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Home health care clinicians seek to provide high quality, safe care in ways that . provide care for more than 2.4 million elderly and disabled people annually. … in the home is to restore or maintain patient physical and mental functioning and … pain management, and general health outcomes for terminally ill patients in this …
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Working physicians have similar concerns about patient safety and quality of care. For example, falls in homes and hospitals can occur, and some measures aimed at preventing falls can apply equally to both settings. However, significant differences between home health care and other forms of health care generally require interventions tailored to home health care.
This chapter includes an analysis of the evidence promoting patient safety and quality of health care in relation to frequent problems in home health care. The following six areas have been selected for review:
Management Management
Fall Prevention
Unplanned hospital admission
Nurse work environment
Functional outcomes and quality of life
Injury and pressure ulcer management
Adverse events in these areas may jeopardize the achievement of one or more home health goals.
Go to:Management
One third of older home health patients have a potential action problem or are taking a drug that is considered inappropriate for the elderly. 15 elderly home health patients are particularly vulnerable to adverse events due to action disorder; They take many medications for various comorbidities recommended by more than one provider.
Home health care is a system of care provided by physicians under the direction of a physician, in their homes. Home health care services include nursing; Physical, and occupational and speech-language therapy; And Medical Social Services 1 The goals of home health services are to help individuals improve function and live with greater independence; To promote the client’s well-being; And help the patient stay at home, avoid hospitalization or access to long-term care institutions.
The Centers for Medicare and Medicaid Services (CMS) estimates that 8,090 home health institutions in the United States care for 2.4 million elderly and disabled people annually. 5 In order to be eligible for Medicare reimbursement, home health services must be considered medically provided by a physician in need and at home. Additionally, care should be provided on an interim and continuous basis. 5 Medicare beneficiaries who are low in health, low income, and are 85 years of age or older have relatively high rates of home health care use. The 6 most common diagnoses are cardiovascular disease (31 percent of patients), cardiovascular disease , injury and poisoning , musculoskeletal and connective tissue disease (14.1 percent), and respiratory disease 
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Health care at home
The home health care environment differs from other institutional environments in which hospitals and nurses work. For example, home health nurses work alone in the field with support resources available from the central office. The nurse-practitioner work relationship involves less direct doctor contact, and the physician relies more on the nurse to make assessments and communicate the findings. Home health care nurses spend more time on paperwork and dealing with reimbursement issues than hospital nurses. , Limited supervision of informal caregivers by professional physicians, and situational variables unique to each home.
Respect for patient autonomy is valuable in hospital-based care. Nevertheless, many decisions are made by physicians on behalf of hospitalized patients. In home health care, physicians recognize that the care setting — the home ರೋಗಿ is the patient’s unalterable domain. Therefore, compared to the hospitalized patient, the home health patient has a greater role in determining how and why certain interventions are implemented. For example, in the hospital, nurses, doctors and pharmacists can play a role in making sure that the patient receives antibiotics at the appropriate intervals. However, despite advice on the importance of a regular action cushion schedule, the patient may choose to take action cuffs at an unlimited time. Thus, interventions that promote patient safety and quality of care are sometimes chosen by patients to behave in a way that does not match the relevant evidence, and the physician’s best efforts may not lead to desired results.
In addition to the deliberate choices made by informed and competent patients regarding their care, individual patient variables may influence home-based outcomes in a different way than hospitalized patients. Ellen Becker and colleagues 10, 11 report that reading skills, cognitive ability, and financial resources affect home health patients’ ability to safely perform their action rules. Yet, hospitalized patients play safe with actions
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Fall Prevention
One of the most frequent adverse events for patients receiving skilled home health services is injury care from falls or accidents. 19 Thirty percent of people 65 and older fall into the community each year. One in five incidents this fall will require medical assistance. 20 False is the leading cause of injury-related death for this population. Among the elderly, Stevens reported 22 direct medical costs in 2000, for fatal fall-related injuries of $ 9 179 million and injuries of $ 19 billion.
Nisarga care Although there is strong evidence for effective fall-prevention interventions for over 65 populations, knowledge of fall prevention in home health care is limited 20, 23, 24. Evidence suggests that for the general elderly population living in the community, muscle strengthening and balance reassessment are individual home programs; Screening and intervention of complex multidisciplinary, multifactorial, health / environmental risk factors; Home risk assessment and modification; And reviewing and adjusting the conditions will reduce the likelihood of a fall. However, patients in the home health service are generally older, sicker and weaker than community-dwelling older adults, and it is unknown if known
Is the patient unable to explain, cause collapse, physical abuse or blood dyscrasia? In both patient self-care and informal caregiver care, safety and quality standards are not understood or achieved.
