RESUMEN
The viability of measuring and integrating preventive cardiovascular care into home healthcare was investigated through a pilot study fielded during 2013 and 2014. The study tested the feasibility of using a data registry to measure preventive cardiovascular care delivered in home healthcare, examined opportunities for quality improvement, and looked at the association between exposure to evidence-based tools and improvement in aspirin use and blood pressure screening and control among a convenience sample of 20 agencies. Based on promising results, the home healthcare cardiovascular quality initiative continues in alignment with Million Hearts® and offers tools that clinicians can use to understand the risks for heart attack and stroke within their agency's population of patients and respond with best practices.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Prestación Integrada de Atención de Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Prevención Primaria/organización & administración , Cuidados de Enfermería en el Hogar/organización & administración , Humanos , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Mejoramiento de la Calidad , Sistema de Registros , Estados UnidosRESUMEN
RATIONALE, AIMS AND OBJECTIVES: To determine whether US home health agencies that intensively engaged with the 2010 Home Health Quality Improvement National Campaign were more likely to reduce acute care hospitalization (ACH) rates than less engaged agencies. METHOD: We included all Medicare-certified agencies that accessed Campaign resources in the first month of the Campaign and also responded to an online survey of resource utilization at month two. We used the survey data and item response theory to estimate a latent construct we called engagement with the campaign. ACH rates were calculated from the Centers for Medicare & Medicaid Services Outcome and Assessment Information Set for pre- and post-intervention periods (March-November 2009 and 2010, respectively). RESULTS: Staff from 1077 agencies accessed resources in the first month of the Campaign. Of these, 382 provided information about resource use and had 10 or more monthly discharges throughout the measurement periods. Dividing these agencies into quartiles based on engagement score, we found an association between engagement and reduction in ACH rates, P=0.049 (χ(2) for trend). Exploratory path analysis revealed the effect of engagement score on reduction in ACH rate to be partially mediated through reduction in average length of service rates. CONCLUSION: We found evidence that early intensity of engagement with the Campaign, as measured through use of activities and resources, was positively associated with improvement. To continue the investigation of this relationship, future work in this and other campaigns should focus on further development of engagement measures.