Evaluation of the transprofessional model of home health care for HIV/AIDS.

OBJECTIVE: To determine if a Transprofessional care-management approach (experimental group) produces savings in service delivery dollars when compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active, medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRINCIPLE FINDINGS: Post-test measures indicate an 8 percent reduction in labor delivery costs for an average experimental patient's entire episode of home-care versus for an average control patient's. CONCLUSIONS: An integrated model of service delivery, which is based on interdiscriplinary, care-management and blended modalities of service, provides a cost-effective method in the provision of home-care services for terminally ill AIDS patients.

A typology of service patterns in end-stage AIDS care: relationships to the transprofessional model.

OBJECTIVE: To determine the relationship among 11 types of home health care services for patients with HIV/AIDS and to develop a terminal-care, service-usage profile of persons receiving such services. Services include the number of psychiatric nurse visits, Medical Social Work (MSW) visits, evaluation visits, physical therapy visits, occupational therapy visits, homemaker visits, home health aide visits, public health nurse visits, registered nurse (RN) visits, Licensed Vocational Nurse (LVN) visits, and Intravenous (i.v.) nurse visits. DATA SOURCES AND STUDY SETTING: Data were collected on 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). The service utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: The relationship among the service types was evaluated with principal component analysis. A service-usage profile was developed for patients using cluster analysis. To control for the variability in the amount of time that patients were on service, the number of days that patients were in the VNA-LA program and were actually receiving services was included as a factor that yielded a variable reflecting the number of each type of service that a patient received per day. PRINCIPAL FINDINGS: Five components were found to best describe the relationships among the service-type variables. These were identified as being: the Number of Evaluation Visits, the Number of Intensive Nursing Visits, the Number of Physical Therapy Visits, the Number of Psychosocial Visits, and the Number of Attendant Visits. Patients were found to cluster into 1 of 5 groups based on the type of service utilization profile that they received. The variables that appeared to have the most influence on this profile were the number of home health aide visits per day that the patient received, the number of RN visits that were made, the number of i.v. nurse visits that were provided, and the number of LVN visits that were made. CONCLUSIONS: Terminally ill AIDS patients receiving home health care services can be identified as having a service utilization profile. This profile can be used to evaluate more precisely the service areas in which costs for patient services differ. Individually assigned to an experimental Transprofessional Model of care had a different service utilization profile than those assigned to a Traditional Model of care.

A profile of personality for a Russian sample: as indicated by the Comrey Personality Scales.

The purpose of our study was to present a personality profile, based on data from the Comrey Personality Scales (CPS), for a diverse, Russian sample. The CPS was administered to 457 subjects drawn from convenience samples throughout St. Petersburg, Russia. In Part 1 of the study, the structure of the Russian sample's personality was identified. Data from the CPS were factor analyzed. Findings showed strong support for the generalizability of Comrey's (1970) eight-factor personality taxonomy to this sample. The CPS's factors derived from the Russians were compared and found to be similar in structure to samples derived from American, Australian, Brazilian, Israeli, Italian, and New Zealand samples. In Part 2, mean differences on the CPS's scales between the Russian sample and the American sample were assessed. Results showed that although the structure of the Russians' personality was similar to that of the Americans' personality, significant differences in the elevation of scale scores did exist. For example, as a whole, the Russians tended to be more defensive, lethargic, egocentric, and unstable. Contrary to popular expectations, however, the Russians were not more conforming.