Nisarga care Another unique feature of home health care is that doctors provide care to each patient in a unique setting. There may be situational variables that pose risks to patients, Nisarga care that is difficult or impossible for a doctor to get rid of. Hospitals may have environmental safeguards to monitor air quality and designers / engineers to ensure that the height of the stair risers is safe. Home health practitioners lack the training or resources to assess and improve such risks to patient safety in the patient’s home.
Finally, considering the large number of elderly people receiving care from Medicare-certified home health care institutions, it is reasonable to assume that some patients are on the path to decline. Due to the common aging and pathological processes that occur frequently in old age, some older people are less able to perform daily life (ADL) activities even when they provide good quality home health care. Thus, the implicit goal of home health care is to facilitate supportive decline. That is, patients who do not show clinical signs of improvement may receive quality care, which may lead to deterioration or improvement in quality of life. This is in line with the American Nurses Association’s assertion that the legitimate goal of home health care is to promote the patient’s excellent well-being.
Nisarga care Assessing the quality of care at home
The goals and multidisciplinary nature of home health services present challenges to quality measurement that are different from those found in a more traditional hospital setting. CMS mandates reporting of home health outcome measures. Outcome-Based Quality Monitoring (OBQM) Program Monitoring, reporting and benchmarking of adverse events, such as emergency care for a fall or accident-related injury, number of pressure ulcers, and significant decline in three or more ADLs.
Paying for performance, a mechanism for attaching a portion of agency reimbursement to care delivery is another CMS quality initiative expected in the near future. 12 In manufacturing, quality-improvement organizations and suppliers are working to identify and develop a set of performance measures that have proven effective in home care. A 2006 Medicare Payment Advisory Commission report to Congress identified patient safety as a key component of quality and the need to expand quality measures to include process and structural measures. An expanded approach to quality measurement should achieve the following goals: evaluating patient populations, expanding the types of quality measures, capturing aspects of care directly under provider control, reducing practice differences, and improving information technology.
In January 2007, the home health community, health care leaders and quality-improvement organizations launched the 2007 Home Health Care Quality Improvement National Campaign. This campaign focuses on improving the quality of patient care in the home health care system by providing excellent agencies monthly. Practice intervention tools. The goal is to prevent hospitals that can avoid home health patients. The National Campaign for Home Health Care Improvement uses a multidisciplinary approach to quality improvement, which includes key home health, hospital and physician stakeholders.
Nisarga care research evidence
In many respects, home health practitioners and other settings
Go to:
Fall Prevention
One of the most frequent adverse events for patients receiving skilled home health services is injury care from falls or accidents. 19 Thirty percent of people 65 and older fall into the community each year. One in five incidents this fall will require medical assistance. 20 False is the leading cause of injury-related death for this population. Among the elderly, Stevens reported 22 direct medical costs in 2000, for fatal fall-related injuries of $ 9 179 million and injuries of $ 19 billion.
Nisarga care Although there is strong evidence for effective fall-prevention interventions for over 65 populations, knowledge of fall prevention in home health care is limited 20, 23, 24. Evidence suggests that for the general elderly population living in the community, muscle strengthening and balance reassessment are individual home programs; Screening and intervention of complex multidisciplinary, multifactorial, health / environmental risk factors; Home risk assessment and modification; And reviewing and adjusting the conditions will reduce the likelihood of a fall. However, patients in the home health service are generally older, sicker and weaker than community-dwelling older adults, and it is unknown if known
Is the patient unable to explain, cause collapse, physical abuse or blood dyscrasia? In both patient self-care and informal caregiver care, safety and quality standards are not understood or achieved.
Nisarga care Another unique feature of home health care is that doctors provide care to each patient in a unique setting. There may be situational variables that pose risks to patients, Nisarga care that is difficult or impossible for a doctor to get rid of. Hospitals may have environmental safeguards to monitor air quality and designers / engineers to ensure that the height of the stair risers is safe. Home health practitioners lack the training or resources to assess and improve such risks to patient safety in the patient’s home.
