and (ii) visited an emergency room (ER) unplanned without hospitalization - for home health agencies (HHAs) in the United States. We conducted a secondary analysis of data about HHAs' various characteristics, process adherence levels, and utilization outcomes collected from disparate public repositories for 2010-2022. We developed descriptive tree-based models using HHAs' hospital admission or ER visit percentages as response variables. Across the board, hospital admission percentages have steadily improved while ER percentages deteriorated for an extended period. Recently, checking for fall risks and depression was associated with improved outcomes for urban agencies. In general, rural HHAs had worse utilization outcomes than urban HHAs. Targeted investments and improvement initiatives can help rural HHAs close the urban-rural gap in the future.

Home Health Agencies With High Quality of Patient Care Star Ratings Reduced Short-Term Hospitalization Rates and Increased Days Independently at Home.

BACKGROUND: Critics argue that Medicare's Quality of Patient Care home health star ratings are inaccurate. Valid ratings are essential to help patients find high-quality care. OBJECTIVE: The aim of this study was to determine whether using the highest-rated home health agency available in a ZIP code improves outcomes. RESEARCH DESIGN: A retrospective study of 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. An instrumental variables approach is used to address the endogeneity of agency choice, where the instrument is the differential proximity of the patient to the closest highest-rated and closest lower-rated agency. OUTCOMES: Days independently at home; health care setting-specific days and death; hospitalization, emergency department use, and institutionalization risk. RESULTS: Treatment by the highest-rated agencies available decreased risks (in percentage points) of hospitalization (-3.2; 95% CI, -4.1 to -2.3), emergency department use (-2.2; 95% CI, -3.2 to -1.1), and institutionalization (-0.9; 95% CI, -1.3 to -0.5) during the initial episode, and increased days independently at home by 2.6% or 3.75 (95% CI, 2.20-5.29) days in the 180 days after the end of the initial episode. Treatment effects were more pronounced for agencies that were above-average (6.51 d; 95% CI, 4.15-8.87), had ≥1 more star than the next-best agency (7.80 d; 95% CI, 4.13-11.47), and nonrural residents (4.57 d; 95% CI, 2.75-6.40). Effects were positive for both postacute (3.40; 95% CI, 1.80-5.00) and community-entry (5.60; 95% CI, 2.30-8.89) patients. CONCLUSIONS: Medicare's Quality of Patient Care star rating correlates with reduced short-term hospitalizations and emergency department use and increased days independently at home in the longer term.

Nota informativa nº 01 /2020 - DVAST/ DVDVZ /SVS/SES: recomendações aos agentes de combates à endemias-ace para enfrentamento da pandemia de Coronavírus ­ covid-19 (infecção pelo SARS-CoV-2) / Informative note nº 01 / 2020 - DVAST / DVDVZ / SVS / SES: recommendations to agents to combat ace-endemic diseases for coping with the Coronavirus pandemic - covid-19 (SARS-CoV-2 infection)

Traz reflexões e recomendações aos gestores e trabalhadores na discussão coletiva de medidas que minimizem os riscos à saúde dos Agentes de Combates à Endemias-ACE, como também, reduzam a disseminação do COVID-19 para seus familiares e a população em geral. Complementa os informes e protocolos emitidos pela SES-TO e seu Comitê Operacional de Emergências em Saúde e pelo Ministério da Saúde.

It brings reflections and recommendations to managers and workers in the collective discussion of measures that minimize the health risks of Agents to Combat Endemics-ACE, as well as reduce the spread of COVID-19 to their families and the population in general. It complements the reports and protocols issued by SES-TO and its Operational Committee for Health Emergencies and the Ministry of Health.

Aporta reflexiones y recomendaciones a directivos y trabajadores en la discusión colectiva de medidas que minimicen los riesgos para la salud de los Agentes de Lucha contra las Endemias-ACE, así como reduzcan la propagación del COVID-19 a sus familias y a la población en general. Complementa los informes y protocolos emitidos por la SES-TO y su Comité Operativo de Emergencias Sanitarias y el Ministerio de Salud.

Desempeño del rol de cuidador primario y eficiencia del programa Atención Hospitalaria a Domicilio / Caregiver role performance and efficiency of the Home Health Care program

Resumen:

Introducción: el programa de Atención Hospitalaria a Domicilio (ATHODO), del Instituto Mexicano del Seguro Social (IMSS), se implemento con el fin de llevar atención médica hasta el domicilio de los pacientes con enfermedades crónicas o terminales. Como requisito indispensable para formar parte del programa, el paciente debe contar con un cuidador primario, persona en la que recae la responsabilidad del cuidado del paciente.

