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The pandemic took its toll on memory clinics with many forced to close or scale back their services. This led to lengthening waits for dementia assessment and left many without a diagnosis.
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The article focuses on the future of diagnostic testing in healthcare, highlighting the importance of testing in tracking and treating diseases like COVID-19. It discusses the advancements in diagnostic technology, including combination tests for multiple respiratory diseases and the rise of at-home testing, which will increase access to testing and empower patients to manage their health.
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What this paper adds: * This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. * Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. * Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce. Keywords: Palliative care;home care services;Education, Nursing;qualitative research;Nurse Practitioner BACKGROUND Palliative care focuses on improving the quality of life of people affected by life-threatening illnesses, including the prevention and relief of suffering through identification, assessment and treatment.1 This care extends to family members, and encompasses physical, psychological, social and spiritual support. Home nursing and care organisations are key providers of community-based palliative care, with staff often the linchpin, in supporting palliative clients, organising and providing care, coordinating the input of other professionals and of specialist equipment.5 Previous research has identified the difficulties faced by home care nurses in meeting their clients' palliative care needs, such as symptom management and communication, as well as requirements for further training to enhance their knowledge and confidence of caring for palliative clients.5-7 In this context, generalist palliative care is delivered by health and care professionals with broad clinical responsibilities who provide primary, ongoing care;and have established relationships with the person and their care community.2 This is distinct from specialist palliative care services which support complex needs through multidisciplinary teams with specialised palliative care training. FINDINGS AND DISCUSSION Thematic analysis identified the following overarching themes: 1) targeted education increased staff knowledge and confidence, but more is needed;2) collaborative teamwork with effective communication and information sharing underpins a successful generalist-specialist partnership;3) the home care setting is unique and requires accessible systems and processes.
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Am J Manag Care. 2021;27(9):369-371. https://doi.org/10.37765/ajmc.2021.88739 _____ Takeaway Points A framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs. * Validated disease-specific tools should be consistently used to measure process metrics, outcome metrics, quality-of-life measures, and caregiver satisfaction measures. * Equity-focused process metrics, care utilization measures, and risk-adjusted outcome metrics should be reported. * Total costs of care for hospital-at-home programs should be consistently measured through a time-driven activity-based costing method. * Personal, societal, technical, and allocative value should be considered when determining the value of hospital-at-home programs. _____ In recent years, home health care has grown to 3% of overall US health care spending.1 Investment in home health care delivery including telemedicine grew considerably during the COVID-19 pandemic.2 One area that has lagged in terms of growth has been the hospital-at-home model. For home health agencies (different from hospital-at-home programs, which provide more acute care services), CMS uses a more comprehensive Home Health Quality Reporting process to assess risk-adjusted process measures, outcomes measures, occurrences of adverse events, utilization of care measures, and cost measures.9 After the COVID-19 pandemic, similar reporting processes should be implemented for measuring the quality and outcomes of hospital-at-home programs. Because hospital-at-home programs share features of both inpatient hospital admissions and home health agencies, they are uniquely positioned to both treat the patient acutely and improve the living conditions and resources that led to the acute illness. The American Heart Association's Get With the Guidelines – Heart Failure, an in-hospital program, describes a comprehensive, robust set of quality measurements including process and outcome measurements for heart failure management.11 Process metrics include assessment of left ventricular ejection fraction, adherence to guideline-recommended medical therapy at discharge, and scheduled follow-up;process metrics correlate well to high-quality heart failure care.12 Outcome metrics include 30-day mortality and 30-day readmission rates.12 Although hospital-at-home programs have been associated with lower costs, these cost reductions are mostly due to reduced length of hospitalization,13 number of consultations,14 and clinical testing.13 It is yet unclear if the reduction in services utilized also leads to a reduction in value for the patient—either through fewer completed process metrics or significantly increased caregiver burden. Of 34 studies included in a meta-analysis comparing the costs of hospital at home with those of hospitalizations, 32 studies found hospital at home to cost less.3 For example, in a recent randomized controlled trial evaluating patients treated in a hospital-at-home program compared with those treated in a traditional hospital, the risk-adjusted cost reduction of home care management was 19%.15 In this trial, costs were calculated by summing the costs of labor, equipment, medications, laboratory tests, imaging tests, and transport during the period of hospitalization.15 In hospital-at-home models, cost savings are thought to be achieved due to reduced length of hospitalization,13 decreased number of consultations,14 reduced nursing labor costs,15 and decreased clinical testing.13 However, no uniform method exists to track and assess costs,16 and there is worry that the costs of hospital-at-home programs are underestimated.17 To fill this gap, these programs should report and analyze the total costs of care—including costs incurred by patients and their caregivers—rather than simply the reimbursement rates for care.