Finally, considering the large number of elderly people receiving care from Medicare-certified home health care institutions, it is reasonable to assume that some patients are on the path to decline. Due to the common aging and pathological processes that occur frequently in old age, some older people are less able to perform daily life (ADL) activities even when they provide good quality home health care. Thus, the implicit goal of home health care is to facilitate supportive decline. That is, patients who do not show clinical signs of improvement may receive quality care, which may lead to deterioration or improvement in quality of life. This is in line with the American Nurses Association’s assertion that the legitimate goal of home health care is to promote the patient’s excellent well-being.
Nisarga care Assessing the quality of care at home
The goals and multidisciplinary nature of home health services present challenges to quality measurement that are different from those found in a more traditional hospital setting. CMS mandates reporting of home health outcome measures. Outcome-Based Quality Monitoring (OBQM) Program Monitoring, reporting and benchmarking of adverse events, such as emergency care for a fall or accident-related injury, number of pressure ulcers, and significant decline in three or more ADLs.
Paying for performance, a mechanism for attaching a portion of agency reimbursement to care delivery is another CMS quality initiative expected in the near future. 12 In manufacturing, quality-improvement organizations and suppliers are working to identify and develop a set of performance measures that have proven effective in home care. A 2006 Medicare Payment Advisory Commission report to Congress identified patient safety as a key component of quality and the need to expand quality measures to include process and structural measures. An expanded approach to quality measurement should achieve the following goals: evaluating patient populations, expanding the types of quality measures, capturing aspects of care directly under provider control, reducing practice differences, and improving information technology.
In January 2007, the home health community, health care leaders and quality-improvement organizations launched the 2007 Home Health Care Quality Improvement National Campaign. This campaign focuses on improving the quality of patient care in the home health care system by providing excellent agencies monthly. Practice intervention tools. The goal is to prevent hospitals that can avoid home health patients. The National Campaign for Home Health Care Improvement uses a multidisciplinary approach to quality improvement, which includes key home health, hospital and physician stakeholders.
Nisarga care research evidence
In many respects, home health practitioners and other settings
Working physicians have similar concerns about patient safety and quality of care. For example, falls in homes and hospitals can occur, and some measures aimed at preventing falls can apply equally to both settings. However, significant differences between home health care and other forms of health care generally require interventions tailored to home health care.
This chapter includes an analysis of the evidence promoting patient safety and quality of health care in relation to frequent problems in home health care. The following six areas have been selected for review:
Management Management
Fall Prevention
Unplanned hospital admission
Nurse work environment
Functional outcomes and quality of life
Injury and pressure ulcer management
Adverse events in these areas may jeopardize the achievement of one or more home health goals.
Go to:
Management of Shaadi
One third of older home health patients have a potential action problem or are taking a drug that is considered inappropriate for the elderly. 15 elderly home health patients are particularly vulnerable to adverse events due to action disorder; They take many medications for various comorbidities recommended by more than one provider.
Home health care is a system of care provided by physicians under the direction of a physician, in their homes. Home health care services include nursing; Physical, and occupational and speech-language therapy; And Medical Social Services 1 The goals of home health services are to help individuals improve function and live with greater independence; To promote the client’s well-being; And help the patient stay at home, avoid hospitalization or access to long-term care institutions.
The Centers for Medicare and Medicaid Services (CMS) estimates that 8,090 home health institutions in the United States care for 2.4 million elderly and disabled people annually. 5 In order to be eligible for Medicare reimbursement, home health services must be considered medically provided by a physician in need and at home. Additionally, care should be provided on an interim and continuous basis. 5 Medicare beneficiaries who are low in health, low income, and are 85 years of age or older have relatively high rates of home health care use. The 6 most common diagnoses are cardiovascular disease (31 percent of patients), cardiovascular disease (16 percent), injury and poisoning (15.9 percent), musculoskeletal and connective tissue disease (14.1 percent), and respiratory disease
Go to:
Health care at home
The home health care environment differs from other institutional environments in which hospitals and nurses work. For example, home health nurses work alone in the field with support resources available from the central office. The nurse-practitioner work relationship involves less direct doctor contact, and the physician relies more on the nurse to make assessments and communicate the findings. Home health care nurses spend more time on paperwork and dealing with reimbursement issues than hospital nurses. , Limited supervision of informal caregivers by professional physicians, and situational variables unique to each home.
