A Predictive Risk Model for Infection-Related Hospitalization Among Home Healthcare Patients.

Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted.

Pain-Related Drug Use Among Older Adults With Activity Limiting Pain Who Received Home Care Services.

Pain is a common problem for patients receiving home care, often limiting mobility and contributing to functional decline. Pharmacological pain management is common, but all drugs bring some risk of side effects and adverse reactions. The opioid epidemic has brought into question analgesic prescribing patterns across all care settings.

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care.

Importance: Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population.

Objective: To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use.

Design, Setting, And Participants: This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care using national Medicare administrative, claims, and home health assessment data from 2013 to 2014.

Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors.

Objective: To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission.

Design: Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data.

Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?

Background: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission.

Objective: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors.

Design: A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis.

Home care providers' experience of translating evidence-based fall prevention programs into practice.

The purpose of the study was to obtain exploratory, descriptive information that would provide insights into the barriers to and facilitators of the implementation of fall prevention programs in home care settings. The study employed a qualitative approach through a series of focus groups with home care providers who work with patients with diabetes (N = 29). The study identified teamwork, resistance to change, and patient's readiness as major factors in fall prevention practice at home care.

Early Post-Intensive Care Syndrome among Older Adult Sepsis Survivors Receiving Home Care.

Background/objectives: New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post-intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care.

Predictors of Hospice Enrollment for Patients With Advanced Heart Failure and Effects on Health Care Use.

Objectives: This study sought to: 1) identify the predictors of hospice enrollment for patients with heart failure (HF); and 2) determine the impact of hospice enrollment on health care use.

Background: Patients with HF rarely enroll in hospice. Little is known about how hospice affects this group's health care use.

Implementing a Pain Self-Management Protocol in Home Care: A Cluster-Randomized Pragmatic Trial.

Objectives: To determine the effectiveness of a cognitive-behavioral pain self-management (CBPSM) protocol delivered by physical therapists (PTs) for use by older adults with activity-limiting pain receiving home care.

Design: A randomized pragmatic trial comparing delivery of the intervention plus usual care with usual care alone.

Setting: Community.

Translating Evidence-Based Protocols Into the Home Healthcare Setting.

Activity-limiting pain is common among older home care patients and pain management is complicated by the high prevalence of physical frailty and multimorbidity in the home care population. A comparative effectiveness study was undertaken at a large urban home care agency to examine an evidence-based pain self-management program delivered by physical therapists (PTs). This article focuses on PT training, methods implemented to reinforce content after training and to encourage uptake of the program with appropriate patients, and therapists' fidelity to the program.

Pain and Function in Home Care: A Need for Treatment Tailoring to Reduce Disparities?

Objectives: To describe racial/ethnic group differences in pain presentation and the prevalence of psychosocial factors among patients admitted to home health care, and to determine the extent of racial/ethnic group differences in the association of psychosocial factors with pain intensity and pain-related disability.

Methods: We analyzed cross-sectional data on 588 patients with activity-limiting pain admitted to home care for physical therapy. Three psychosocial factors were assessed: depressive symptoms, pain self-efficacy, and health literacy.

Reducing Readmissions among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up.

Objective: To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care.

Data Sources: National Medicare administrative, claims, and patient assessment data.

Study Design: Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality.

Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure.

Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates.

Frontloading and intensity of skilled home health visits: a state of the science.

Frontloading of skilled nursing visits is one way home health providers have attempted to reduce hospital readmissions among skilled home health patients. Upon review of the frontloading evidence, visit intensity emerged as being closely related. This state of the science presents a critique and synthesis of the published empirical evidence related to frontloading and visit intensity.

Implementing a cognitive-behavioral pain self-management program in home health care, part 2: feasibility and acceptability cohort study.

Purpose: The prevalence of pain in older adults receiving home health care is high, yet safety concerns for analgesic therapy point to a need for nonpharmacologic approaches to pain management in this population. The purpose of this study was to determine the feasibility and acceptability to physical therapists (PTs) and patients of a cognitive-behavioral pain self-management (CBPSM) program.

