scholarly journals Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 355-356
Author(s):  
Joanne Spetz ◽  
Laura Wagner ◽  
Jacqueline Miller ◽  
Susan Chapman ◽  
Connie Kwong
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Economic Analysis ◽  
Home Care ◽  
Informal Caregivers ◽  
Financial Stress ◽  
Emergency Department Visits ◽  
Life Questionnaire ◽  
Middle Income

Abstract The Support at Home pilot program provided financial support for home care services by middle-income adults with disabilities in San Francisco to support aging in place. This presentation reports the results of the mixed-methods evaluation of the program, which incorporated administrative records, surveys of clients and comparison group members, surveys of informal caregivers of clients, surveys of the care providers hired by clients, and focus groups with clients and with informal caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons and comparisons of changes between the client and comparison groups. Multivariate regression analyses were conducted to control for demographic differences between the groups. An economic analysis was conducted to learn whether changes in costs associated with medical appointments, emergency department visits, and hospitalizations were greater than the costs of the program, including both voucher and administrative costs. Results indicated statistically significant positive changes in personal stress and financial stress, but not in the composite quality of life score. There also were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. The focus group data supported the findings regarding personal and financial stress, and also indicated that clients and their caregivers perceived positive quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services.

scholarly journals Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults With Disabilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 78-78
Author(s):  
Joanne Spetz ◽  
Jacqueline Miller ◽  
Connie Kwong ◽  
Laura Wagner
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Economic Analysis ◽  
Home Care ◽  
San Francisco ◽  
Comparison Group ◽  
Financial Stress ◽  
Emergency Department Visits ◽  
Middle Income

Abstract The Support at Home pilot program provided financial support for the purchase of home care services by middle-income adults with disabilities in San Francisco to support aging in place. Enrollees had income below the area median and made copayments based on household income. The mixed-methods evaluation of the program incorporated administrative records, surveys of clients and comparison group members, surveys of unpaid caregivers, surveys of paid care providers, and focus groups with clients and unpaid caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons between client and comparison groups and multivariate regressions. An economic analysis was conducted to learn whether changes in costs associated with reduced health care utilization were greater than the costs of the program. Results indicated statistically significant positive changes in client ratings of personal and financial stress, but not in the composite quality of life score. There were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. Similar changes were not found in the comparison group. The focus group data supported the findings regarding personal and financial stress and indicated that clients and their caregivers perceived quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services. Due to its positive impacts, San Francisco has made Support at Home a permanent program.

A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
Yanying Chen ◽  
Yi Jin Tan ◽  
Ya Sun ◽  
Cheng Zhan Chua ◽  
Jeffrey Kwang Sui Yoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Transitional Care ◽  
Controlled Trial ◽  
Care Program ◽  
Emergency Department Visits ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Hospital To Home

Background Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital. Methods Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life.

scholarly journals Quality of life predictors in informal caregivers of seniors with a functional performance deficit – an example of home care in Poland

2019 ◽  
Vol Volume 14 ◽  
pp. 889-903
Author(s):  
Barbara Ślusarska ◽  
Agnieszka Bartoszek ◽  
Katarzyna Kocka ◽  
Alina Deluga ◽  
Agnieszka Chrzan-Rodak ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Home Care ◽  
Functional Performance ◽  
Informal Caregivers ◽  
Performance Deficit

scholarly journals The Feasibility of a Home Care Management Model Based Coaching Intervention on Indonesian Caregivers' Outcomes of Relatives with Schizophrenia

2018 ◽  
Vol 13 (2) ◽  
pp. 84
Author(s):  
Jenny Marlindawani Purba ◽  
R H Simamora ◽  
E D Ginting
Keyword(s):  
Quality Of Life ◽  
Home Care ◽  
Family Caregivers ◽  
Care Management ◽  
Management Model ◽  
Life Questionnaire ◽  
Model Base ◽  
Coaching Intervention ◽  
Persons With Schizophrenia