Respect for patient autonomy is valuable in hospital-based care. Nevertheless, many decisions are made by physicians on behalf of hospitalized patients. In home health care, physicians recognize that the care setting — the home ರೋಗಿ is the patient’s unalterable domain. Therefore, compared to the hospitalized patient, the home health patient has a greater role in determining how and why certain interventions are implemented. For example, in the hospital, nurses, doctors and pharmacists can play a role in making sure that the patient receives antibiotics at the appropriate intervals. However, despite advice on the importance of a regular action cushion schedule, the patient may choose to take action cuffs at an unlimited time. Thus, interventions that promote patient safety and quality of care are sometimes chosen by patients to behave in a way that does not match the relevant evidence, and the physician’s best efforts may not lead to desired results.
In addition to the deliberate choices made by informed and competent patients regarding their care, individual patient variables may influence home-based outcomes in a different way than hospitalized patients. Ellenbecker and colleagues 10, 11 report that reading skills, cognitive ability, and financial resources affect home health patients’ ability to safely perform their action rules. Yet, hospitalized patients play safe with actions
None of these variables play a meaningful role in the decline.
In addition to self-care, some in-home patients seek help from family members or other informal caregivers. Professional practitioners have no authority over these caregivers. Moreover, the home environment and the intermediate nature of professional home health services may limit the ability of physicians to observe the quality of care provided by informal caregivers the Unlike in a hospital, where care provided by auxiliary staff can be easily observed and evaluated. For example, with limited access to transportation, the husband may decide not to buy diabetes paraphernalia for his dependent wife. This behavior does not go unnoticed by the physician until an adverse event occurs. Evidence-based interventions are focused on careful assessment. However, the limited opportunity to directly address the patient and informal caregivers may hamper efforts to quickly determine the etiology of adverse events. If the home health patient is found with bruising
Effective in other settings. Therefore, there is a need for research into effective practices in home health care settings to support optimal and evidence-based care.
When reviewing existing studies, the authors of this chapter found useful evidence in all selected fields. However, the number of studies is low and many questions remain. Replicas of the investigation are basically run
For wound care at home, and refrigerated solutions were found to be growth-free within 4 weeks. The Quality Improvement Project reports reduction in adverse events through structured nurse education, introduction of protocols and capability review.
Stress ulcer management
Rodriguez and Meggie found that 37 percent of the 80 home health patients were wound ulcers, with an average injury duration of about 27 months. Approximately 1 in 10 patients enrolled in home health care had pressure ulcers and approximately one third were at risk of developing new ulcers; One study found that only 27 percent of patients with existing ulcers and 14 percent of those at risk were receiving appropriate stress-reducing therapy. [81] Incontinence, limitations in ADLs, mobility impairment, skin drainage, recent fractures, anemia, oxygen consumption, and recent institutional discharge are associated with the development of pressure ulcers. 81, 82 Guidelines for the Injury, Asthma and Continence Nurses Society 83 call for early risk assessment for all patients’ pressure ulcers when entering home health care, and reevaluating each subsequent visit, using a validated risk assessment tool. However, one study found that only 21 percent of agencies use a validation tool such as the Braden Scale 84 to identify at-risk patients, about 8 percent have no assessment of admission, and only 33 percent use risk prediction or pressure ulcer prevention protocols. Half the agencies report routine skin checkups from at-risk patient nurses.
The literature review led to the identification of five studies on stress ulcer management in home health care. The findings are summarized in Table 7. Three studies tested randomized controlled trials of randomized controlled trials to improve pressure ulcer healing. 86–88 An intervention examined the use of air-liquefied mattresses with the services of nurse specialists; Wound healing. 88 Compared to conventional moisture dressing, both resulted in significant improvement in wound healing. Overall cure rates were similar for polymer hydrogels and hydrocolloidal dressings, although the breakdown performance of hydrogel dressings led to a more favorable clinical evaluation.
Summary of evidence related to stress ulcer management
The remaining two studies of Nisarga care evaluated the use of the Braden Scale for the prediction of stress ulcer in home health patients with mixed health outcomes. Ramundo 89 reported that the Braden Scale was valid for identifying at-risk patients, but limited predictive ability, while the Bergqvist 82 measure of summary score was found to be significantly associated with pressure ulcer development. All subcategory scores, except for nutrition, were significantly and negatively correlated with pressure ulcer development.
