Peri Rosenfeld

Access to multilingual medication instructions at New York City pharmacies

An essential component of quality care for limited English proficient (LEP) patients is language access. Linguistically accessible medication instructions are particularly important, given the serious consequences of error and patient responsibility for managing often complex medication regimens on their own. Approximately 21 million people in the U.S. were LEP at the time of the 2000 census, representing a 50% increase since 1990. Little information is available on their access to comprehensible medication instructions. In an effort to address this knowledge gap, we conducted a telephone survey of 200 randomly selected NYC pharmacies. The primary focus of the survey was translation need, capacity, and practice. The majority of pharmacists reported that they had LEP patients daily (88.0%) and had the capacity to translate prescription labels (79.5%). Among pharmacies serving LEP patients on a daily basis, just 38.6% translated labels daily; 22.7% never translated. In multivariate analysis, pharmacy type (OR=4.08, 95%CI=1.55–10.74, independent versus chain pharmacies) and proportion of Spanish-speaking LEP persons in the pharmacy’s census tract (OR=1.09, 95%CI=1.05–1.13 for each 1% increase in Spanish LEP population) were associated with increased label translation. Although 88.5% of the pharmacies had bilingual staff, less than half were pharmacists or pharmacy interns and thus qualified to provide medication counseling. More than 80% of the pharmacies surveyed lacked systematic methods for identifying linguistic needs and for informing patients of translation capabilities. Consistent with efforts to improve language access in other health care settings, the critical gap in language appropriate pharmacy services must be addressed to meet the needs of the nation’s large and ever-growing immigrant communities. Pharmacists may require supplemental training on the need and resources for meeting the verbal and written language requirements of their LEP patients. Dispensing software with accurate translation capability and telephonic interpretation services should be utilized in pharmacies serving LEP patients. Pharmacists should post signs and make other efforts to inform patients about the language resources available to them.

Peer education for secondary stroke prevention in inner-city minorities: Design and methods of the prevent recurrence of all inner-city strokes through education randomized controlled trial

BACKGROUND The highest risk for stroke is among survivors of strokes or transient ischemic attacks (TIA). However, use of proven-effective cardiovascular medications to control stroke risk is suboptimal, particularly among the Black and Latino populations disproportionately impacted by stroke. METHODS A partnership of Harlem and Bronx community representatives, stroke survivors, researchers, clinicians, outreach workers and patient educators used community-based participatory research to conceive and develop the Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) trial. Using data from focus groups with stroke survivors, they tailored a peer-led, community-based chronic disease self-management program to address stroke risk factors. PRAISE will test, in a randomized controlled trial, whether this stroke education intervention improves blood pressure control and a composite outcome of blood pressure control, lipid control, and use of antithrombotic medications. RESULTS Of the 582 survivors of stroke and TIA enrolled thus far, 81% are Black or Latino and 56% have an annual income less than

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

15,000. Many (33%) do not have blood pressures in the target range, and most (66%) do not have control of all three major stroke risk factors. CONCLUSIONS Rates of stroke recurrence risk factors remain suboptimal in the high risk, urban, predominantly minority communities studied. With a community-partnered approach, PRAISE has recruited a large number of stroke and TIA survivors to date, and may prove successful in engaging those at highest risk for stroke and reducing disparities in stroke outcomes in inner-city communities.

Are there Racial Differences in Attitudes Toward Hospice Care? A Study of Hospice-Eligible Patients at the Visiting Nurse Service of New York

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.

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.

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. An alarming proportion of African American and white home health clients held erroneous ideas about hospice care and had not discussed this option with their providers. These findings suggest that increased referrals to home-based hospice care among home health clients depend on the availability and professional dissemination of accurate, spiritually sensitive information.

Using technology to enhance the quality of home health care: three case studies of health information technology initiatives at the visiting nurse service of New York.

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.

Preparing Newly Licensed Associate Degree Nurses to Work in Home Health Care

&NA; There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not‐for‐profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation.

Assisting Patients to Age in Place An Innovative Pilot Program Utilizing the Patient Centered Care Model (PCCM) in Home Care

This article describes an innovative learning program, designed for associate degree nurse (ADN) graduates, developed at the visiting Nurse Service of New York (VNSNY) to expand its hiring pool of potential applicants to home health care nursing positions. The program, “Transitions to Home Health Care,” provides a strong emphasis on independent judgment, assessment skills, and collaboration with other professions and resources outside the home health care agency. In view of the expanding number of ADN graduates and the increasing competition for a limited number of new bachelor of science in nursing (BSN), VNSNY developed and is testing a model that combines a specially designed one-year didactic educational course and a clinical practice internship program to prepare new ADN graduates to work in the home health care field at a level more comparable to that of BSN graduates. To date, VNSNY has had preliminary success with this new approach.

Articulating the evidence base for effective social work practices: building a database to support a geriatric social work policy agenda.

This article describes how one large not-for-profit home health care agency sought to stimulate a practice change among their nurses to better service the frail, complex patient population in a Long-Term Home Health Care Program (LTHHCP). This LTHHCP designed an innovative initiative that encouraged a combination of coaching techniques, assessment tools, and a range of patient-centered evidence-based practices to provide clinicians with necessary skills and competencies to provide the highest standards of care for their patients. The innovative model, called patient-centered care model (PCCM) was piloted in one service area, and a formal evaluation was integrated into the initiative to allow measurement of desired outcomes. This article describes the long- and short-term goals of PCCM, examine the components of the PCCM model, and discuss how the progress of the initiative is being evaluated and assessed.

A review of factors influencing utilization of home and community-based long-term care: trends and implications to the nursing workforce.

SUMMARY In an era that demands accountability and cost-effectiveness, health care and social service professionals are increasingly expected to demonstrate the effectiveness of their interventions and treatments. Social workers, specifically those serving the elderly, have been markedly slow in embracing the need to measure outcomes and produce evidence of their practices, which stymies efforts at advocacy and policy development for the profession. Using a modified systematic review method, the New York Academy of Medicines (NYAMs) Center for Aging Policy created an evidence database comprising peer-reviewed journal articles on social work interventions and outcomes research on cost-effectiveness and other measures of effectiveness. The evidence database, though focused on care of the elderly, draws on research studies involving age groups across the lifespan. A key product of this initiative is a series of white papers on cost-effective interventions in areas such as care management. A work group of social work professionals and a team of NYAM staff with diverse expertise reviewed articles based on their content, key topics, and outcomes. This article describes the steps taken, from the conceptualization of the review process to the development and implementation of the Web-based interface for user access to the evidence database. Though originally conceived as a tool for supporting a policy agenda for the Center for Aging Policy, the evidence database is also a useful reference tool for social workers, policy makers, and others interested in quality of care for elderly.