Objective: This study was designed to better understand perceived barriers and facilitators to providing medication therapy management (MTM) services by pharmacists who recently provided telephonic MTM services to home health care patients. These services were provided as part of a randomized, controlled trial (RCT) to develop suggested quality improvement strategies for future service design. Design: This was a qualitative study. A semi-structured individual interview format was used to elicit responses. Setting: Interviews were conducted by phone with participants. Participants: All pharmacists who recently provided telephonic MTM services as a part of an RCT participated in this study. Interventions: Pharmacists were asked questions regarding their perceptions of the services, training opportunities, patient perceptions of the services, interactions with physicians, and suggestions for improvement. General demographic information was collected for each pharmacist and summarized using descriptive statistics. Interview data were analyzed using inductive qualitative methods to reveal key themes related to facilitators and barriers of MTM services in home health care patients. Main Outcome Measures: The main outcome measures were major themes identified from pharmacist interviews pertaining to barriers, facilitators, and quality improvement strategies for telephonic MTM delivery. Results: A total of four pharmacists (i.e., 100% of those who participated in the prior RCT) were interviewed. Several themes emerged from the analysis, including: communication and relationships, coordinating care and patient self-management, logistics, professional fulfillment, service delivery and content, and training opportunities. Conclusions: This study provides possible strategies to overcome barriers and facilitate service provision for future telephonic MTM services.

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The marketing of home heal_th care services is unique in its considerable variance in successes across geographic regions in the United States. Through surveys to home health companies, this study investigates four key factors believed to contribute to the success of home health care companies: marketing techniques, variation in technology, demand for services, and effects of regulations. Many factors. determine success, but it is important to determine the significance of regional differences as a factor in that success. Based on the importance of location selection, it is believed that results will show that location and marketing differences play a significant part in the success of a company (Spaeder 2005). It is indicated by the marketing concept that "firms should analyze the needs of their customers and then make decisions to satisfy those needs," (Weitz 1985); This indicates that areas with more companies can actually be more successful because they were forced to develop better marketing practices and plans due to the density of companies in the region. The potential impact of this research upon the home health industry is considerable. Little substantial research has been conducted regarding the marketing of home health, arid even less research projects have been implemented involving regional differences. The importance of researching this is found in its impact on how agencies market themselves. By spreading this new information about what makes a company successful and the regional differences, companies can improve marketing techniques, stimulating their success rates. In addition, given the increased number of people retiring in the next decade, this research is relevant and needed.

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.

The profession of occupational therapy is widely misunderstood. Other healthcare professionals and clients do not understand the values, scope of practice, or skillset occupational therapy practitioners (OTPs) embody. This leads to OTP burnout and suboptimal patient care. Further, OTPs have assimilated to the practices of other health disciplines which perpetuates the problem. This project proposes a solution to be utilized within a home health setting that addresses the issue from three angles: instruction for other healthcare professionals that is provided at a level commensurate with previous experience and education, education for clients accessible for all levels of general and health literacy, and support for OTPs in the form of updated documentation methods to facilitate a return to occupation-based practice. EKB Model of Consumer Behavior drives the approach, and instruction methods are based on Adult Learning Theory. AOTA’s Occupational Therapy Practice Framework: Domain and Process 4th Edition (OTPF-4) supports the development of documentation to facilitate occupation-based practice. This proposal is the first to provide a comprehensive, theory-driven solution to the issue and this model can easily be adapted to settings outside home health.

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No description available.

Within the framework of economic constraints and demographic changes which the health care sector is confronted to, the Home Health Care (HHC) which has been created sixty years ago, has known an important growth during this last decade. The main objective of this alternative to the traditional hospitalization consists in solving the problem of hospitals' capacity saturation by allowing earlier discharge of patients from hospital or by avoiding their admission while improving or maintaining the medical, psychological and social welfare of these patients. In this thesis, we are interested in the operations management within the HHC structures. In the first part of this thesis, we develop a qualitative analysis of the operations management in the HHC context. More specifically, we identify the complexity factors that operations management has to face up within this type of structures. For each complexity factor, we discuss how it can affect the organization of the care delivery. These factors pertain to the diversity of the services proposed, the location of care delivery, the uncertainty sources, etc. Thereafter, we survey operations management based models proposed in the literature within the HHC context. Based on this literature review, we identify several emerging issues, relevant from an organizational point of view, that have not been studied in the literature and thus represent unexplored opportunities for operations management researchers. In the second part of this thesis, we are interested in the partitioning of the area where the HCC structure operates into districts. This districting approach fits the policies of improvement of the quality of care delivered to patients and the working conditions of care givers as well as costs' reduction. We begin by proposing a classification of the different criteria that may be considered in the districting problem. We then propose two mathematical formulations for the HHC districting problem for which we consider criteria such as the workload balance, compactness, compatibility and indivisibility of basic units. After that, we present a numerical analysis of the computational experiments carried out on randomly generated instances to validate these two models. We also present two possible exploitations of these models and propose two extensions to these basic formulations. After formulating the problem with a static approach, we also develop a dynamic extension which allows the integration of the different variations that can be observed within the activities of an HHC structure from period to period. We then introduce a new partitioning criterion that concerns the continuity of care evaluated on the basis of two sub-criteria. Depending on the preferences of the decision-makers concerning the sub-criteria related to the continuity of care in the districting problem, we then distinguish three scenarios for which we propose the associated mathematical formulations.

