Madeline R Sterling1, Nicola Dell2, Benedetta Piantella3, Jacklyn Cho4, Harveen Kaur5, Emily Tseng2, Fabian Okeke2, Mikaela Brown2, Peggy B K Leung4, Ariel F Silva4, Amy L Shaw4, Lisa M Kern4. 1. Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, New York, NY, 10021, United States. mrs9012@med.cornell.edu. 2. Cornell Tech, New York, NY, USA. 3. New York University, New York, NY, USA. 4. Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, New York, NY, 10021, United States. 5. Hackensack Meridan Health, Hackensack, NJ, USA.
Abstract
BACKGROUND: Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal. OBJECTIVE: We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist. DESIGN AND PARTICIPANTS: In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018. APPROACH: Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image. KEY RESULTS: Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step. CONCLUSIONS: Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.
BACKGROUND: Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HFpatients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal. OBJECTIVE: We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist. DESIGN AND PARTICIPANTS: In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HFpatients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018. APPROACH: Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HFpatients. We synthesized the drawings into a final image. KEY RESULTS: Study participants (N = 80) described HHC for HFpatients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step. CONCLUSIONS: Our findings suggest that HHC for HFpatients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HFpatients in the post-discharge period.
Entities:
Keywords:
health services research; heart failure; home health care; qualitative research
Authors: Barbara Riegel; Debra K Moser; Stefan D Anker; Lawrence J Appel; Sandra B Dunbar; Kathleen L Grady; Michelle Z Gurvitz; Edward P Havranek; Christopher S Lee; Joann Lindenfeld; Pamela N Peterson; Susan J Pressler; Douglas D Schocken; David J Whellan Journal: Circulation Date: 2009-08-31 Impact factor: 29.690
Authors: Christine D Jones; Kathryn H Bowles; Angela Richard; Rebecca S Boxer; Frederick A Masoudi Journal: Circ Cardiovasc Qual Outcomes Date: 2017-05
Authors: Christopher M Murtaugh; Partha Deb; Carolyn Zhu; Timothy R Peng; Yolanda Barrón; Shivani Shah; Stanley M Moore; Kathryn H Bowles; Jill Kalman; Penny H Feldman; Albert L Siu Journal: Health Serv Res Date: 2016-07-28 Impact factor: 3.402
Authors: Lawrence A Palinkas; Sarah M Horwitz; Carla A Green; Jennifer P Wisdom; Naihua Duan; Kimberly Hoagwood Journal: Adm Policy Ment Health Date: 2015-09
Authors: Madeline R Sterling; Ariel F Silva; Laura Robbins; Savira K Dargar; Marilyn M Schapira; Monika M Safford Journal: BMJ Open Date: 2018-09-19 Impact factor: 2.692