Planning Strategies for Home Health Care Delivery

In home health care, continuity of care, wherein a patient is always visited by the same nurse, can be just as important as cost, as it is closely correlated to quality of care. While a patient typically receives care for two to three months, such that assigning a nurse to a patient impacts operations for lengthy periods of time, previous research focusing on continuity of care uses planning horizons that are often a week or shorter. This paper computationally demonstrates that considering a long planning horizon in this setting has significant potential for savings. Initially, a deterministic setting is considered, with all patient requests during the planning horizon known a priori, and the routing cost of planning for two to three months is compared with the cost when planning is done on a weekly basis. With inherent uncertainty in planning for such a long time horizon, a methodology is presented that anticipates future patient requests that are unknown at the time of planning. Computational evidence shows that its use is superior to planning on a weekly basis under uncertainty

Nursing Informatics and Digital Technology Using in Aging Home Care Delivery Development

This participatory action research aimed to enhance nurses’ role in informatics and digital technology for aging home care delivery at 13 health-promoting hospitals, in Kantharawichai District, Mahasarakham Province, Northeastern Thailand from January - December 2021. There were 139 participants; 13 nurses, 52 community caregivers, 37 family caregivers, and 37 bed-bound elderly. The researchers facilitated the participants sharing of their own experiences and reflected on aging home care. This research included four phases; 1) Assessment; data was collected through in-depth interviews, small group dialogue, and observation of nurses and caregivers practicing, 2) Intervention planning; three times brainstorming was created for health problem identification and intervention planning, 3) Intervention; participants joined aging home care delivery, 4) Evaluation; brainstorming was created for each health promoting hospital evaluation. Content analysis was used for data analysis. Results showed that; Nurses as care managers of this PAR cooperative learning efforts increased knowledge, attitude, and practice in informatic and digital technology to develop aging home care. They formulated strategies to supervise caregivers caring for bed-bound elderly; 1) enhancing caregivers’ knowledge through the application, raising awareness and skill regarding informatics and digital technology applied for care plan and counseling, 2) promotion of online reports for aging caregiver activities, 3) creation line official for supervising caregiver caring, and 4) online network development of aging home care delivery linked to district hospital for medical consulting and local administrative organization for economic and social consulting. The empowering participatory process of this PAR could encourage nurses to create a way for effective supervision and cooperative primary care through line official effectiveness. This process can be applied to create and enhance informatics and digital technology for complex caring in rural areas

Effective health care for older people living and dying in care homes: A realist review

Background: Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes. Methods: We conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effective in some situations and not others. We searched electronic databases and related grey literature. Finally the findings were reviewed with an external advisory group. Results: Strategies that support and sustain relational working between care home staff and visiting health care professionals explained the observed differences in how health care interventions were accepted and embedded into care home practice. Actions that encouraged visiting health care professionals and care home staff jointly to identify, plan and implement care home appropriate protocols for care, when supported by ongoing facilitation from visiting clinicians, were important. Contextual factors such as financial incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support relational working to occur, but of themselves appeared insufficient to achieve change. Conclusion: How relational working is structured between health and care home staff is key to whether health service interventions achieve health related outcomes for residents and their respective organisations. The belief that either paying clinicians to do more in care homes and/or investing in training of care home staff is sufficient for better outcomes was not supported.This research was funded by National Institute of Health Research Health Service Delivery and Research programme (HSDR 11/021/02)

Promoting contraceptive uptake to reduce the unmet need for family planning during the postpartum period in Ethiopia:PPFP in Ethiopia

This thesis explores how postpartum family planning (PPFP) could be enhanced and promoted in Ethiopia. It attempts to recommend approaches and strategies that can improve and promote the PPFP in the Ethiopian context, which can also be adopted in other similar settings.Integrating PPFP into existing community-based care along the pregnancy-to-extended-postpartum continuum is promising for improving uptake in populations with high rates of home delivery. These urges integrating PPFP into the existing MNCH services, particularly at the health and community levels, to improve contraceptive uptake during the postpartum period in Ethiopia.Findings in this thesis also showed that each additional MNCH contact where family planning was discussed increased the likelihood of PPFP uptake in health facilities. Family planning discussions during pregnancy and child immunization contacts were found to have an impact on PPFP uptake for women who delivered at home, and family planning discussions during postnatal care were important for women who delivered in health facilities.The success of the PPFP implementation plan must be regularly monitored and evaluated in order to assess how successfully the goals have been met. In order to do this, PPFP indicators must be included in the country’s HMIS, and health facilities must get assistance in order to continue offering services and keeping records and reports. This requires policies and strategies supporting these activities.Moreover, increasing women's FP literacy both at community and health facility levels can support the HTSP and lessen the SIPI we currently see among Ethiopian women. This could be achieved through individual and group education at the community and health facility levels. Addressing social determinants of health (SDOH) that are impacting poor PPFP uptake through already validated approaches is also critical to improving women’s health and wellbeing

Promoting contraceptive uptake to reduce the unmet need for family planning during the postpartum period in Ethiopia:PPFP in Ethiopia

This thesis explores how postpartum family planning (PPFP) could be enhanced and promoted in Ethiopia. It attempts to recommend approaches and strategies that can improve and promote the PPFP in the Ethiopian context, which can also be adopted in other similar settings.Integrating PPFP into existing community-based care along the pregnancy-to-extended-postpartum continuum is promising for improving uptake in populations with high rates of home delivery. These urges integrating PPFP into the existing MNCH services, particularly at the health and community levels, to improve contraceptive uptake during the postpartum period in Ethiopia.Findings in this thesis also showed that each additional MNCH contact where family planning was discussed increased the likelihood of PPFP uptake in health facilities. Family planning discussions during pregnancy and child immunization contacts were found to have an impact on PPFP uptake for women who delivered at home, and family planning discussions during postnatal care were important for women who delivered in health facilities.The success of the PPFP implementation plan must be regularly monitored and evaluated in order to assess how successfully the goals have been met. In order to do this, PPFP indicators must be included in the country’s HMIS, and health facilities must get assistance in order to continue offering services and keeping records and reports. This requires policies and strategies supporting these activities.Moreover, increasing women's FP literacy both at community and health facility levels can support the HTSP and lessen the SIPI we currently see among Ethiopian women. This could be achieved through individual and group education at the community and health facility levels. Addressing social determinants of health (SDOH) that are impacting poor PPFP uptake through already validated approaches is also critical to improving women’s health and wellbeing