Thesis advisor: Rosanna DeMarco / Abstract Testing the Efficacy of A Nurse-Led, Patient Self-Management Intervention to Decrease Rehospitalization in Older Adults Merrily Evdokimoff, Ph.D. Rosanna DeMarco, Ph.D., Committee Chair Rehospitalization rates of 20% within 30 days of hospital discharge and 27% within 60 days are one of the highest strains on the federal Medicare budget. The Center for Medicare and Medicaid Services (CMS) has responded by imposing financial disincentives in reimbursement regulations directed to those providers deemed responsible for preventable rehospitalizations. Identifying cost-effective interventions that are appropriate for individuals with chronic illnesses that may be provided within the current home health care system of reimbursement is critical. The purpose of this quasi-scientific intervention study was to test the efficacy of a cost-effective, nurse-led intervention to decrease rehospitalizations of community dwelling older adult Medicare beneficiaries receiving certified home health services following an acute care hospital admission. The intervention was based on Eric Coleman's Care Transition Intervention SM utilizing a personal health record, patient goal setting, and knowledge of "red flags" or changes in condition. Coaching by the home care nurses was added to Coleman's intervention to facilitate support of patient self-management. Three home care agencies, 60 clinicians and 87 patients participated in the study. Findings demonstrated a lower rate of readmission to the hospital in patients receiving the intervention. However, it was not statistically significant. Significant differences were noted between the intervention and the comparison groups including more married or partnered members and higher Case Mix Weight (CMW) or acuity score within the intervention group. Among the rehospitalized participants, provision of a greater number of skilled nursing visits was found. Future replication of the study should include a larger sample and greater time for education of the clinical staff. Inclusion of therapists and productivity adjustments for participating staff during initiation of study is also needed. Further examination of the role of depression in rehospitalization with a larger sample would provide greater understanding of the role depression plays in self-management and rehospitalization. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Across the US, 22% of Medicare patients hospitalized with a diagnosis of heart failure (HF) will be readmitted within 30-days of discharge. There is no one costeffective process identified to help patients transition home and maintain their own selfcare. The aim of this study is to compare readmission rates, HF knowledge, self-care, and quality of life for patients who transition home from the hospital under the care of a Heart Failure Nurse Navigator (HFNN) with patients who receive usual care. The HFNN is a home health RN with specialized training in HF care. The HFNN visited intervention group (IG) participants once in the hospital, followed by weekly home visits for one month. Control group (CG) participants received usual care, consisting of discharge teaching by their primary nurse and follow-up with their primary care provider (PCP) or cardiologist. Using a sequential mixed methods research design, this experimental randomized controlled trial measured HF knowledge, HF self-care, and HF quality of life (QOL) at enrollment and one month after discharge. Hospital readmissions and/or ED visits were tracked in both groups. IG participants were interviewed using semi-structured questions, findings of which were analyzed using conventional content analysis. There were fewer all-cause hospital readmissions in the IG (3 of 19) than the CG (6 of 21.) CG participants were 2.2 times more likely to be readmitted than the IG participants. [x(1)=.935, p=.334 O.R.=2.2219]. Due to limited enrollment, these results were underpowered and not statistically significant. There was improvement in HF knowledge (p=.06) and HF self-care maintenance (p=.07), approaching significance. HF self-care maintenance improved in both groups, although the IG was not significantly better (p=.48). There was significant improvement in the IG for HF confidence (p=.002) and HF QOL (p<.001). The qualitative findings revealed two main categories from the IG: (1) personal clarification of patient education, especially related to diet, exercise, and medications and (2) feelings of support, reassurance, and safety. The HFNN may be one role to meet the triple aim of improving patient quality care and health outcomes at a reduced cost, especially in areas where a comprehensive HF management program is not available. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection