The Relationship Between Agency Characteristics and Quality of Home Care

ABSTRACT. Background. This project assessed the relationship between home care quality indicators HCQIs) and agency characteristics. Methods. Twelve agencies completed a mailed survey on a variety of characteristics, including size of their caseload and for-profit (FP) status of contracted service providers. The HCQIs were derived from standardized assessments completed voluntarily for home care clients in Ontario and in Manitoba, Canada. Results. The average caseload was 121.3 clients per case manager, and over 40% of nursing, personal support and therapy providers were considered FP. For individual HCQIs, few correlations were statistically significant. An overall summary measure of quality was correlated with the size of the population served (r = _0.80; p \u3c 0.05) and the number of clients per case manager (r = _0.56; p \u3c 0.1). Conclusion. These data represent unique information on home care quality and organizational characteristics in Canada. The question remains as to how best to use HCQI data to inform practice in an era of limited resources and increasing caseloads

Effect of Preventive Home Visits by a Nurse on the Outcomes of Frail Elderly People in the Community: a randomized controlled trial

Background: Timely recognition and prevention of health problems among elderly people have been shown to improve their health. In this randomized controlled trial the authors examined the impact of preventive home visits by a nurse compared with usual care on the outcomes of frail elderly people living in the community. Methods: A screening questionnaire identified eligible participants (those aged 70 years or more at risk of sudden deterioration in health). Those randomly assigned to the visiting nurse group were assessed and followed up in their homes for 14 months. The primary outcome measure was the combined rate of deaths and admissions to an institution, and the secondary outcome measure the rate of health services utilization, during the 14 months; these rates were determined through a medical chart audit by a research nurse who was blind to group allocation. Results: The questionnaire was mailed to 415 elderly people, of whom 369 (88.9%) responded. Of these, 198 (53.7%) were eligible, and 142 consented to participate and were randomly assigned to either the visiting nurse group (73) or the usual care group (69). The combined rate of deaths and admissions to an institution was 10.0% in the visiting nurse group and 5.8% in the usual care group (p = 0.52). The rate of health services utilization did not differ significantly between the 2 groups. Influenza and pneumonia vaccination rates were significantly higher in the visiting nurse group (90.1% and 81.9%) than in the usual care group (53.0% and 0%) (p \u3c 0.001). Interpretation: The trial failed to show any effect of a visiting nurse other than vastly improved vaccination coverage

Screening Seniors for Risk of Functional Decline: Results of a Survey in Family Practice

To measure functional status, determine risk of functional decline and assess consistency between responses and standardized instruments. Design: A mailed survey which measured functional impairment, recent hospitalization and bereavement. A positive response on at least one of these factors indicated that the individual was “at risk” for functional decline. A random sample (n=73) of “at risk” subjects (specifically, family practice patients aged 70 and older) were assessed by a nurse. Results: The response rate was 89% (369/415), 59% of seniors were female and the mean age was 77.1 (SD=5.5) years. Self-reported risk, based on activities of daily living (ADLs), was associated with impairment in at least one basic ADL (p\u3c0.0005) using a standardized instrument. The positive predictive value of the survey for ADL impairment was 65%. Conclusion: Response to a mailed survey was high and self-reported ADL risks were consistent with findings from standardized assessment tools

Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial

Objective To evaluate the impact of a provider initiated primary care outreach intervention compared with usual care among older adults at risk of functional decline

Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care

BACKGROUND: There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). METHODS: A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI). RESULTS: The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. CONCLUSIONS: Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the ranking of many individual home care providers

Not Bad for an 85-year-old!\u27--the Qualitative Analysis of the Role of Music, Therapeutic Benefits and Group Therapeutic Factors of the St Joseph\u27s Alzheimer\u27s Adult Day Program Music Therapy Group

The aim of this interdisciplinary research project was to gain new understanding into how a music therapy intervention affects the quality of life for clients with dementia. The research was based on the qualitative paradigm, adapted grounded theory, and narrative inquiry (Amir, 2005; Ceglowski, 1997; Coffey & Atkinson, 1996; Corbin & Strauss, 1998; Denzin & Lincoln, 2000; Glaser & Strauss, 1967, 1999; Glaser, 1998;; Glesne, 1997; Strauss & Corbin, 1990, 1997). Music therapy sessions of the Music Therapy program at St. Joseph\u27s Health Centre, Guelph, Ontario, Canada were videotaped and qualitatively analyzed. Residents, family members, and staff were interviewed and the interviews were qualitatively analyzed in order to obtain their perspective. This article summarizes one set of the results of this interdisciplinary study, the qualitative analysis of therapeutic benefits and group therapeutic factors of the St Josephs Alzheimer\u27s Adult Day Program Music Therapy Group. The videotaped sessions of clients with dementia showed that, by participating in the MT sessions, they (1) were able to work through some of their initial negative feelings (e.g., feeling sad, frustrated, stupid), (2) began to feel proud of their accomplishments and eventually (3) began to really enjoy the experience. The Lloyd Carr-Harris Foundation funded the research project. (PsycINFO Database Record (c) 2018 APA, all rights reserved

Predictors of Influenza Immunization among home care clients in Ontario

Background: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients. Methods: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument - Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients' needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment. Results: The overall rate of immunization reached about 80% by 2002. Factors such as age, respiratory problems, diabetes and congestive heart failure were associated with greater uptake, but overall rates of influenza immunization were lower than expected. Low education, smoking and poor medication adherence were negatively associated with influenza immunization. In addition, there was considerable variation in uptake among CCACs after adjusting for other significant individual-level independent variables. Interpretation: Comprehensive assessments like the RAI-HC can be used to help identify and respond to health promotion and disease prevention issues in this population, and to compare rates across Canada