Objetivo: evaluar el desempeño del cuidador principal y su relación con la eficiencia del programa ATHODO.

Metodología: estudio descriptivo y transversal correlacional en 72 cuidadores principales inscritos en el programa ATHODO. El desempeño del cuidador principal se evaluó con el instrumento elaborado por Landeros y Huitzache "Valoración para el Agente de Cuidado Dependiente", validado con alfa de Cronbach de 0.862; y la eficiencia del programa, con una lista de cotejo realizada conforme a lo establecido en los siete indicadores de calidad que marca el IMSS. Se consideró eficiente si se cumplieron positivamente los siete indicadores.

Resultados: el desempeño del rol de cuidador principal fue bueno en 58 % y regular en 42 %. El programa ATHODO fue evaluado como insuficiente por los cuidadores debido a que no se cumplió favorablemente con los siete indicadores. Se identificó asociación entre desempeño y eficiencia del programa.

Conclusiones: la asociación entre desempeño y eficiencia del programa ATHODO permite proponer acciones que lo perfeccionen y que mejoren el desempeño del cuidador principal.

Abstract:

Introduction: Instituto Mexicano del Seguro Social's (IMSS) Home Health Care program (ATHODO, according to its initials in Spanish) was implemented to bring medical care to the home of patients with chronic or terminal diseases. As a prerequisite for joining the program, the patient must have a primary caregiver: a person with the responsibility of giving care to him.

Objective: To evaluate the performance of the primary caregiver role and its relationship with the efficiency of ATHODO program.

Methodology: A descriptive, correlational cross-sectional study in 72 primary caregivers enrolled in ATHODO. Primary caregiver performance was assessed with the instrument developed by Lan-deros and Huitzache "Valoración para el Agente de CuidadoDependiente" ("Calculation for Dependent Care Agent"), validated with Cronbach's alpha of 0.862. The efficiency of the program was validated with a checklist made as provided in the seven indicators of quality that marks the IMSS. The program was considered efficient if it met with the seven points positively. Results: the performance of the role of primary caregiver was good in 58 %, fair in 42 %. The ATHODO program was evaluated as inefficient by all caregivers, because it didn't met favorably with the seven indicators. An association between performance and efficiency of the program was identified. Conclusions: the association between performance and efficiency of the program allows to propose actions to improve the program and consequently the performance of the primary caregiver.

Práticas de saúde da mulher no espaço domiciliar: análise a partir de Agentes Comunitários de Saúde / Women's health practices in the home space: analysis from Community Health Agents

política atual de reorganização do Sistema de Saúde no Brasil utiliza a estratégia de atendimento domiciliar, tendo a atenção primária como base de sua ação, revalorizando o uso das práticas de saúde no domicílio. Este espaço, histórica e culturalmente atribuído às mulheres, influencia e é influenciado por diferentes práticas sociais. Este estudo tem como objetivo analisar como as práticas de saúde voltadas para a Mulher e realizadas no domicílio, estão sendo desenvolvidas por ACS do Distrito Sanitário Barra/ Rio Vermelho reproduzindo as desigualdade de gênero. Utilizou-se a metodologia qualitativa, usando o Materialismo Histórico Dialético como referencial teórico- filosófico. Para a coleta de dados, utilizou-se da observação participante e entrevista semi-estruturada e gravada dos ACS, usando-se a análise de conteúdo. A visita domiciliar apresenta-se como instrumento de trabalho revalorizado. A articulação dos ACS com os serviços apresenta-se com deficiências, considerando-se o atendimento à demanda espontânea. O trabalho dos agentes reproduz características do Modelo Médico Assistencial. Da mesma forma, as práticas de saúde mesmo voltadas para promoção/prevenção de problemas de saúde não são suficientes para enfrentar os conflitos e as necessidades existentes no âmbito domiciliar. O despreparo dos agentes para lidar com problemas complexos reproduzem desigualdades de gênero, na medida em que reforçam o papel da mulher como única cuidadora reafirmando estereótipos sexistas. (AU)

Assistência domiciliar na cidade de Salvador-BA: possibilidade de atuação fonoaudiológica em Motricidade Orofacial / Home care in Salvador-BA: a work possibility for speech therapists in orofacial myofunction

