Search

Background: Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal.Objective: We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist.Design and Participants: In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018.Approach: Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image.Key Results: Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step.Conclusions: Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period. [ABSTRACT FROM AUTHOR]

Objective: To use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) - the FRESH Foods Survey.Design: New and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed.Setting: Three US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY.Participants: Food pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years.Results: Measures of dietary correlates performed well psychometrically: Cronbach's α range 0·71-0·90, slope (α) parameter range 1·26-6·36, and threshold parameters (β) indicated variability in the 'difficulty' of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07-4·71), indicating unidimensionality. Average (median, Q1-Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87-4·58); junk foods (1·16, 0·58-2·16); fast foods and similar entrées (1·45, 0·58-2·03); whole-grain foods (0·87, 0·58-1·71); sugar-sweetened beverages (0·58, 0·29-1·29); milk and milk alternatives (0·71, 0·29-1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity.Conclusions: The FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact. [ABSTRACT FROM AUTHOR]