Evidence-Based Practice Implications
Most wound treatments tested have high efficacy or low cost when compared with wet or dry saline dressings. Home health nurses must be knowledgeable in the use of a full range of existing and emerging injury products, practices and treatments and demonstrate competence in accurate wound assessment and staging. Providing structured resources, consultation with experts and competency testing for home health nurses can improve home health care injury management. Pressure ulcer
ದಾ Nurses must be knowledgeable in risk factors for growth and related preventive measures; They must assess each patient using a valid and reliable tool such as the Braden Scale on a regular basis before and after access to home health care.
Research implications
There is relatively little known about the most effective practices for wound care in the home health care system. Although studies have compared different treatments for injuries, the most effective treatments for different injuries are unknown in the presence of different risk factors found in the home health care system. Unlike other types of injury care, randomized controlled clinical trials exist to compare different pressure ulcer treatments at home. Promising findings from studies with smaller sample sizes should be replicated with larger samples and heterogeneous populations.
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Conclusion
Nisarga care The home health practitioner wants high-quality, safe care that respects the autonomy of patients and is tailored to the individual characteristics of each patient’s home and family. False, deteriorating functional abilities, pressure ulcers and incurable injuries and adverse events associated with administration of shadhi are all leading to unplanned hospital admissions. Such hospitals undermine the achievement of the home’s main health goals: keeping patients at home and promoting good well-being. Nonetheless, the unique characteristics of home health care can be difficult to use – or have been shown to be necessary – interventions to change
If the nurses are supportive in their work. Support can be provided by electronic communication, reminders of protocols, disease-specific educational materials for patients, and by serving as a clinical specialist to staff with APN colleagues. Home health nurses are relatively isolated in this field, and any mechanism to improve communication with office supervisors and other providers will assist nurses in their practice. Adding the use of remote technology as a substitute for some personal visits may improve access to home health care for patients and caregivers.
Specific patient interventions are helpful to improve patient health and quality of life. Personalized education and disease-specific programs such as behavioral management programs for urinary incontinence or educational programs for foot care should be included in practice. It can slow down the rate of patient functional decline and reduce costs through a systematic approach that provides assistive technology and environmental interventions to elderly patients in their homes. The patient’s need for these interventions can be determined with comprehensive evaluation and continuous monitoring.
Nisarga care research implications
Evidence of health care outcomes provided at home is limited; There are very few controlled trials in which providers can base their practice. Research is limited in the areas of composition, duration and home health services required to ensure patient safety and quality. Research is needed to determine effective interventions to improve, manage, or slow down performance decline in the home health population. Further research is needed to determine mechanisms to inform and support nurses. Providing communication and support is a challenge when providers are geographically dispersed and spend too much time in the field. Remote technology has the potential to reduce costs: it can be a substitute for some personal visits and improve access to patients and caregivers to home health care staff.
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Injury and pressure ulcer management
Adverse injury incidents are monitored under the OBQM program. Emergency care for wound infections, deterioration of injury status and an increase in the number of pressure ulcers are monitored and reported as adverse events. 70 Data is used to reflect changes in a patient’s health status at two or more times, usually between home health care and transfer to a hospital or other health system. These results data are collected using OASIS-designated intervals. Patient outcome measures related to surgical injuries include improvement in the number of surgical injuries and improvement in the status of surgical injuries.
Injury Management
One-third of home health care patients require treatment for injuries, and about 42 percent of those with injuries have multiple injuries. About 60 percent of the injuries found in home health care are surgery, with only one quarter being vascular leg ulcers and another quarter being pressure ulcers. 71 Most home health nurses can accurately identify the wound bed and peri wound characteristics; Most (88 percent) of wound treatments were found to be appropriate. 72 The appropriateness of wound treatments in home health care is significantly related to wound healing. Patients with healing wounds have less mana
Had health visits and shorter home health periods
The literature review identified seven studies that examined interventions to improve wound care management in home health care. 73–79 findings are summarized in Table 6. Comparative effectiveness of three different wound treatments. Capasso and Munro74 found no significant difference in wound closure between amorphous hydrogel dressings and wet-dried saline dressings, but the costs of saline dressing were significantly higher due to the need for more nursing visits. Kerstin and Gahtan 76 Hydrocolloidal dressing The rate of cured leg ulcers is six times higher than saline gauze dressing and nearly four times that of una boot Hydrocolloidal dressing was more expensive. The use of negative negative wound therapy has resulted in the successful closure of 43 percent of the wounds that failed to respond to previous treatment
Summary of evidence related to Nisarga care injury management
Four studies reported positive outcomes from interventions to improve and support the practice of home health nurses. 73, 75, 77, 79 Use of telemedicine to provide consultation with injury management specialists is associated with improved healing rates, reduced healing time and reduced home visits and hospitalizations. 73, 77 Fellows and Crestodina 75 studied bacterial contamination of common saline solutions made from distilled water and table salt, a common practice
Access is more effective.
Numerous randomized controlled trials have examined the effectiveness of specific interventions to improve patient safety and quality of care in Nisarga care, 62, 63 urinary incontinence, 64, 65 ADL functioning levels, 44, 46, 66-68, quality of life, general health outcomes, and patient satisfaction . 44, 46, 59, 62, 66-70 Corbett showed that individual patient education in foot care for diabetics was effective in improving the self-care of 63 patients. Scott and colleagues demonstrated an improvement in the quality of life in 62 CHF patients, although a program of patient education and mutual targeting. Dougherty and colleagues 64 and McDowell and colleagues tested 65 behavioral management interventions to treat urinary incontinence in the elderly and reported positive results based on behavioral management interventions for self-monitoring and bladder training. Mann and co-workers examined the introduction of 67 assistive technology (cane, walkers and bath benches) and changes in the home environment (adding slopes, reducing cabinets and removing throw rugs) with a population of vulnerable elderly. These interventions have been successful in slowing functional decline in study patients.
Some research evidence suggests more effective mechanisms for providing care. In exploring the magnitude of effective care, Weaver and colleagues found that 71 patients who underwent knee and hip replacement (compared to general care) decreased the number of hospitalized follow-up visits and included a preoperative home visit. There were no differences in functional ability, quality of life or satisfaction between patients receiving general care (more visits) and those receiving the intervention (fewer postoperative visits and one preoperative visit). Numerous studies have examined the use of technology in patient performance and independence. Johnston and colleagues examined 69 real-time video nursing visits and found no difference in patient outcomes or levels of general care or care satisfaction enhanced by video technology.
Numerous randomized controlled trials have examined the outcomes of interventions based on providers’ specialization, which are combined with different types of care management, or interventions based on different models of care management. 44, 46, 65, 70, 71 Research suggests that the impact of APN providers has a positive impact on the quality of patient care. In two studies examining the transitional care model, the APN-guided teams treated COPD46 and CHF70 patients and found improvements in the group in the transitional care model. Patients experienced fewer depressive symptoms and an increase in functional abilities compared with patients receiving general care. These studies required fewer nursing visits, fewer unplanned hospital admissions, and fewer intensive care visits. Behavioral treatment of urinary incontinence by a nurse practitioner is effective in reducing the number of patients’ urinary incontinence accidents. program.44 An added component is continuity of care and team management with primary care managers, availability of 24-hour on-call nursing for patients, pre-approval of hospital admissions and discharge planning
Emphasized the participation of Danda. Investigators found significant improvements in patients’ quality of life, performance, pain management, and general health outcomes, and increased satisfaction with sick patients and family caregivers.
However, so far mixed results have been obtained from research on the effectiveness of models of care management. 66, 68 Some intervention models are less effective than others. Interventions are usually an add-on to routine care and their effectiveness is determined by comparing it to a general or routine home health care control group. The model of management outcomes and evaluation of health outcomes examined by Feldman and colleagues is an intervention model that does not appear to be effective. 66 This model incorporates client-oriented patient self-care guidance and training to improve nurses ’teaching and support skills. Results of the study showed no difference in patient quality of life or satisfaction. Tinetti and colleagues compared the outcomes of a systematic, multidisciplinary rehabilitation program with 68 home physical and functional disabilities treatments with general home-based rehabilitation care outcomes. No differences were found between the two groups.
