Trends in home diagnostic testing for medicare beneficiaries.
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Diagnostic Techniques and Procedures↗
Biomedical subjects
Elizabeth A Madigan
Publications and source records attributed to Elizabeth A Madigan.
Functional status decline as a measure of adverse events in home health care: an observational study.
BACKGROUND: Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research. METHODS: Data come from the Outcomes and Assessment Information Set (OASIS) from a large urban home health care agency and other agency data. Prognostic data yields 49,437 episodes, while follow-up data yields 47,684 episodes. We tested three indices defined as substantial decline in three or more (gt3_ADLs), two or more (gt2_ADLs), and one or more (gt1_ADLs) ADLs. Multivariate logistic regression determines the performance of the models for each index as measured by the c-statistic and Hosmer-Lemeshow chi square (chi2). RESULTS: Frequencies for gt3_ADLs, gt2_ADLs, and gt1_ADLs are 212 (0.43%), 783 (1.58%), and 4,271 (8.64%) respectively. Follow-up results are comparable with frequencies of 218 (0.46%), 763 (1.60%), and 3,949 (8.28%) for each index. Gt3_ADLs does not produce valid models. The model for gt2_ADLs consistently yields a higher c-statistic compared to gt1_ADLs (0.754 vs. 0.679, respectively). Both indices' models yield non-significant Hosmer-Lemeshow chi square indicating reasonable model fit. Findings for gt2_ADLs and gt1_ADLs are consistent over time as indicated by follow-up data results. CONCLUSION: Gt2_ADLs yields the best models as indicated by a high c-statistic and a non-significant Hosmer-Lemeshow chi2, both of which exhibit exceptional consistency. We conclude that gt2_ADLs may be preferable in defining ADL adverse events in the context of home health care.
Activities of Daily Living↗
A data mining approach in home healthcare: outcomes and service use.
BACKGROUND: The purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. In particular, discharge destination and length of stay have not been studied using a data mining approach which may provide insights not obtained through traditional statistical analyses. METHODS: The data were obtained from the 2000 National Home and Hospice Care Survey data for three specific conditions (chronic obstructive pulmonary disease, heart failure and hip replacement), representing nearly 580 patients from across the US. The data mining approach used was CART (Classification and Regression Trees). Our aim was twofold: 1) determining the drivers of home healthcare service outcomes (discharge destination and length of stay) and 2) examining the applicability of induction through data mining to home healthcare data. RESULTS: Patient age (85 and older) was a driving force in discharge destination and length of stay for all three conditions. There were also impacts from the type of agency, type of payment, and ethnicity. CONCLUSION: Patients over 85 years of age experience differential outcomes depending on the condition. There are also differential effects related to agency type by condition although length of stay was generally lower for hospital-based agencies. The CART procedure was sufficiently accurate in correctly classifying patients in all three conditions which suggests continuing utility in home health care.
Aftercare↗
OASIS coding, your license, and your reputation.
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Community Health Nursing↗
Risk factors for hospitalization among Medicare home care patients.
This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.
Aged↗
Medical characteristics and tuberculosis treatment outcomes in an urban tertiary hospital, Thailand.
The purpose of this study was to describe medical characteristics and assess treatment outcomes at a respiratory clinic, tertiary hospital, Bangkok, Thailand. One hundred seventy-seven patients diagnosed as having any type of TB and having taken anti-TB drugs for one month were included in the study. The patients were interviewed the end of the first month and their medical files were reviewed at the end of treatment to obtained the treatment outcome. Descriptive statistics and chi-square test were used in the data analyses. Of the total of 177 patients, 33.3% were new smear-positive, 19.2% were new smear-negative, 18.1% were extra-pulmonary TB, and 29.4% were other. The prevalence of TB/HIV co-infection was 33% (18 of 54). Resistance to at least one anti-TB drug was 31.6% (6 of 19). Due to high treatment default rates, treatment completion rates were low, 64.4% in new smear-positives, 61.8% in new smear-negatives, 71.9% in extra-pulmonary TB, and 46.2% in other. Treatment default rates significantly differed among the four types of TB (chi2 = 8.3, p = .04). The findings indicate a high proportion of extra-pulmonary TB, high prevalence of TB/HIV coinfection, and low treatment completion in urban TB patients at the tertiary hospital. Interventions are needed to integrate the strengths of the tertiary hospital regarding the availability of chest specialists and advance diagnostic tools into the other levels of health service to improve treatment outcomes in urban populations.
