Uppsatsen är gjord som en systematisk litteraturstudie med en kvalitativ ansats där nio artiklar analyserades. Litteraturstudiens syfte var att beskriva patientens upplevelse av att befinna sig i den sena fasen av den palliativa vården. Vårt resultat visade att patienter som befinner sig i den palliativa vården ville ha kontroll över livet, uppleva trygghet och värderade saker annorlunda. Trygghet upplevdes t.ex. när patienter kunde vårdas i det egna hemmet. Våra fynd visade att förtroende skapar en känsla av trygghet vilket leder till att välbefinnande förstärks och sjuksköterskan får bättre kunskap om patienten och patientens livsvärld. För att fördjupa oss i patientens upplevelse av den palliativa vården har vi använt oss av livsvärldsteori och teori om att finna mening med livet.

This study had two purposes: 1) to compare the difference between home health care only and home health care plus telemonitoring on heart failure patients' symptom burden, self-care of heart failure and re-hospitalization; and 2) to explore which patient characteristics might moderate telemonitoring's impact.Heart failure has emerged as a major public health burden. Like other chronic conditions, heart failure patients have an important role to play in the day-to-day management of their condition. One of the principal reasons for introducing telemonitoring in home health care was to increase heart failure patients' capacity to self-manage their conditions at home.This study used a prospective, non-experimental, comparative, descriptive design. A total of 68 participants were recruited with 34 in each group. Symptom burden and self-care of heart failure were measured on enrollment and 40 days later. Hospitalization was measured as an event that either occurred or did not occur.Although no between-group differences in symptom burden were found, both groups showed significant decreased symptom burden over the 40-day period. Of the three self-care measures, only self-care maintenance differed significantly between the two groups at the 40-day follow-up (p<.05). Only the participant's functional status had significant moderator effect on the relation between type of service received and self-care maintenance (p<.05).The addition of telemonitoring produced similar outcomes to regular home health care, except for self-care maintenance. Like most prior study, this study focused on evaluating the overall relationship between telemonitoring and outcomes without concern for the transformation process. Although these evaluation were able to provide an overall assessment of whether or not the telemonitoring program worked, they cannnot identify the underlying mechanisms that generate the effects. Without knowing what make the program work or not work, it is difficult to pinpoint what needs to be done for future improvement. A theory-oriented evaluation will be needed in future research. Theory-oriented evaluation not only allow reseachers to clarify the connection between a program's operation and its effect, but also to specify intermediate effects of a program that might become evident and measurable.

Abstract Home Health Care (HHC) is a health care service delivered by sending caregivers such as nurses or personal support workers (PSW) to visit patients in their homes. The assignment of patients to nurses as well as the sequencing of patients for each nurse is called the Home Health Care Scheduling and Routing Problem (HHCSRP). This thesis proposes a heuristic approach to solve HHCSRP to which it is hard and even impossible to obtain an optimal solution for relative larger instances in a reasonable amount of computational time by using an exact algorithm as HHCSRP is NP hard. In the approach, this thesis developed and contributed a heuristic partition method to partition patients into a number of single nurse groups. The computational test result shows that the proposed approach can achieve good solutions which remain within 5% of the commercial solver CPLEX’s best solution using an acceptable solution time on all test instances.

No description available.

Optimized Routing and Scheduling (RS) for mobile caregivers is essential for the efficient management of Home Health Care services. Unexpected events, such as traffic jams and visits lasting longer or shorter than expected, may affect the initial caregiver’s schedule by delaying or accelerating visits. Therefore, the RS should be continuously updated to deliver services that respect the problem constraints, e.g., patients’ and caregivers’ availability, caregivers’ breaks, etc., while minimizing the total costs of services. The services costs include travel, overtime, time exceeding patient time windows, and working time differences among caregivers. In this research, we formulate and solve a mixed-integer linear programming RS model that considers delays and earliness throughout the day. Once delays or earliness arise, we propose a rescheduling approach capable of updating the current schedule to consider the time difference and instantly provide a new optimal outcome. Results show a decrease in total costs in 48% of the cases, with an average saving of 349$ per day when rescheduling patients. 15% of the cases present an increase in total costs by an average of 143$ per day. No change is observed in 37% of the cases. Finally, when applying the rescheduling approach, results show that larger time windows provide more significant savings when delays are observed throughout the day.

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.

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.

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.