Home health services research.

This chapter reviews 69 published research reports of home health care from a health services perspective by nurse researchers and researchers from other disciplines. Reports were identified through searches of the National Library of Medicine (MEDLINE), and the Cumulative Index to Nursing and Allied Health Literature and Social Sciences Citation Index using the following search terms: home health care, health services research, and elders. Within the major areas identified, the following additional terms were specified: resource use and outcomes. Reports were included if published between 1995 and 2001, used samples age 65 and older, performed in the U.S., and published in English. Studies of all types were included. The key findings follow: (a) Most studies were a theoretical. If a theoretical model was used, it was most often the Andersen Behavioral Model. (b) Few conclusions can be drawn about resource use--increasing age and higher severity of health related problems are associated with higher numbers of home visits. The variety of measures of resource use and the study approaches (large national data sets versus single or several agency samples) limits the ability to draw conclusions on resource use. (c) There is a growing body of evidence on rehospitalization of home health care patients which indicates rehospitalization is prevalent but largely not predictable. (d) Patient outcomes research is inconclusive at this point, primarily because there are few studies that examine patient outcomes using a consistent set of measures. The main recommendations are: to study rehospitalization using a more profile-based approach to determine visit patterns that may be effective, to further specify the kinds of outcomes that may be achieved as a result of home health care and which patients might be expected to achieve positive outcomes, and to examine the integration of home health care with the broader community-based services.