Carolyn E. Adams

Effect of locale on health status and direct care time of rural versus urban home health patients.

Objective The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time. Background Implemented in October 2000, the Medicare home health prospective payment system (PPS) made only temporary allowance for differences in cost of delivering home health services in rural versus urban environments. However, past research documented differences in health status and service utilization between rural and urban home health patients. Methods Data were collected retrospectively on a convenience sample of 2,788 patient episodes of care. Patient health status was measured using items form the Outcome Assessment and Information Set (OASIS). Obtained from itinerary records, direct care time was the time clinicians spent in the home. Results The results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural patients. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal, living in a rural locale increased total direct care time by 150 minutes over living in an urban environment. Conclusions Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients.

The Effects of Religious Beliefs on the Health Care Practices of the Amish

The religious and cultural beliefs of the Amish result in many health care beliefs and practices which are significantly different from the dominant American culture. For example, the Amish are excluded from social security and health insurance coverage; they have different perceptions of health and illness; they do not practice birth control; they often lack the preventive practices of immunizations and prenatal care; and they may use a variety of traditional and nontraditional health care providers. Only by understanding the religiocultural belief system of this minority religious sect can nurse practitioners effectively meet the health care needs of their Amish patients.

Home health quality outcomes. Fee-for-service versus health maintenance organization enrollees.

Quality outcomes were compared between home health patients enrolled in the traditional Medicare fee-for-service (FFS) program versus a health maintenance organization (HMO) with a Medicare cost contract with the federal government. The quality outcome scores were similar between the two patient groups. However, other home health research showed superior quality outcomes for patients enrolled in the traditional Medicare FFS program versus an HMO with a risk contract with the federal government. Before signing contracts with HMOs, home health administrators will want to identify the type of Medicare contract the HMO has with the federal government.

Enhanced quality through outcome-focused standardized care plans.

Methods to improve the quality of care are a national issue for home healthcare agencies. In comparison with the traditional process-focused care plans, outcome-focused care plans (OCPs) resulted in significantly belter quality indicator scores for clients cared for by agency staff members. Although OCPs are a valuable tool for enhancing quality, tools are only as good as the individuals who use them. Before deciding to change to an OCP format, administrators must assess all resources needed to effect the change.

Reduced resource utilization through standardized outcome-focused care plans.

When evaluating ways to improve client outcomes, home healthcare administrators must consider the amount of resources used to provide the outcomes. Previous research has shown that outcome-focused care plans (OCPs) result in significantly better quality indicator scores than the traditional process-focused care plans (PCPs). The authors report the amount of resources used by a home healthcare agency when nursing care was guided by PCPs versus OCPs. The results showed that nurse visit time was less when OCPs were used. Outcome-focused care plans offer home healthcare administrators a mechanism to enhance quality while reducing resource utilization.

Work environment perceptions of staff nurses and aides in home health agencies.

Nurse executives are responsible for ensuring a therapeutic work environment in their organizations. Understanding how staff members perceive their environment is the first step in creating such an environment. In this study, perceptions of the work environment between staff nurses and home health aides in home health agencies were compared. The results suggest that nurse executives need to foster home health aides job commitment and support for one another and increase opportunities for staff nurses to be innovative and autonomous in their practice.

Environmental and behavioral factors that can affect blood pressure.

ABSTRACT A patients blood pressure may vary considerably and not be a sign of a pathological process in the patient. Environmental factors which cause blood pressure changes are climate, temperature and time of day. There are also age and sex differences in blood pressure. Body and extremity position, activity and exercise, food, tobacco and alcohol consumption, and psychological stress are behavioral factors which alter blood pressure. When the nurse practitioner measures a patients blood pressure, as many transient variables as possible need to be controlled. Those factors which cannot be controlled must be carefully evaluated so the NP does not erroneously interpret the blood pressure change as a sign of pathology.

Leader Behavior in Rural Directors of Nurses

In several ways the scope of rural nursing practice differs from that of urban nursing. This study showed that rural rural directors of nursing are adjusting their leadership style to accommodate these differences. However, in the process of making these adjustments, the directors may be limiting their leader effectiveness.

Home health resource utilization. Health maintenance organization versus fee-for-service subscribers.

A commonly held belief is that patients enrolled in health maintenance organizations (HMOs) are authorized fewer home health services than patients enrolled in fee-for-service (FFS) plans. This study compared home health resource utilization patterns between patients enrolled in a cost HMO and in FFS plans. Although no significant differences were found, the cost HMO subscribers actually received more services. Despite these similarities, home health administrators need to carefully craft contracts with cost HMOs.

Using the outcome-based quality improvement model and OASIS to improve HMO patients' outcomes. Outcome Assessment and Information Set.

The study purpose was to determine if use of the Outcome-Based Quality Improvement (OBQI) model, including a subset of the outcome Assessment and Information Set (OASIS), enhanced outcomes for health maintenance organization (HMO) patients referred for care to six contracted home health agencies (HHAs). After four quarters of data-driven quality improvement activities, the improvement scores of the patients were not changed significantly from the baseline period. Stabilization scores increased significantly for two of the five outcome measures. Use of OASIS and the OBQI model for HMO patients referred to multiple HHAs requires that contracted HHAs share outcome results and quality improvement conclusions.