Joan Marren

FAMILY CAREGIVERS: caring for older adults, working with their families.

As the U.S. population ages and health care costs soar, family and friends are called upon increasingly to provide care. While the typical caregiver is a 46-year-old woman with at least some college education, anyone in the infirm persons circle may be called upon to provide care. The kind of care provided varies greatly--from managing treatment and medication regimens to driving in from out of town to help with shopping--as does each caregivers reaction to providing such care. While some find caregiving terribly stressful, others find it rewarding. Nurses need to know how to identify the primary caregiver, discern the level of strain caused by caregiving, and create a partnership with the caregiver to help ease the burden. Accompanying text explores one caregivers experience.

A Model for Improving Medication Use in Home Health Care Patients

OBJECTIVES (1) To develop a model for the identification and resolution of problems associated with suboptimal medication use in elderly patients receiving home health care; (2) To select the most important identifiable problems and develop structured procedures for their resolution. DESIGN Expert panel review, problem selection, and development of a problem resolution model and guidelines. SETTING Home health care. PARTICIPANTS A panel with expertise in home health nursing, pharmacy, clinical pharmacology, gerontology, pharmacoepidemiology, and health services research. INTERVENTIONS A list of potential problems associated with the most frequently used classes of drugs was compiled for review by the panel. Problems that were controversial or that could not be identified in the home care setting were excluded. Panel members individually ranked the remainder. Detailed procedures for identification and resolution of the 15 top-ranking problems were developed. MAIN OUTCOME MEASURES Not applicable. RESULTS Potential medication problems were defined by both drug use and symptoms or clinical signs associated with specific adverse effects, to ensure that clinically relevant problems would be identified. The model developed for problem assessment and resolution was centered on the drug utilization review (DUR) coordinator and the attending home health nurse. Following guidelines developed by the panel, the DUR coordinator advises the home health nurse about identified problems and how to resolve them. One of these practitioners, usually the nurse, then contacts the attending physician to explain their concerns, offer potential solutions, and request instructions. CONCLUSION A potentially useful model for the identification and resolution of medication problems in the home health care setting was developed. This model is currently being evaluated in a randomized controlled trial.

Continuity in home health care: is consistency in nursing personnel associated with better patient outcomes?

Abstract: A growing body of evidence suggests that patients who receive coordinated and uninterrupted health care services have better outcomes, more efficient resource utilization, and lower costs of health care. However, limited research has considered whether attributes of continuity in home health care service delivery are associated with improved patient outcomes. The present study examines the relationship between one dimension of continuity of care, consistency in nursing personnel, and three patient outcomes: hospitalization, emergent care, and improvement in activities of daily living. Analyses of data from a large population of home health patients (N=59,854) suggest that greater consistency in nursing personnel decreases the probability of hospitalization and emergent care, and increases the likelihood of improved functioning in activities of daily living between admission and discharge from home health care. These results provide preliminary evidence that efforts to decrease dispersion of nursing personnel across a series of home visits to patients may lead to improved outcomes. The implications of these findings for clinical practice and further research are discussed in the paper.

Evidence-based practice improvement: merging 2 paradigms.

This article presents a new model, Evidence-Based Practice Improvement, for improving patient care. The model merges 2 extant paradigms currently used for quality improvement initiatives—evidence-based practice and practice or performance improvement. The literature expounds on the virtues of each of these approaches, yet no authors have moved beyond parallel play between them. The merged model, Evidence-Based Practice Improvement, may provide a more effective and practical approach to reach our quality goals.

Implementing a transitional care program for high-risk heart failure patients: findings from a community-based partnership between a certified home healthcare agency and regional hospital.

Abstract: Provisions within the recently passed health reform law provide support for new approaches to reducing the high cost of care for clinically complex patients. This article describes the characteristics of a recent transitional care pilot initiative that aims to reduce hospital readmissions among high‐risk heart failure patients. The program was designed and implemented through a joint collaboration between a Certified Home Healthcare Agency and regional hospital. As a preliminary assessment of the impact of this program on patient outcomes, we compare the odds of rehospitalization among patients who received the transitional care services (n = 223) and a similar group of patients who received usual home care services (n = 224). Analyses indicated that patients who received the transitional care services were significantly less likely to be readmitted to the hospital than the patients in the control group. Although preliminary, our findings suggest that providing transitional care services to high‐risk heart failure patients can be an effective deterrent against patterns of rehospitalization. The opportunities and challenges associated with implementing this pilot program are discussed.

The Linkage between Employee and Patient Satisfaction in Home Healthcare

Abstract: Greater accountability for patient outcomes, reduced reimbursement, and a protracted nursing shortage have made employee and patient satisfaction results central performance metrics and strategic imperatives in healthcare. Key questions are whether the two interact and if so, how can that relationship be leveraged to obtain maximum gains in both employee and patient satisfaction. This article examines the experience of a large, nonprofit home care agency in exploring these issues. The agency found that organizational commitment to patient care and customer service are fundamental to patient satisfaction. The more employees perceived that the organization is focused on quality and customers, the more patient satisfaction increased. Among nurses, work‐life balance, fair compensation, and regard for employees all influenced patient satisfaction.

Developing a Competency Tool for Home Health Care Nurse Managers

Identifying the competencies required for the nurse manager role is a focus of much of the literature on nursing education and workforce. The unique nature of home health care nursing requires specially designed tools that reflect its distinctive nature. This article describes how one home health care nursing agency developed an assessment tool to measure nurse manager competencies and how the agency uses the tool to provide staff-development programs for their nurse managers.

Spreading Improvement Strategies Within a Large Home Healthcare Organization

&NA; This article describes the process of the spread of improvement strategies to improve relationships between professional and paraprofessional service providers within a large home healthcare organization and its partnering home health aide vendors. We describe the method for spreading the strategies, which emerged from a learning collaborative, and the successes and challenges of the spread. Two case studies highlight how the attributes of innovations and the methods for spreading them can influence the effectiveness of an improvement effort.