Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol.

In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.

Exploring Occupational Therapists' Experiences in U.S. Primary Care Settings: A Qualitative Study.

IMPORTANCE: Occupational therapy's scope of practice aligns with the goals of comprehensive primary care set forth by the 2010 Patient Protection and Affordable Care Act (Pub. L. 111-148). To successfully integrate occupational therapy into primary care, we must understand occupational therapy practitioners' experiences in this setting. OBJECTIVE: To explore facilitators of, barriers to, and recommendations for integrating occupational therapy into primary care. DESIGN: A descriptive qualitative design that incorporated semistructured interviews, member checking sessions, and deductive thematic analysis. Interviews were structured to capture occupational therapists' experiences of and recommendations for practicing in primary care. SETTING: Primary care. PARTICIPANTS: A purposive sample of licensed occupational therapists with at least 6 mo primary care experience in the United States. RESULTS: Seven participants reported 1 to 8 yr of experience in primary care. Four themes emerged that contextualized the experiences of occupational therapists in primary care. The first theme captured the process of gaining entry onto the primary care team. Once structurally embedded on the team, the second and third themes, respectively, captured barriers and facilitators to navigating team-based care and providing patient-centered care. The fourth theme reflected participants' vision and ideas of how to expand reach nationally to promote consistent integration of occupational therapy into primary care. Conclusion and Relevance: Given the important role of an interprofessional primary care team in improving population health, this study is timely in that it explored occupational therapists' experiences in this emerging practice area. What This Article Adds: Occupational therapists in this study used their skills, resources, and networks to become part of a primary care team. They indicated that they contributed to positive outcomes through working with patients on self-management, functional problem solving, and behavior change.

Evidence for the Effectiveness of Interventions for Caregivers of People With Chronic Conditions: A Systematic Review.

IMPORTANCE: Caregivers are pivotal in supporting the growing population of people with chronic conditions. Yet, engaging in the caregiver role involves the risk of poor outcomes. Caregiver interventions are needed that address poor outcomes while fostering engagement in role-related activities. OBJECTIVE: To evaluate the evidence for interventions to support caregivers of adults with chronic conditions. DATA SOURCES: Five databases were searched for studies of interventions for caregivers and patient-caregiver dyads published between 1995 and 2019. Study Selection and Data Collection: We reviewed the titles, abstracts, and full-text articles of the initial search results (N = 12,216 studies) according to a predetermined protocol. FINDINGS: Forty-eight studies met the inclusion criteria. Psychoeducation and education with skills training were the two caregiver intervention themes. Studies evaluating psychoeducation (n = 28) provided low strength of evidence for improved psychosocial outcomes. Within this theme, problem-solving and coping skills training were common intervention components associated with significant improvements in depression and quality of life. Studies evaluating education with skills training (n = 20) provided moderate strength of evidence for improved knowledge and low strength of evidence for improved psychosocial outcomes. Dyadic self-management education and hands-on training were common components associated with significant improvements in knowledge, quality of life, and burden or strain. CONCLUSIONS AND RELEVANCE: We found low strength of evidence to support the use of psychoeducation and education with skills training. Within these approaches, problem-solving and coping skills training, dyadic self-management education, and hands-on training show promise for improving caregiver outcomes. What This Article Adds: Findings of this systematic review are inconclusive with respect to psychoeducation and education with skills training leading to improved caregiver well-being. Within these broad approaches, the findings support the use of problem-solving and coping skills training, dyadic self-management education, and hands-on training to improve knowledge and well-being among caregivers of people with chronic conditions.