Adolescent↗
Home health care nursing research priorities.
The purpose of this study was to determine research priorities for home health care nursing. A Delphi study was undertaken to generate and prioritize research topics. The first round consisted of members of the Home Health Nurses Association Research Committee (n = 27); subsequent rounds also included nurse researchers who had conducted research in home health care (n = 17). Consensus emerged after three rounds, with the four most important priorities identified as outcomes, health policy, the use of advanced practice nurses, and models of care/best practice. These areas are consistent with the regulatory events in home health care in the last 10 years.
Delphi Technique↗
Exercise of autonomous home care practice: the relationship with nurse characteristics.
This study examined how the value of autonomy is reflected in home healthcare agencies' practice models and how staff registered nurse (RN) characteristics (education, experience, certification) relate to the RNs' perception of their ability to exercise autonomous practice: control over practice decisions (clinical autonomy) and control over practice setting decisions (organizational autonomy). RNs (N = 82) from 11 agencies were found to have more control over practice decisions than practice setting decisions. No significant relationship was found between RN characteristics of education, RN experience, home healthcare experience, and specialty certification.
Attitude of Health Personnel↗
Interrater reliability of the outcomes and assessment information set: results from the field.
The Outcomes and Assessment Information Set (OASIS) is now used extensively for regulatory, reimbursement, research, and clinical purposes in home health care. However, little is known about the interrater reliability of OASIS items based on assessments from home-health-agency clinicians. Therefore, we evaluated OASIS item interrater reliability among 88 patients from 21 agencies. Of 25 items studied, all except 2 had weighted kappa values of kappa > or = 0.60. We conclude that OASIS item interrater reliability was highly adequate in this study, but we recommend routine interrater-reliability evaluation by agencies to maximize the quality of OASIS data nationally.
Female↗
An examination of the most frequent adverse events in home care agencies.
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Accidental Falls↗
Where does self-care fit within home healthcare?
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Chronic Disease↗
Gender differences in community services knowledge, needs, and use among older African-Americans.
The primary purpose of this study was to compare knowledge of use of and need for community services between older (60 years of age and older) African-American men and women. A secondary purpose was to determine whether predisposing, enabling, and health-status factors could predict knowledge of need for, and use of specific community services among African-American women and men, 60 years of age and older Data were gleaned from a community-based random telephone survey of African-Americans (77 female and 23 male), 60 years of age and older, living in northeastern Ohio. Data generated from this study were analyzed using chi-square, and independent samples t-test, and multiple regression. Findings from this study suggested that women had higher levels of knowledge of use of and need for community-specific services than their male counterparts. Another finding from this study suggested that none of the identified predisposing, enabling, and health-status factors found in this study could plausibly explain knowledge of need for, or use of community-specific services.
Black or African American↗
Accuracy in the Outcomes and Assessment Information Set (OASIS): results of a video simulation.
There is little information regarding the accuracy of the Outcomes and Assessment Information Set (OASIS), the patient assessment tool mandated for use in Medicare-funded home health care. The purposes of this study were to evaluate the accuracy of OASIS completion by home health nurses and rehabilitation therapists, to compare responses of nurses and therapists, and to determine whether dispersion of answers would affect the home health resource group (HHRG) to which patients were assigned for Medicare home health care payments to agencies. Using a video simulation of admission and discharge visits, 436 clinicians from 29 Ohio home health care agencies scored selected OASIS items. Although the majority of the items were rated accurately, discrepancies were found between clinician responses and the "correct" answer on several items. Nurses and therapists provided similar ratings on most items studied, but for most cases in which discrepancies were found, nurses were more likely to agree with the "correct" answer. Discrepancies most often led to patients being assigned to lower-payment HHRGs. Continued monitoring of OASIS data collection accuracy is recommended to maximize the value of the OASIS instrument in home health care research, practice, and policy.