Nisarga care Evidence-Based Practice Implications
Previous discussion suggests that working closely with and supporting family caregivers is an important component of helping patients stay in their homes and will continue to do so. This suggests that the effectiveness of nurses in working with patients may be e
Exploring the relationship between work environment, patient safety and home health care is in the early stages of development. There have been no randomized controlled studies to date. Feldman and colleagues examined the relationship of 56 patients ‘adverse events with the characteristics of the nurses’ work environment in a large urban home health organization. Characteristics of 86 home health teams within the agency were examined. Researchers have reported lower incidence of adverse events for teams with higher patient rates and visits, fewer weekend admissions, more evenly distributed incentives, and more teamwork. Rates increased when teams perceived the support of supervisors for adverse event reporting. This is the first rigorous study to identify organizational factors related to potential adverse events and there are limitations. This was a descriptive, correlational study, and the agency involved in the study was not unique to most agencies in the United States, as it serves disproportionately diverse urban populations. Several findings reached significance only at the probability level
Kropowski and Alexander 57 explored the relationships between patient satisfaction, nurses’ perceptions of patient outcomes, and organizational structure. They reported that nurses and supervisors had better working relationships, higher patient satisfaction scores in health-sharing agencies, shared decision-making, and formal formalization of corporate and professional guidelines. Limitations of this study include the lack of a reliable and validated tool to measure nurses’ perceptions of multiple agencies from one state to the other, with unlimited design and patient outcomes. The findings are summarized in Table 4.
Summary of evidence related to the nurse’s work environment
Evidence-Based Practice Implications
Agencies should consider how characteristics of the work environment can impact patient safety and quality outcomes. Exploring the ecological context is essential when examining physician practices in an attempt to identify necessary system changes.
Research implications
It is unknown what characteristics of the home health nursing work environment are related to patient safety and quality. Home health research is needed to investigate the relationship between work environment characteristics, nurses ’satisfaction, and patient outcomes.
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Functional outcomes and quality of life
The goal of care provided at home is to restore or maintain the patient’s physical and mental functioning and quality of life, or to slow the rate of decline for the patient to stay home and avoid institutionalization. Most patients and family members want a home environment, when it is feasible. The ability of the patient and family to work independently and safely at home increases the likelihood that the patient will stay there.
Improving patient safety and quality of care by educating and assisting caregivers (families and providers) is one method that has been tested in several randomized controlled trials. The findings are summarized . Archbold and colleagues examined , Enrichment, and Prediction (PREP), a clinical practice intervention designed to prepare family caregivers to provide care. Although the study has many limitations, the primary evidence for the effectiveness of the intervention is cutum
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Summary of evidence relating to functional outcomes and quality of life
Other researchers have examined interventions to improve the knowledge and awareness of nurse providers. Interventions often provide additional education for nurses, additional resources for patients, and specialized patient information. In a frequently reported study, evidence-based care with specific disease-related information was sent to nurses via “just-in-time” e-mail reminders.
Interventions in all cases improved nurses ’performance, which led to better outcomes for patients. These studies have shown a significant improvement in nurse patients’ pain management, quality of life, satisfaction with care and other variables related to improved quality of care, including better communication with providers, better management, and improved symptoms. Patients’ evaluations documentation includes improved performance of nurses. In the case of “just-in-time” e-mail reminders, an intervention group with additional clinical and patient resources has better patient outcomes, indicating a more versatile approach or stronger interval
Seas Management, Positive Physician and Hospital Relations, Data-driven Services, Safety and Risk Assessment and Telehealth. However, these recommendations have not been empirically tested.
Only eight studies have examined the effectiveness of interventions to prevent unplanned hospital admissions for home health patients. Five of these studies used a randomized controlled trial design, and three used an arbitrary control or comparison group design. Tested interventions increase the severity of care provided primarily through a disease management program, team management based primary care program, multidisciplinary specialist intervention, advanced practice nurse (APN) transitional care, telehealth services and intensive rehabilitation care. Most of these interventions are effective or slightly effective in preventing or delaying hospitalization before hospital discharge. In addition, four studies reported lower average costs or fees for intervention groups related to lower hospital costs, while one study reported higher costs for the intervention group based on 40, 42–44 and one study 45 team-managed primary care intervention costs.
In these studies, patients with congestive heart failure (CHF) had unplanned hospital admissions and prolonged survival time before first admission 39–42, if they received epilateral transitional care, team-managed home-based primary care, or multidisciplinary specialty team intervention. – 43 CHF patients who received telecare and telephone interventions had significantly less emergency room visits, but no changes in hospital admissions. The team-managed home-based primary care was found to be more effective for the severely disabled. Dolly and colleagues 44 reported that long-term mechanically ventilated patients who received intervention in a disease management program that included APN services and interdisciplinary coordination had lower average days of hospitalization.