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Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR;(2) Benefits of EHR;(3) Benefits of other HIT;(4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR;an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.
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To investigate occupational therapists' experiences with home assessments and modifications in VHA, while comparing virtual to in-person home visits. A preliminary qualitative study using semi-structured individual interviews. Department of Veterans Affairs (VA) Home Based Primary Care (HBPC). Purposefully selected occupational therapists implementing home assessments and modifications for rural Veterans (N=3). Not applicable. Semi-structured individual interview via Microsoft Teams. Home visits to conduct home assessments and modifications for rural Veterans were standards of care delivery. However, travel restrictions and social distance during the COVID-19 pandemic required a shift toward virtual care. Our preliminary results show that the VA Video Connect (VVC) application allows occupational therapists to provide instant feedback and training to Veterans when new equipment is installed in the Veteran's home, without the need to drive long-distance. However, the VVC does not allow occupational therapists to measure physical features of the home, such as door threshold height and hallway width. Participants also reported difficulty evaluating Veterans' functioning, such as balance, strength, and gait pattern. Thus, the VVC improves access to the services but requires additional assistance from caregivers compared to in-home assessments. Initial home assessments are recommended to be conducted during home visits, but follow-up visits can be conducted via telehealth depending on Veterans' and caregivers' ability to utilize telehealth devices and perform self-assessments. The study team has no conflicts of interest to report.
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Globally, the growing number of elderly people, chronic disorders and the spread of COVID-19 have all contributed to a significant growth of Home Health Care (HHC) services. One of HHC's main goals is to provide a coordinated set of medical services to individuals in the comfort of their own homes. On the basis of the current demand for HHC services, this paper attempts to develop a novel and effective mathematical model and a suitable decision-making technique for reducing costs associated with HHC service delivery systems. The proposed system of decision making identifies the real needs of HHCs which incorporate dynamic, synchronized services and coordinates routes by a group of caregivers among a mixed fleet of services. Initially, this study models the optimization problem using Mixed Integer Linear Programming (MILP). The Revised Version of the Discrete Firefly Algorithm is designed to address the HHC planning decision-making problem due to its unique properties and its computational complexity. To evaluate the scalability of this proposed approach, random test instances are generated. The results of the experiments revealed that the algorithm performed well even with the different scenarios such as dynamic and synchronized visits. Furthermore, the improved version of nature-inspired solution methodology has proven to be effective and efficient. As a result, the proposed algorithm has significantly reduced costs and time efficiency. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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The purpose of the pilot survey was to understand current practice patterns and responses to the Patient-Driven Groupings Model and the coronavirus disease 2019 (COVID-19) pandemic in home health occupational therapy care. Fifty home health occupational therapy practitioners from 27 states in the United States completed the survey. Descriptive analysis was used to organize and summarize survey responses. The survey items on practice patterns included assessment tools, treatment approaches, and care coordination with physical therapy colleagues. The most reported assessment of occupational performance was the Barthel Index. The common treatment approaches included activities of daily living retraining, energy conservation, and functional mobility and transfer. The majority of respondents (n = 44) communicated with their physical therapy colleagues at least once a week. The communications were often related to scheduling and changes in a patient's condition. Seventy percent of practitioners experienced a reduction in home visits during the recent Medicare payment reform and the pandemic. These practitioners perceived that some patients might have been discharged from home health care prematurely. Additional studies to investigate the impact of policy changes and the pandemic on therapy intensity and patients' functional outcomes are warranted.
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Health care facilities have not increased in response to the growing population. Therefore, government and health agencies are constantly seeking cost-effective alternatives so they can provide effective health care to their constituents. Around the world, health care organizations provide home health care (HHC) services to patients, especially the elderly, as an efficient alternative to hospital care. In addition, recent pandemics have demonstrated the importance of home health care as a means of preventing infection. This study is the first to simultaneously take into account nurses' working preferences and skill levels. Since transferring samples from the patient's home to the laboratory may affect the test results, this study takes into account the time it takes to transfer samples. In order to solve large instances, two metaheuristic algorithms are proposed: Genetic Algorithms and Particle Swarm Optimization. Nurses are assigned tasks according to their time windows and the tasks' time windows in a three-stage scheduling procedure. Using a case study set in Tehran, Iran, the proposed model is demonstrated. Even in emergencies, models can generate effective strategies. There are significant implications for health service management and health policymakers in countries where home health care services are receiving more attention. Furthermore, they contribute to the growing body of knowledge regarding health system strategies by providing new theoretical and practical insights.
