A Home-Care Service for Frail Older Adults: Findings from a Quasi-Experiment in Milan

Population aging is particularly pronounced in Italy. Recently, home-care services emerged as one of the desirable strategy when dealing with such situations of fragility. In this framework, we present the evaluation of a home-care service which was experimentally implemented by Fondazione Sacra Famiglia and Casa di Cura Ambrosiana in the 2017–2018 biennium. The service consisted of a twice-weekly nursing visit intended to monitor patient health conditions and to gather data constantly supervised by a geriatrician. The eligible population consisted of the users of San Carlo Hospital Emergency Department (91 individuals). Twenty of these individuals had access to the experimental home-care service. The results show the smaller probability of mortality for the treatment group compared to the control group, but similar probabilities in admissions to ER and in hospitalizations. These findings suggest that health home-care policies could reduce mortality by lessening the negative effects of relational isolation.

Cost-analysis of Treatment of Patients with Acute Myeloid Leukemia

Background: Acute myeloid leukemia (AML) is the second common leukemia (5.18%) and the third deadliest leukemia in Iran. Moreover, it is the fifth prevalent cancer in the world, which involves 8% of all cancers. Objectives: The aim of this study was to calculate direct medical and non-medical costs of AML in 2019. Methods: The present retrospective-descriptive analysis was conducted on 192 patients with AML aged 19 to 70 years from 2016 to 2018. The data were collected from hospital records and interviews with experts. The bottom-up micro-costing approach and payer perspective was considered for cost analysis status. The relationship of affective variables was investigated, using nonparametric tests, including Mann–Whitney and Kruskal–Wallis tests. Costs were divided into costs of diagnosis, hospitalization, medication, nursing, visit and consultation, operating room, and medical supplies. The data were described by mean ± standard deviation and reported by percentage and also analyzed by SPSS 11 software. Results: According to the findings, the average age of all patients was 43.91 years and 55.7% of the patients were male. The highest and the lowest diagnostic costs were associated with laboratory tests at $1656459.48 and ultrasound charges $4229.46, respectively. The total direct medical costs per patient were $1056624.78 with an average of $4846.90 and the cost of medication included 36% of the total costs. The direct medical and non-medical costs were $10485488.48 and $487522.87, respectively Conclusions: Costs of AML treatment were estimated to be $1056624.78. Finally, it can be concluded that the cost of AML in Iran is much cheaper than that compared to other countries and also due to hidden subsidies from the public sector, the payment from the patient's pocket is very small.

Planning the Episode: Home Care Admission Nurse Decision-Making Regarding the Patient Visit Pattern

During home health care (HHC) admissions, nurses provide input into decisions regarding the skilled nursing visit frequency and episode duration. This important clinical decision can impact patient outcomes including hospitalization. Episode duration has recently gained greater importance due to the Centers for Medicare and Medicaid Services (CMS) decrease in reimbursable episode length from 60 to 30 days. We examined admissions nurses’ visit pattern decision-making and whether it is influenced by documentation available before and during the first home visit, agency standards, other disciplines being scheduled, and electronic health record (EHR) use. This observational mixed-methods study included admission document analysis, structured interviews, and a think-aloud protocol with 18 nurses from 3 diverse HHC agencies (6 at each) admitting 2 patients each (36 patients). Findings show that prior to entering the home, nurses had an information deficit; they either did not predict the patient’s visit frequency and episode duration or stated them based on experience with similar patients. Following patient interaction in the home, nurses were able to make this decision. Completion of documentation using the EHR did not appear to influence visit pattern decisions. Patient condition and insurance restrictions were influential on both frequency and duration. Given the information deficit at admission, and the delay in visit pattern decision making, we offer health information technology recommendations on electronic communication of structured information, and EHR documentation and decision support.

The Association Between African American Father–Child Relationships and HIV Testing

The existing literature identifies parent communication as a protective mechanism in the reduction of sexual risk behaviors among youth; however, not much is known about father–child communication and bonding and its association with HIV testing. Therefore, this study examines the link between the relationship, bonding, and communication shared by African American (AA) fathers and their children and HIV testing over time. This secondary data analysis included data from Waves 1 and 3 of the National Longitudinal Study of Adolescent to Adult Health on the health of adolescents to adults in a sample of AA males and females ( N = 509), with a mean age of 16 years. The independent variables included fathers’ communication, bonding, and relationships, and the dependent variables included HIV testing. A multinomial analysis assessed the factors that contributed to or prevented HIV testing. It was found that the overall model was statistically significant; F(24, 55) = 8.95; p < .001. The results suggest that father–adolescent communication was statistically significant and positively associated with HIV testing ( B = 23.88; p < .05). AA adolescents who reported going to the doctor or making a nursing visit were more likely to get tested multiple times ( B = 13.91; p < .001). Our findings indicate that father–child relationships are essential to adolescent sexual development and serve as a protective factor against threats to sexual health. Future studies should be designed to investigate the cognitive mechanisms through which the father–child bonding and communication may impact HIV testing.

Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

Improving patient prioritization during hospital-homecare transition: A protocol of a mixed-methods study of a clinical decision support tool implementation (Preprint)

BACKGROUND Homecare settings across the United States provide care to more than 5 million patients every year. About one in five homecare patients are rehospitalized during the homecare episode, with up to two-thirds of these rehospitalizations occurring within the first two weeks of services. Timely alloca-tion of homecare services might prevent a significant portion of these rehospitalizations. The first homecare nursing visit is one of the most critical steps of the homecare episode. This visit includes an assessment of the patient's capacity for self-care, medication reconciliation, an examination of the home environment, and a discussion regarding whether a caregiver is present. Hence, appro-priate timing of the first visit is crucial, especially for patients with urgent healthcare needs. However, nurses often have limited and inaccurate information about incoming patients and patient priority decisions vary significantly between nurses. We developed an innovative decision support tool called “Priority for the First Nursing Visit Tool” (PREVENT) to assist nurses in prioritizing patients in need of immediate first homecare nursing visits. OBJECTIVE To evaluate the effectiveness of the PREVENT tool on process and patient outcomes; and to exam-ine aspects of PREVENT’s reach, adoption, and implementation. METHODS Employing a pre post design, and survival analysis and logistic regression with propensity score matching analysis we will test the following hypotheses: Compared to not using the tool in the pre-intervention phase, when homecare clinicians use the PREVENT tool, high risk patients in the inter-vention phase will: a) receive more timely first homecare visits and b) have decreased incidence of rehospitalization and have decreased emergency department (ED) use within 60 days. Reach, adoption, and implementationwill be assessed using mixed methods including homecare admis-sion staff interviews, think-aloud observations, and analysis of staffing and other relevant data. RESULTS The study research protocol was approved by the institutional review board in October 2019. PRE-VENT is currently being integrated into the electronic health records at the participating study sites. Data collection is planned to start in early 2021. CONCLUSIONS Mixed methods will enable us to gain in-depth understanding of complex socio-technological as-pects of the hospital to homecare transition. The results have the potential to (1) influence the standardization and individualization of nurse decision making thru the use of cutting-edge technol-ogy and (2) improve patient outcomes in the understudied homecare setting. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04136951, https://clinicaltrials.gov/ct2/show/NCT04136951?term=Maxim+Topaz&id=NCT04136951&draw=2&rank=1