<p><strong>Background.</strong> Caring for schizophrenia is a challenge and a burden for caregiver. In fact, family caregivers did not know how to care schizophrenia at home. A home management care base coaching is urgently needed. It can be used as a basis for nurses to assist caregivers in caring for persons with schizophrenia. <strong>Aims and Objectives.</strong> The study aimed to determine the feasibility of a home care management model base coaching for family caregivers of persons with schizophrenia.</p><p><strong>Methods.</strong> The study was two groups pre-test post-test quasi-experimental design. Thirty family caregivers were assigned into experimental and control group with each group 15 persons. Data were collected using the Chiang Mai Psychiatric Caregiving Scale, the Zarit Caregiver Burden Scale and the Schizophrenia Caregiver Quality of Life questionnaire. It was six weeks activities with several methods, such as discussion, watching videos, providing information, training, and home visit.</p><p><strong>Results:</strong>The participants who receive interventions reported significantly more improved in caregiving skills (p&lt;0.05), increased quality of life (p &lt; 0.05)and decreased the level of burden care (p&lt;0.05) than those receiving the routine care.</p><p><strong>Conclusions:</strong>The study revealed that home care management model base coaching intervention was effective to improve caregivers’ outcomes in caring for relatives with schizophrenia.</p>

Self-reported financial stress among patients evaluated at a community cancer program.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6553-6553
Author(s):  
Christopher S. Lathan ◽  
Ruth N. Akindele ◽  
Ludmila Svoboda ◽  
Daniel A. Gundersen
Keyword(s):  
Quality Of Life ◽  
Underserved Populations ◽  
Financial Burden ◽  
Financial Stress ◽  
Stress Index ◽  
Life Questionnaire ◽  
European Organization ◽  
Cancer Program ◽  
Patient Reported

6553 Background: Cancer related financial stress has been linked to a multitude of factors including socio-economic status, but its impact on the quality of life (QOL) for underserved populations is less well characterized. We evaluated patient reported financial stress, QOL, and quality of health (QOH) at an outreach cancer program located in a federally qualified health center. Methods: Study participants were interviewed at initial clinic visit for financial stress, QOH and QOL between January 2012 and December 2016. Demographic information, insurance coverage, clinical parameters, and comorbidities were abstracted from participants’ medical records. Responses to the financial stress index question “how difficult is it for you or your family to meet monthly payment of your/your family bills?” and overall QOL and QOH of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 were analyzed. Proportional odds logistic regression models were constructed for 5-point quality of life measures and three levels of financial toxicity. Results: Of the 288 participants analyzed, 52% and 12% reported somewhat and extreme financial stress. In an adjusted analysis, patients who reported financial stress were more likely to be younger in age (OR = 4.03, p < 0.001) unemployed (OR = 3.24, p = 0.002), have less than bachelor’s degree (OR = 0.035, p = 0.018), insured by Medicaid (OR = 3.22, p < 0.011), and were more likely to rate their QOL (OR = 3.76, p = 0.031) as poor, compared to those without financial stress. Race, gender, presence of cancer diagnosis and comorbidities were not associated with financial distress. Independent predictors of poor QOL were disability (OR = 3.12, p = 0.005), depression (OR = 2.12, p = 0.007) and extreme financial difficulty (OR = 2.57, p = 0.011). There was a nearly perfect positive correlation between overall QOL and QOH (r = 0.984, p < 0.001). Conclusions: There is a high prevalence of financial burden among underserved minority patients seeking cancer related care, and this is closely associated with poor quality of life. Interventions targeting cancer disparities need to assess financial stress in order to address this issue.

scholarly journals The Role of Primary Care in Asthma Control and Severity

Spectrum ◽  
2019 ◽  
Author(s):  
Joel Agarwal ◽  
Monette Dimitrov ◽  
Kerri MacKay ◽  
Alan Kaplan ◽  
Donald Cockcroft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Emergency Department ◽  
Asthma Control ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Life Questionnaire ◽  
Care Providers ◽  
Ed Visits

Background: Asthma is a common chronic inflammatory disease of the airways affecting 3 millionCanadians. Primary Care Providers (PCPs) are integral to care coordination, enhanced through thedevelopment of a strong patient-PCP relationship with Continuity of Care (COC). A recent CIHI studynoted that 40% of Albertans do not have a COC model for primary care.Objectives: We aim to evaluate how primary care for adults with asthma impacts different measures ofcontrol.Methods: Prospective population-based recruitment of adults through various community venuesacross Alberta. Those who had self-reported asthma and were willing to participate completed a surveywhich included demographics, comorbidities, medication use (including biologics, allergy medications,steroids), Asthma Control Questionnaire (ACQ-5), Asthma Control Test (ACT), Quality of Life (QoL)measured through the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) and health care utilization(including Emergency Department (ED) visits, hospitalizations and ICU stays for asthma).Results: Of the 1685 individuals approached, 61 (3.6%) reported having asthma, of which 47 lived inAlberta. Most (41, 87%) had a PCP, with 30 (64%) visiting their PCP at least twice a year. Uncontrolledasthma was noted in 21 (45%) with either the ACQ-5 or ACT. The mini-AQLQ indicated 5 (11%) withreduced QoL. Mean lifetime hospitalizations, lifetime Emergency Department (ED) visits, and ICU staysrelated to asthma were 1.52, 4.55 and 0.25 respectively. Further, mean hospitalizations and ED visits inthe past 12 months related to asthma were 0.05 and 0.30 respectively.Conclusions: Asthma control was poor in 21 (45%) surveyed individuals, suggesting sub-optimal asthmamanagement in Alberta. Knowledge of Primary Care Networks (PCNs) was low, while ED and hospitalusage was high.

