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This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient's admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤.001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions. [ABSTRACT FROM AUTHOR]

Palliative care is a comprehensive approach aimed at improving the quality of life of patients with serious illness and their families. Nevertheless, there exists a dearth of systematically synthesized empirical evidence regarding the key elements that contribute to good home palliative care (HPC) from a familial standpoint in the context of South and Southeast Asia. This paper aims to describe family perspectives on key elements of good home palliative care in both regions. We conducted a scoping review using Arksey and O'Malley's methodological framework. The search was done in 6 electronic databases: PubMed, Ovid MEDLINE, EMBASE, Web of Science, APA PsycINFO, and APA PsycArticles Full Text. Inclusion criteria were (1) exploring family experiences of palliative care, (2) home setting, and (3) South and Southeast Asian countries. Twenty-four studies were included from Bangladesh (n = 1), India (n = 6), Indonesia (n = 7), Malaysia (n = 2), Singapore (n = 2), and Thailand (n = 6). Five key elements of HPC from family perspectives were comprehensive moral and psychological support; religious and spiritual activities with religious figures involvement; empathetic, responsive, and continued home palliative care; adequate access to information and skills training; and facilitation in dealing with systemic barriers. The crucial role of religious and spiritual activities and the need for facilitation in facing systemic barriers were specific to South and Southeast Asia. HPC teams should be able to provide holistic support for patients and their families, which is influential for the quality of care. Improving care on a systemic level in these regions should be a policy priority. [ABSTRACT FROM AUTHOR]

Due to demographic changes and structural developments in the healthcare system, an increasing number of patients receive home care nursing in Denmark. Little is known about the complexity of home care. The aim of this paper was to investigate the challenges that home care nurses experience in their clinical practice by studying factors related to home care nurses' experiences of encounters with patients as burdensome. A population-based survey was undertaken involving all nurses in homecare services in one municipality in Denmark. The participating nurses registered all home care contacts by the patients during the daytime for 1 week. A registration form was used including a series of items designed to identify factors related to the perceived burden of each visit. Statistical frequency analyses were used to examine factors related to the home care nurses' experiences of encounters with patients as burdensome, and to investigate the challenges that home care nurses meet in their clinical practice. Home care nurses estimated 7.6% of 941 representative homecare visits as burdensome. Assessment of burden was associated with patients being below 60 years of age, time consumption and unexpected problems during the visit, especially of a psychosocial nature. Even though <10% of the encounters were considered burdensome, there is reason to believe that an increase can be expected due to ongoing emphasis on achieving greater efficiency in the healthcare system. [ABSTRACT FROM AUTHOR]

The aim of this scoping review was to examine the national and international literature on the response of adult Hospital at Home (HAH) services to the global Covid-19 pandemic and explore key themes to emerge and make recommendations for further research. The databases were searched using agreed search terms and Arksey and O'Malley's scoping review framework was utilized and papers were identified and analyzed for common themes. Thirty-one papers were included in the review. Of the papers included, general adult medicine was the largest service group (n = 15) with geriatric services the next largest (n = 12). Most papers were European in origin (n = 19). Key themes to emerge include (1) similar outcomes for HAH patients compared with traditional inpatient care, (2) expansion of capacity for inpatient care due to HAH use, (3) growth of virtual monitoring in HAH setting, (4) reduction in infection transmission in HAH setting, and (5) cost reduction due to HAH utilization. Hospital at home demonstrated good outcomes for both patients with Covid-19 and other conditions during the pandemic. These services also expanded capacity during a global healthcare crisis. Remote monitoring played a major role in the expansion of capacity and the reduction of infection transmission during the pandemic. Although some papers discuss how HAH is more cost effective than traditional hospital, more work is needed around this as many of the patients may not have been as sick as those admitted to traditional hospital during the pandemic. [ABSTRACT FROM AUTHOR]

Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover. [ABSTRACT FROM AUTHOR]

In Asia where family caregiving is part of the culture, palliative home care becomes the most suitable service to keep patients close to their family and to reduce costs. There is a wide variety of palliative home care services due to different cultures and levels of involvement of the family. This review aims to explore the implementation of palliative home care in East and Southeast Asian countries. The articles reviewed in this study were obtained from 3 electronic databases: EbscoHost, PubMed, and Scopus. Journal articles that discussed palliative home care for patients with cancer in East and Southeast Asia countries were included. Review papers were excluded. Seven studies were used in the current review. In general, there are 6 services provided for palliative home care in this region, which are daily activity living care, planning and preparation for palliative home care, education and counseling, patients' follow-up, symptom management, and direct care for family. Most of the programs involve family caregivers during the treatment. The palliative home care team consists of at least a doctor and a nurse. Symptom management is the most common service and direct care for family is the least offered palliative home care service in this region. Alleviating symptoms is one of the targets in palliative care, therefore involving family in symptom management for palliative home care is fundamental. Although caregiving is part of the culture, family members need to be supported to maintain their quality of life. [ABSTRACT FROM AUTHOR]