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Home Care Services , Humans , Aged , Iran , AlgorithmsABSTRACT
Domestic workers—specifically in-home health care workers, childcare providers, and house cleaners—are generally concentrated at the bottom of the US labor market. Yet, there is also substantial stratification among and within each of these occupations. This article explores the heterogeneity in pay and working conditions among domestic workers in the 21st-century United States, which has been understudied to date. After sketching national patterns of stratification in this set of occupations, the focus shifts to qualitative evidence on inequalities among domestic workers drawn from focus groups conducted in New York City shortly before the COVID-19 pandemic. Finally, the impact of the pandemic on in-home domestic workers is briefly considered. © The Author(s) 2022.
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Children living in out‐of‐home care are at greater risk of poor educational outcomes compared to other children. To address their educational needs, several programs have been developed. Within a qualitative paradigm, this study explored the experiences of students about their involvement in TEACHaR (Transforming Educational Achievement for Children at Risk), a specialized education programme. Eight students (aged 13 to 18 years) from the programme participated in individual, semi‐structured interviews. Responses were analysed using Interpretive Phenomenological Analysis. Participants indicated that the programme provided individualized and flexible academic support, reduced their shame and embarrassment and provided them with more than academic support. They highlighted the importance of the student–educator relationship, and the need for encouragement and motivation to pursue their educational goals. Finally, findings report on how COVID‐19 impacts on student experiences of the programme. Recommendations for the development and improvement of education programs for students in out‐of‐home care conclude this paper.
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A multichannel interaction service is a practice whereby organizations communicate and interact with their existing customers and potential new customers through different channels. This article presents a brief case study of multichannel interaction in healthcare services, which studies the viability of continuous multichannel interaction for personalized healthcare services to enable health professionals to follow up and monitor patients in home-based care. Furthermore, this study aims to explore the possibility of the continuity and complementarity of the interactions across different communication channels with the patients. The data used for this study was gathered during the first wave of the COVID-19 pandemic. This study showed that despite this type of interaction being relatively new in healthcare services, it has considerable potential for improving the relationship between patients, health professionals, and care providers. Upon completion of the data analysis, several conclusions were drawn. One such conclusion was the ability to maintain continuity of interaction across multiple channels, as well as the synergy between the different channels of interaction available to patients and the impact this has on the way patients and health professionals interact. Additionally, it was determined that the complementarity of different interaction channels is crucial when implementing multichannel interaction services. Furthermore, the implementation of this solution resulted in improved communication between patients and health professionals. Also, it has decreased health professional's workload and reduced care providers costs regarding remote patient follow-up. © 2023 by the authors.
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Although the use of voice assistants to support older adults at home shows promise, little is known about how the next generation of these devices, which also include displays, can support health and care needs. This question has become more important during COVID-19, when issues of social isolation for older adults have been exacerbated. During social distancing measures in the UK, eleven older adult households (16 participants) were interviewed before receiving an Amazon Echo Show, shortly after receiving it, and after three months of use. We identify ways in which this multi-modal device is used by people in social isolation to support social, care, and information needs in the home. We frame these findings within the growing research area of smart homes for health and care, and provide implications for the adoption, use and acceptance of these devices to support aging in place together. © 2022 ACM.
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Telemedicine systems that involve the use of video conferencing technologies have been available for more than three decades. Yet, they have primarily been used for specialist appointments or within health care facilities. We are now seeing a shift with the proliferation of commercial technologies, such as smartphone apps that allow people to have appointments with a general practitioner from nearly any location for various reasons. Telemedicine has also seen an uptake due to the COVID-19 pandemic. However, little is known about how doctors and patients perceive smartphone-based telemedicine systems, what types of medical ailments are best suited for these systems, what sociotechnical challenges might emerge through their usage, and how systems should be designed to best meet the needs of both doctors and patients. Thus, we applied a scenario-based design method by presenting a set of medical situations to both general practitioners and patients, and conducted contextual interviews with them to investigate their thoughts on video-based appointments for a range of medical situations. Results show that video consultations using smartphone apps could raise challenges in delivering appropriate care and utilization, conducting camera work to assist different types of examinations, supporting doctor-patient relationship creation and maintenance, allowing doctors to maintain control over the appointment, as well as protecting patients' and doctors' privacy. This suggests the need to create designs that can support particular workflows, relationship building, safety and privacy protection, and camera work for varying contexts. © 2022 Association for Computing Machinery.