OBJETIVO: caracterizar o atendimento fonoaudiológico nas empresas de Assistência Domiciliar de Salvador. MÉTODOS: pesquisa retrospectiva por meio da aplicação de questionário às empresas, fonoaudiólogos e pacientes atendidos com fonoaudiólogo, de Janeiro a Março de 2006. RESULTADOS: o tempo médio de funcionamento das empresas é 9,17 anos. A média de pacientes atendidos por fonoaudiólogo é 14,33 com média de 3,17 fonoaudiólogos atendendo por empresa; profissionais presentes em 100 por cento das empresas são médicos e fisioterapeutas; os fonoaudiólogos trabalham por prestação de serviço, com valor médio de 33 reais por atendimento. A maioria dos pacientes são mulheres, idosos (média de 69 anos), com diagnóstico de doença neurológica: AVE (39,1 por cento), Demências (19,1 por cento); os fonoaudiólogos são em maioria mulheres, jovens e graduadas no próprio estado. CONCLUSÕES: a assistência domiciliar é atividade recente na Bahia, porém a presença do Fonoaudiólogo já é estabelecida, com profissionais graduados no próprio estado e trabalhando por prestação de serviço.

PURPOSE: to characterize the speech therapy service of home care service companies in Salvador. METHODS: a partially retrospective survey through questionnaires done by companies, speech therapists and patients attended by speech therapist from January to March 2006. RESULTS: companies have been open an average of 9.17 years. The average number of speech therapists per company is 3.17 and the average number of patients attended by speech therapist is 14.33; 100 percent of the company professionals are licensed doctors and physical therapists; speech therapists work as service rendering self-employed professionals, with average cost of R$ 33,00 per attendance. Most patients are women, elderly (average of 69 years), with diagnosis of neurological illness: Cerebrovascular disease (39.1 percent), Dementia (19.1 percent); most of the speech therapists are young women, who graduated from a local school. CONCLUSIONS: home care service is a recent activity in Bahia. However, speech therapist presence is already settled, with professionals graduated in their own states and working as service rendering self-employed professionals.

O home care e o cooperativismo médico / Home care and medical cooperation

No presente artigo, os autores buscaräo fazer uma síntese de toda a experiência e os conhecimentos acumulados por uma cooperativa médica que mantém, há quase quatro anos, um serviço de Home Care inédito em sua regiäo e que hoje certamente se constitui em uma iniciativa de sucesso. Partindo-se de uma visäo histórica que se inicia pelo surgimento das primeiras modalidades de assistência domiciliar na Inglaterra e nos EUA e chega a uma perspectiva da situaçäo do Home Care no Brasil dos dias atuais, passar-se á a uma delimitaçäo dos papéis desempenhados pelo médico e demais profissionais que compöem uma Equipe Multidisciplinar na assistência em domicílio. A seguir seräo abordadas as razöes pelas quais o Sistema Unimed, maior cooperativa de trabalho médico do mundo, vem investindo na criaçäo destes programas em muitas de suas Singulares, e porque tais serviços assumen uma configuraçäo própria quando florescem no ambiente fértil do cooperativismo. Em termos de experiência concreta, a parte mais ilustrativa deste trabalho será aquela que apresenta detalhadamente o funcionamento do Unimed Domiciliar de Juiz de Fora/MG...

Home care in America

This article discuss the American history and the evolution of home health care that has taken place over the last few years

Assistência domiciliar: uma modalidade de assistência para o Brasil? / Home care: a dishospitalization strategy to Brazil?

O presente estudo tem como objetivo discutir a modalidade assistência domiciliar como uma proposta a ser considerada na estratégia de desospitalização no Brasil. Para realizar esse trabalho, dois recursos metodológicos foram utilizados: pesquisa bibliográfica referente ao tema e entrevistas semi-estruturadas com profissionais e representantes de organizações que trabalham com assistência domiciliar no Brasil. A assitência domiciliar à saúde é entendida como uma prestação de serviços de saúde às pessoas de qualquer idade em seus domicílios. Entretando, tem sido utilizada, freqüentemente nos países mais desenvolvidos, no cuidado à saúde dos idosos. Diante da tendência de rápido crescimento do número de idosos no nosso país, justifica-se discutir essa modalidade sob a perspectiva estratégica de desospitalização. Manter o status quo com a assistência centrada na hospitalização gerará uma situação de superlotação das unidades hospitalares, ocupadas por doentes idosos, com doenças crônico-degenerativas, aumentando os custos da assistência à saúde, aumentando a premência no hospital, expondo esse paciente a riscos de toda série de agravos, em particular a depressão, causadora de aceleração de diversas doenças e do comprometimento da qualidade de vida. No momento em que a modalidade existe basicamente no setor privado e ainda assim de forma ainda incipiente - 1 por cento do número de empresas comparado aos Estados Unidos - o Ministério da Saúde deveria considerar esse tipo de atenção, entre outros, como uma opção importante no cuidado de idosos, não só definindo diretrizes para a implantação do modelo na assistência pública, como discutindo a regulamentação das atividades no setor privado, no sentido de assegurar um padrão de qualidade.