The onset of the COVID-19 pandemic has accelerated the adoption of virtual care as a modality for home-based care delivery to individuals and cohorts who might not otherwise have access. While a number of positive outcomes have been reported, rapid growth has occurred without critical consideration of clinician education and training. Little is known about the curricular and pedagogical requirements for educating current and future clinicians in virtual care provision. This review was informed by Arksey and O'Malley's five-stage methodological framework for scoping reviews, first published in 2005. Using a clearly articulated search strategy and reporting process, over 4000 pieces of literature were analysed to inform this review. A final 17 papers were included. Common themes emerging in relation to curricula content include the basics of virtual care, cultural awareness, interprofessional collaboration/training, telepresence, encompassing non-verbal, verbal and environmental considerations, and virtual care clinical skills. Standalone modules are recommended for delivering 'the basics' of virtual care, while the interactive/participative approach is endorsed as an appropriate method of instruction. The reviewed literature reviewed offers a set of core inclusions and pedagogical approaches for a virtual care education program, although these are often mentioned in general terms and are not always well described. Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a consistent and cohesive approach to curricula and pedagogies. These approaches should be rigorously evaluated as part of a continuous quality improvement process. [ABSTRACT FROM AUTHOR]

Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses' experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses' experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman's techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: "threat to patient safety" and "Care breakdown". Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care. [ABSTRACT FROM AUTHOR]

This study aimed to examine the concept of Managed Long Term Care service from a care manager's perspective. The Walker and Avant concept analysis approach was applied. The defining attributes include (1) chronic disease or disability, (2) coordination of care, and (3) services. Core components of Managed Long Term Care service were found to be a network of providers and capitation. A conceptual model of Managed Long Term Care service was developed with Managed Long Term Care service operationally defined as "a program with a set of services delivered to patients who have a chronic illness or disability and wish to stay safe and healthy at home in the community. The services or benefits are coordinated by a care manager who serves as a point of contact for the patient and provider(s), and are delivered by providers in the network." Care management is a core concept of Managed Long Term Care. The triple aims of Managed Long Term Care are to deliver the right care at the right time at the right cost to Managed Long Term Care eligible patients. This paper sought to illuminate and clarify varied perspectives on the concept of Managed Long Term Care service. Without a clear understanding of a community-based service or program, delivery of nursing care may be less effective. This study was the first to examine this widely used but often imprecisely defined community health service from a case manager's point of view. [ABSTRACT FROM AUTHOR]

The development of new management solutions is needed to generate great changes in the health sector, especially in addressing the current collision course between growing health care demands, rising costs, and limited resources. One of these solutions is the hospital at home (HAH). This article aims to explore the existing literature, regarding possible health gains and economical outcomes in HAH programs versus traditional inpatient hospitalization. A search of literature was conducted to identify papers regarding HAH programs and their respective health and economical outcomes. The concept of HAH encompasses different levels or care schemes. Several examinations and treatments can be carried out at home. Hospital at home may optimize patient flow and relieve pressure on hospital bed availability. However, questions are raised regarding the uncertainty of the efficacy of HAH and the limited evidence on which model setting is most appropriate. [ABSTRACT FROM AUTHOR]

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 (n = 33) and Phase 2 (n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management. [ABSTRACT FROM AUTHOR]

A mixed methods descriptive study explored 38 nurses’ perceptions of usability and factors influencing the use of 13 symptom management protocols when caring for patients with cancer in the home. Descriptive analysis of the usability survey revealed protocols had high readability, right amount of information, appropriate terms, and were self-evident to complete. Thematic analysis of transcripts identified barriers to using the protocols including lack of time, paper-based documentation systems, and length of the protocols. Facilitating factors included high usability of the protocols, integration of a remote symptom support nursing role, and the usefulness for education and training. In summary, the protocols were described as a useful resource and beneficial for nursing orientation but required support to overcome some barriers and improve fit with clinical workflow. [ABSTRACT FROM AUTHOR]

Many older adults across all settings are on antipsychotic medications; all too frequently for long periods of time. There are very few studies about the long-term effects of these medications, especially when used in those with declining physiological ability to metabolize medications. This paper looks at the three most commonly prescribed classes of antipsychotic medications used in older adults. A second purpose is to increase knowledge and potential strategies home health nurses can use to help their patients. [ABSTRACT FROM AUTHOR]

Appropriate and efficient provision of services at home requires more than skilled personnel} effective communication between the primary care provider and the agency is an often overlooked but essential tool for maintaining the patient's health in the community. A method was developed to create home care orders (the "e-485") that guides the physician through the order writing process, uploads data from the electronic medical record, and creates a legible, complete order set that can be faxed quickly to the agency. This paper describes this tool and the challenges and rewards of its implementation in an academic medical center. [ABSTRACT FROM AUTHOR]