Chapter 9 Home Health and Related

Community-Based Systems

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Introduction

 Home is the optimal location for diverse health and nursing services.

 Home can be:

 House

 Apartment

 Dormitory

 Trailer

 Boarding and care home

 Hospice house

 Assisted living facility

 Shelter

 Car

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Evolution and Milestones

 1893: Henry Street Settlement House is opened.

 Early 20th century: Public health departments are

established.

 1965: Medicare legislation includes home health

services.

 1970s: Hospice care is introduced.

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Practice Models

 Home health

 Delivery of intermittent health-related services in

patients’ places of residence with the goal of promoting

self-care and independence, rather than

institutionalization

 Palliative care and hospice

 Delivery of services by teams of interprofessional

clinicians for those who have exhausted curative

treatment measures or have life expectancies of

6 months or less

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Practice Models (Cont.)

 Public health

 Offers health services to individuals, families, and

communities to provide services and education to promote

wellness

 Nurse-managed health centers

 Primarily offers outpatient clinic and primary healthcare

and social services provided by nurses

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Practice Models (Cont.)

 Other practice sites

 Noninstitutional settings (eg, school, community)

 Similarities among practice models

 Interprofessional collaboration

 Based on the consumer movement

 Triple Aim for Health Care model

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Standardized Datasets

 Outcome and Assessment Information Set (OASIS)

 Standardized dataset that home health agency clinicians

complete with their patients

 Continuity Assessment Record and Evaluation (CARE)

 Standardized dataset that can predict the appropriate

level of care or care setting that supports optimal patient

outcomes at the lowest possible cost

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Standardized Datasets (Cont.)

 Hospice quality measures

 2008: Conditions of participation for hospice

 2010: The Affordable Care Act

 Patient experience surveys

 Required in home health agencies and skilled nursing

facilities to measure the interpersonal value of healthcare

experienced by the patient

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Supporting Home Health with Electronic Health Records and Information Technology

 Billing solutions

 As financial systems and electronic capabilities advanced, bi-directional

exchange of claims information management became commonplace.

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Supporting Home Health with Electronic Health Records and Information Technology (Cont.)

 Point-of-care solutions

 Enable electronic capture of the service date and time for billing and payroll

purposes.

 Value increased in 1998 with Prospective Payment System.

 Use of standardized dataset changed payment methodology and improved the

quality of the services offered.

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Transition of Risk from Payer

to Provider

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Supporting Home Health with Electronic Health Records and Information Technology (Cont.)

 Clinical decision support systems

 Applications analyze data and help healthcare providers make clinical

decisions.

 Approaches include the following:

 Best and evidence-based practice options are presented to the clinician by finding

and displaying what is known about the patient to a knowledge base, using rule sets

and an interface engine.

 Process of machine learning presents or displays best and evidence-based practice

options to the clinician as a result of analyzing the data entered and comparing it

with similar patterns or scenarios that exist in the system.

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Standardized Terminologies

 American Nurses Association (ANA) recognizes 12

reference and point-of-care or interface terminologies.

 Standardized terminologies are important for the

following two reasons:

 Interoperability among systems

 Interoperability with future systems

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Omaha System

 Is an example of point-of-care terminology.

 More than 9000 interprofessional clinicians, educators,

and researchers use the Omaha System.

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Description of the Omaha

System

 Consists of the:

 Problem Classification Scheme

 Intervention Scheme

 Problem Rating Scale for Outcomes

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Description of the Omaha

System (Cont.)

 Problem Classification Scheme

 Is a comprehensive, orderly, nonexhaustive, mutually

exclusive taxonomy designed to identify diverse patients’

health-related concerns

 Intervention Scheme

 Is a comprehensive, orderly, nonexhaustive, mutually

exclusive taxonomy designed for use with specific

problems

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Description of the Omaha

System (Cont.)

 Problem Rating Scale for Outcomes  Consists of three five-point, Likert-type scales for

measuring the entire range of severity for the concepts of

Knowledge, Behavior, and Status

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Description of the Omaha

System (Cont.)

 Should demonstrate:

 Patient-centered care and the power of the patient and

family

 Evidence-based practice

 Interprofessional practice

 Practice and documentation using standardized

terminology

 Practice, documentation, and information management

linkages

 External monitoring and quality control

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Conclusion and Future

Directions

 The evolution of the home health field takes into

consideration the goals of:

 Supporting safe transitions among care settings

 Effectively managing patient populations

 Participating in accountable care organizations

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The focus of Chapter 9 is home health and related community- based systems. What are your experiences with such settings? Do you expect to have more contact with them in the future?

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