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From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient's home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome. Copyright © 2022 The Authors.
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OBJECTIVES: This study aimed to explore how the COVID-19 pandemic shaped the experiences of family caregivers of older adults who were hospitalized with COVID-19 and discharged to post-acute, skilled home health care (HHC) services. METHODS: Thirty semi-structured interviews with family caregivers of older adults who received services from a large, not-for-profit HHC agency following hospitalization with COVID-19 infection were conducted between March-July 2021 and analyzed using thematic analysis. RESULTS: During the pandemic, family caregivers encountered societal and institutional barriers to assisting older adults across post-acute care transitions. These barriers included hospital visitation restrictions as well as difficulties accessing community-based resources and medical equipment. Despite limitations and delays in HHC services, many family caregivers identified post-acute HHC, delivered in-person or via telehealth, as important to addressing care gaps for older adults, as well as their own needs for training and support during the pandemic. CONCLUSIONS: Policies intended to reduce the spread of COVID-19 introduced new challenges for caregivers during HHC. However, HHC agencies and their staff adapted within this context to provide a needed bridge of support.
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COVID-19 , Home Care Services , Humans , Aged , Caregivers/education , Pandemics , COVID-19/epidemiology , HospitalizationABSTRACT
Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR;(2) Benefits of EHR;(3) Benefits of other HIT;(4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR;an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.
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With the emergence of the Covid-19 disease, hospitals and health care professionals (HP) had to deal with a huge number of patients presenting with the virus that kept increasing every day, resulting in the increase of the pandemic transmission. To deal with this issue, minimize patients' and healthcare professionals' exposure, and be able to treat all patients, HP turned to home hospitalization. In-home hospitalization, doctors need to monitor their patient's health status remotely, and patients need to share this data with them. But in this scenario, patient privacy is exposed to several external threats and intrusions, sometimes resulting in the loss of patient life. To deal with the above issues, our focus in this article is on access control (AC). Thus, we propose a Blockchain (BC) smart contract-based model, where each object owner creates one ACC (Access control contract) for each subject in the system and defines his access policies in it. © 2022 IEEE.
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BACKGROUND: Since COVID-19 emerged, over 514 million COVID-19 cases and 6 million COVID-19-related deaths have been reported worldwide. Older persons receiving home health care often have co-morbidities that require advanced medical care, and are at risk of becoming severely ill or dying from COVID-19. In Sweden, over 10,000 COVID-19-related deaths have been reported among persons receiving municipal home health and social care. Home health care professionals have been working with the patients most at risk if infected. Most research has focused on the experiences of professionals in hospitals and assistant nurses in a home care setting. It is therefore valuable to study the experiences of the registered nurses and physicians working in home health care during the COVID-19 pandemic to learn lessons to inform future work. METHOD: A thematic qualitative study design using a semi-structured interview guide. RESULTS: The health care professionals experienced being forced into changed ways of working, which disrupted building and maintaining relationships with other health care professionals, and interrupted home health care. The health care professionals described being forced into digital and phone communication instead of in-person meetings, which negatively influenced the quality of care. The COVID-19 pandemic brought worry about illness for the health care professionals, including worrying about infecting patients, co-workers, and themselves, as well as worry about upholding the provision of health care because of increasing sick leave. The health care professionals felt powerless in the face of their patients' declining health. They also faced worry and guilt from the patients' next of kin. CONCLUSION: Home health care professionals have faced the COVID-19 pandemic while working across organizational borders, caring for older patients who have been isolated during the pandemic and trying to prevent declining health and feelings of isolation. Due to the forced use of digital and phone communication instead of in-person visits, the home health care professionals experienced a reduction in the patients' quality of care and difficulty maintaining good communication between the professions.
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COVID-19 , Home Health Aides , Humans , Aged , Aged, 80 and over , COVID-19/epidemiology , Pandemics , Qualitative Research , Health PersonnelABSTRACT
This time last year it looked like cancer services were back on the road to recovery. The number of people starting treatment was on the rise and had even nudged above pre-pandemic levels.