Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.

Background: Home health is the fastest-growing healthcare setting in the country. Through Home Health Value-Based Purchasing (HHVBP), the Center for Medicare and Medicaid Services (CMS) provides incentives or penalties to HHAs based on outcomes. Hospitalization and emergency department use are weighted heaviest as poor outcomes. HHVBP requires HHAs to report on whether they are engaging in advance care planning (ACP) conversations. For this study, ACP was defined as a conversation held in advance of a medical crisis with a loved one and/or a health care provider about goals; values; preferences for future medical treatments; and choice of a surrogate decision-maker. Purpose: to determine whether the proportion of Black patients was correlated with robustness of HHAs’ ACP protocols and levels of acute care services use. Methods: A cross-sectional, quasi-interventional design was used. The sample size was n = 89. Electronic surveys about ACP protocols were distributed to HHAs. Existing data about demographics and acute care services use were accessed via CMS websites. Spearman’s correlation coefficient was used. Results: No relationship was found between robustness of ACP protocols and the proportion of Black population per agency. No relationship was found between overall acute care services use rates proportion of Black patients. However, a trend was found: The greater proportion of Black patients, the greater the tendency for an agency to have a higher hospitalization rate. Discussion: Results are compared to current literature and to a CMS-commissioned study’s discussion about the potential for value-based purchasing programs to exacerbate health disparities in vulnerable populations.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23385号 / 人健博第92号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 田村 恵子, 教授 稲富 宏之, 教授 溝脇 尚志 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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Hedström Tom, Care planning teams. Advantages and disadvantages. Examination work C-level, 15 hp, Malmö Högskola, Health and society, Social works program, autumn semester 2009.The purpose of my work was to find out what the advantages and disadvantages might be with a care planning team from a support administrators point of view. The data collection for this work was done by semi-structured qualitative interviews with five people, all working as support administrators within the social services in the same region and town in Sweden. In my choice of interviewees i have tried to get such a diverse mix as possible when it comes to the interviewees experience in the profession and experience with care plannings. My results show that support administrators approach to care planning teams is profound positive, but that its structure and organization has a very vital role.

Children with cleft lip/palate receive team care which typically ends at eighteen. Young adults then need to transition into an adult centered model of care. A paucity of literature exists regarding their perspective on transition of care experience. This research explores the experiences young adults with CLP regarding their transition of care process, within the person centered ICF framework.

Chronic cardiovascular and pulmonary diseases are prevalent in the US home health population. Heart failure and chronic obstructive pulmonary disease are both chronic and terminal, but they are not always perceived as serious illnesses with imminent death. Therefore, they provide a context for advance care planning that is distinct from the diagnostic contexts of cancer, end-stage renal disease, or dementia. Advance care planning is defined as a process that supports adults at any age or stage of health in understanding and sharing their goals, values, and preferences about future medical care, including the designation of a surrogate decision-maker. This study tests the hypothesis that US home health agencies with higher percentages of patients with chronic cardiovascular and pulmonary conditions have less robust advance care planning protocols. The Spearman correlation coefficient was r = 0.22 (S = 74684, P =.025, 1-tailed), which was statistically significant and an unexpected finding. The greater percentage of patients with chronic cardiac and pulmonary diagnoses in an agency, the more robust the advance care planning protocol was. This supports our previous findings and existing literature indicating that agencies may be using exacerbation events marked by acute care use as opportunities to initiate or repeat advance care planning.

Trots lagstiftning kring patienters delaktighet i vården ses en tydlig brist på delaktighet vid vårdplanering hos patienter inom psykiatrisk vård. Syftet med det här arbetet var att sammanställa kunskap genom en metasyntes för att nå en djupare förståelse av patienters upplevelser av delaktighet vid vårdplanering i den psykiatriska vården. Detta genom frågeställningarna vad beskriver patienter främjar respektive hindrar delaktighet vid vårdplanering i den psykiatriska vården. Tio artiklar svarade mot vårt syfte och inkluderades. Analysen av dessa resulterade i att tre teman identifierades: 1.“Det yttre lagret: Vårdplanen som ett värdefullt stödverktyg eller en meningslös upprepning” 2. Det mellersta lagret: “Att navigera oenigheter för en känsla av att äga innehållet”, och 3. Det inre lagret: “En vilja att ses som expert men en samtidigt upplevd maktlöshet”. De tre identifierade lagren syntetiserades i syfte att få en djupare förståelse och ny kunskap av patienters upplevelser av delaktighet i vårdplaneringsprocessen. Syntesen visar på tre lager som har en bestämd ordning där kärnan i syntesen och de tre identifierade lagren utgår från individen, som är expert.

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