Preoperative Nomograms Predict Patient-Specific Cervical Spine Surgery Clinical and Quality of Life Outcomes

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 104-113 ◽  
Author(s):  
Daniel Lubelski ◽  
Vincent Alentado ◽  
Amy S Nowacki ◽  
Michael Shriver ◽  
Kalil G Abdullah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Emergency Department Visits ◽  
Patient Specific ◽  
Median Income ◽  
Cervical Spine Surgery ◽  
Presenting Symptoms

Abstract BACKGROUND Clinical and quality of life (QOL) outcomes vary depending on the patient's demographics, comorbidities, presenting symptoms, pathology, and surgical treatment used. While there have been individual predictors identified, no comprehensive method incorporates a patient's complex clinical presentation to predict a specific individual postoperative outcome. OBJECTIVE To create tool that predicts patient-specific outcomes among those undergoing cervical spine surgery. METHODS A total of 952 patients at a single tertiary care institution who underwent anterior or posterior cervical decompression/fusion between 2007 and 2013 were retrospectively reviewed. Outcomes included postoperative emergency department visit or readmission within 30 d, reoperation within 90 d for infection, and changes in QOL outcomes. Nomograms were modeled based on patient demographics and surgical variables. Bootstrap was used for internal validation. RESULTS Bias-corrected c-index for emergency department visits, readmission, and reoperation were 0.63, 0.78, and 0.91, respectively. For the QOL metrics, the bias-corrected adjusted R-squared was EQ-5D (EuroQOL): 0.43, for PHQ-9 (Patient Health Questionnaire-9): 0.35, and for PDQ (Pain/Disability Questionnaire): 0.47. Variables predicting the clinical outcomes varied, but included race and median income, body mass index, comorbidities, presenting symptoms, indication for surgery, surgery type, and levels. For the QOL nomograms, the predictors included similar variables, but were significantly more affected by the preoperative QOL of the patient. CONCLUSION These prediction models enable referring physicians and spine surgeons to provide patients with personalized expectations regarding postoperative clinical and QOL outcomes following a cervical spine surgery. After appropriate validation, use of patient-specific prediction tools, such as nomograms, has the potential to lead to superior spine surgery outcomes and more cost effective care.

scholarly journals A Comprehensive Assessment of Informal Caregivers of Patients in a Primary Healthcare Home-Care Program

2021 ◽  
Vol 18 (21) ◽  
pp. 11588
Author(s):  
Virginia Rodrigo-Baños ◽  
Marta del Moral-Pairada ◽  
Luis González-de Paz
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Home Care ◽  
Primary Healthcare ◽  
Informal Caregivers ◽  
Care Program ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Studies of the characteristics of informal caregivers and associated factors have focused on care-receiver disease or caregiver social and psychological traits; however, an integral description may provide better understanding of informal caregivers’ problems. A multicenter cross-sectional study in primary healthcare centers was performed in Barcelona (Spain). Participants were a random sample of informal caregivers of patients in a home-care program. Primary outcomes were health-related quality of life and caregiver burden, and related factors were sociodemographic data, clinical and risk factors, social support and social characteristics, use of healthcare services, and care receivers’ status. In total, 104 informal caregivers were included (mean age 68.25 years); 81.73% were female, 54.81% were retired, 58.65% had high comorbidity, and 48.08% of care receivers had severe dependence. Adjusted multivariate regression models showed health-related quality of life and the caregivers’ burden were affected by comorbidity, age, time of care, and dependency of care receiver, while social support and depression also showed relative importance. Aging, chronic diseases, and comorbidity should be included when explaining informal caregivers’ health status and wellbeing. The effectiveness of interventions to support informal caregivers should comprehensively evaluate caregivers when designing programs, centering interventions on informal caregivers and not care receivers’ conditions.

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