Methods: Thirty-one PTs volunteered to participate, completed two 4-hour training sessions, and recruited 21 patients with activity-limited pain who consented to participate in the study.

Implementing a cognitive-behavioral pain self-management program in home health care, part 1: program adaptation.

Background And Purpose: Pain is highly prevalent among older adults receiving home care, contributing to disability, increased health care utilization, nursing home placement, and diminished quality of life. Pain is a particular problem in the home care setting, where current approaches are often inadequate, resulting in persistent high levels of pain and disability in this vulnerable population. Cognitive-behavioral approaches to pain management have demonstrated effectiveness in reducing pain intensity and associated disability but have not been systematically implemented in home health care.

Lifetime risk and duration of chronic disease and disability.

Objective: To estimate risk and duration of chronic conditions and disability for all older Americans and demographic subgroups.

Method: Analysis of National Mortality Followback Survey data for survivors to age 65 to project lifetime risk and duration of selected conditions and examine their relationship with life expectancy and disability.

Results: For women, Blacks, and non-Blacks, arthritis is most common and has the longest average duration, followed by diabetes and COPD.

Complexity in geriatric home healthcare.

The aging population and the associated rise in the prevalence of chronic conditions suggest that the home health population is increasingly complex and challenging to manage. The purpose of this study was to use national administrative data (Outcome and Assessment Information Set assessments of persons discharged in 2004 and 2005) to examine the clinical complexity of older adults admitted to home healthcare. Our descriptive analyses confirm that multiple chronic conditions and cognitive impairment are common and result in longer lengths of stay.

Risk adjustment and public reporting on home health care.

Risk adjustment is a critical tool in public reporting of quality measures. Its aim is to level the playing field so that providers serving different patients can be meaningfully compared. We used a theory and evidence-based approach to develop risk-adjustment models for the 10 publicly reported home health quality measures and compared their performance with current models developed using a data-driven stepwise approach.

Are there racial differences in attitudes toward hospice care? A study of hospice-eligible patients at the Visiting Nurse Service of New York.

Research on African American and white attitudes, perceptions, and knowledge of hospice care has focused predominantly on patients and providers in institutions and community-based care settings. Little is known about patients receiving home health services, despite growing trends toward noninstitutional care in the United States. This study of home health clients who are eligible for hospice, but not currently receiving it, found few differences between racial groups with regard to attitudes about end-of-life care.

Improving the transition to home healthcare by rethinking the purpose and structure of the CMS 485: first steps.

Transition points are the weak links in communication between providers. As an example, the discharge home often is a hurried "handoff" from inpatient physician to home care agency, whose visiting nurse admits the patient for a period of observation, medication management, rehabilitation, and teaching. The primary means of communication between physician and home health agency is the CMS 485, a form that contains the orders and that physicians frequently sign well after patients begin receiving services.

Exploring the utility of automated drug alerts in home healthcare.

Computerized drug utilization review (DUR) can potentially reduce adverse drug events. We examined automated DUR for home healthcare patients with diabetes or hypertension. Sixty-eight percent of diabetes patients and 50.

Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes.

Objective: To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients.

Data Sources/study Setting: Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF.

Study Design: Patients were treated by nurses randomly assigned to usual care or one of two intervention groups.

Just-in-time evidence-based e-mail "reminders" in home health care: impact on nurse practices.

Objective: To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients.

Data Sources/study Setting: Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban, nonprofit home care agency.

Study Design: The study employed a randomized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient.

Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients?

The purpose of this randomized, controlled, home care intervention was to test the effectiveness of two nurse-targeted, e-mail-based interventions to increase home care nurses' adherence to pain assessment and management guidelines, and to improve patient outcomes. Nurses from a large urban non-profit home care organization were assigned to usual care or one of two interventions upon identification of an eligible cancer patient with pain. The basic intervention consisted of a patient-specific, one-time e-mail reminder highlighting six pain-specific clinical recommendations.