Hip Fractures↗
Measuring disability in Medicare home care patients: application of Rasch modeling to the outcome and assessment information set.
BACKGROUND: The Outcome and Assessment Information Set (OASIS) is the universal clinical assessment tool for adult nonmaternity patients receiving skilled care at home from Medicare-certified home health agencies in the United States. Anticipating increased use of OASIS data for research purposes, this article explored the usefulness of Rasch modeling to address disability measurement challenges presented by the unique response category structure of the seven activities of daily living (ADL) and eight instrumental ADL (IADL) items in the OASIS. OBJECTIVES: To illustrate how Rasch model statistics can be used to evaluate OASIS ADL and IADL item unidimensionality and model fit; to illustrate how Rasch modeling simultaneously estimates ADL and IADL item difficulty, thresholds between item response categories, and person disability; and to compare Rasch estimates of item difficulty and person disability scores to estimates based on more conventional Likert scoring techniques. SUBJECTS: Medicare-eligible home health care patients (n = 583) served by one of 12 home care agencies in Ohio between November 1999 and September 2000. MEASURES: ADL and IADL items were measured three ways: according to the original OASIS scoring (raw Likert); transformed raw Likert scores accounting for the nonuniform item structure (corrected Likert); and Rasch Partial Credit model scores. RESULTS: The items bathing and telephone use showed evidence of unexpected response patterns; recoding of these items was necessary for good Rasch model fit. Partial Credit model results revealed that interval distances between response categories varied widely across the 15 ADL and IADL items. When ADL and IADL items were ranked by level of difficulty, results were similar between Rasch and corrected Likert measurement approaches; however, corrected Likert person scores were found to be nonlinear at highest and lowest disability levels when plotted against Rasch person scores. CONCLUSIONS: Rasch modeling can help improve the precision of disability measurement in Medicare home care patients when using ADL and IADL items from the OASIS instrument.
Activities of Daily Living↗
The scientific dimensions of OASIS for home care outcome measurement.
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Data Collection↗
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.
Clinical Nursing Research↗
OASIS is here to stay. Where do you go from here?
Some version of OASIS will be required for the foreseeable future. Regardless of approach, there are several factors that can influence the accuracy or inter-rater reliability during collection of OASIS data. The authors focus on factors affecting OASIS accuracy within the agency and strategies to evaluate and improve OASIS accuracy.
Clinical Competence↗
The effect of a feeding skills training program for nursing assistants who feed dementia patients in Taiwanese nursing homes.
A quasi-experimental 2-group repeated-measures design was used to test the impact of a feeding skills training program on 67 nursing assistants (treatment group n = 31; control group n = 36) regarding their knowledge, attitudes, perceived behavior control, intentions, and behaviors in feeding dementia patients. The treatment group received a feeding skills training program. Nursing assistants' knowledge, attitudes, perceived behavior control, and intentions were measured before (Pretest) and after the program (Posttest 1), and again 4 weeks later (Posttest 2). Nursing assistants (treatment group n = 20; control group n = 16) and the same number of dementia patients were measured on feeding behaviors during mealtimes before and after the training. The treatment group had significantly more knowledge (P < .001), greater intention to feed (P = .05), and better behaviors toward feeding dementia patients (P = .009) than the control group. There were no significant differences between the groups in attitude (P = .85), intention beliefs (P = .11) or perceived behavior control (P = .99). Thus, the intervention was effective at changing knowledge, intention, and behaviors among nursing assistants.
Adult↗