The results of a nonrandomized controlled study suggest that patients with chronic obstructive pulmonary disease (COPD) who received care for APN conversion also experienced less unplanned hospital admissions. Inpatient rehabilitation post-care services compared to patients receiving only inpatient services. The findings are summarized in Table 3.
Summary of evidence relating to unplanned hospital admission
Evidence-Based Practice Implications
Evidence suggests that specialist, integrated, interdisciplinary care has a positive impact on unplanned hospital admissions in a selected home health population. Agencies can identify the characteristics of hospitalized patients that are unique to their patient population. High risk patients may need special interventions beyond the traditional scope of home health services. Targeted interventions, using data available from the Outcome and Evaluation Information Set (OASIS) within the framework of process-care analysis and OBQI, can lead to unplanned hospital admissions for home health patients.
Nisarga care research implications
Available evidence suggests that in addition to using APNs for complex case care, traditional home health professionals may, individually or through interdisciplinary practice, be effective in preventing unplanned hospital admission with targeted interventions. Although several strategies have been recommended by researchers and other home care experts, most interventions have not been empirically tested. The costs and benefits of the various interventions are worth further exploration
There is. Measurement of intervention costs and cost savings from preventive hospitals are poorly understood. Because of the nature and complexity of the advanced disease process for some patient populations, more intensive and specialized home health care services may be required, which does not result in cost savings. On the other hand, the use of more expensive transition resources, such as APNs, has proven to be cost effective, although adopting such research-based best practices can be hampered by a lack of reimbursement and incentives. 48 Research is needed to understand the impact of transferring care and expenditure on home health care to patient outcomes and financial health of the home health industry.
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Nurse work environment
Evidence from the acute care setting suggests a link between the nurses’ work environment, patient safety and patient care quality. 49–51 A positive work environment supports nurses’ autonomy and control over the work environment, including shared governance or decision making. It is an environment of strong and visible nursing leadership, organizational support, peer support and positive physician collaboration.
Research
The vast majority of elderly home health care patients routinely take five prescriptions, and many patients opt out of their prescribed ation regimen.
Health Search identified only three studies testing interventions to improve home health management and compliance among home health patients. The 16–18 studies are summarized in Table 1. All three studies used a controlled trial design, with either randomized placement of patients or two treatment groups and a control group of general care. The study population included elderly Medicare patients receiving home health care, 41 to 259 patients.
Table 1
Table 1
ಸಾ Summary of Evidence for Shaadi Management
Interventions examined are patient education delivered by nurse followup by telephone or videophone, individualized patient education, and review and collaboration between providers (eg, nurse, pharmacist, physician) and patients. Specific outcomes include identifying unwanted and duplicated ation shapes, improving the use of specific classes of ation shades such as cardiovascular or psychotropic drugs, and identifying the extent of use of nonsteroidal anti-inflammatory drugs (NSAIDs). The effectiveness of interventions is measured by improved adherence and adherence to drug protocols. Objective adherence was assessed by ation cuff refill history and ation cuff event monitoring, and subjectively assessed the patient’s self-report scores on pre-and post-questionnaire test knowledge, disease understanding and follow-up.
Nisarga care Evidence from these studies indicates that all interventions examined are to some extent effective. Use Use of shirts has improved for patients receiving the intervention, but control groups have had a significant decline in adherence to drug use protocols. Educational interventions have been extremely successful in adapting to patients’ learning abilities separately. Interventions have been more effective in preventing therapeutic transcription and improving the use of cardiovascular ations, less effective for patients taking psychotropic ation shades or NSAIDs. In general, as knowledge scores improve, compliance improves. When more than one intervention was examined, there was generally no difference between the two intervention groups.
Evidence-Based Practice Implications
Identifying relevant risk factors, nurses must be alert for the possibility of ation disorders in the home health care system. Technology provides many opportunities to improve communication with patients, provide patients with accurate information, inform them of their ations, and monitor ation rules. Paying more attention to patients at risk is more effective; Therefore, it is important to review the exact enrollment and ations conditions during each patient encounter. Evidence suggests that frequent ation review and collaboration with other members of the health team, particularly pharmacists, can help prevent adverse events associated with poor ation conditioning.
Nisarga care research implications
More effective methods are needed to improve the use of ation cavities in the home health population. Research should continue to expand the knowledge of the factors that contribute to ation impairment in home health care and determine which interventions are most effective in improving ation impairment at home.
