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The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes

Riggs, Jennifer Sue
http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522

Abstract Details

2009, Doctor of Philosophy, Case Western Reserve University, Nursing.
The relationship between patient characteristics, frontloading nursing visits and home care heart failure (HF) patient outcomes was investigated in this descriptive correlational study, guided by Andersen’s Behavioral Model. Patient characteristics were age, gender, race (predisposing), Medicaid, primary caregiver (enabling), prior hospitalization, HF severity, and comorbidity (need). Frontloading nursing visits was the health service variable. Patient outcomes were dyspnea, oral medication management and activities of daily living (ADL) status at home care discharge and hospitalization during the home care episode. CMS OASIS, home health claims and Medicare Provider Analysis and Review data were merged to construct the 2005 national Medicare-certified home health HF patient population (N=82,258). Logistic regression was used for the dyspnea, oral medication and hospitalization models; multiple regression was used for ADL status.The study population was elderly (mean age 81 years), mostly (62.5%) female and white (83%). Comorbidity was prevalent, but the overlap of comorbidity, disability and geriatric syndromes revealed the extent and complexity of multimorbidity of this patient population. Key findings indicated that older patients were less likely to have dyspnea on discharge, while older patients were more likely to need assistance with oral medication management at discharge. Older age and being female were associated with more ADL impairment at discharge, while baseline ADL status was a very weak predictor. The association between frontloading and the dyspnea and medication outcomes was weak; no significant association was identified with the ADL outcome. For the hospitalization outcome models, findings indicated that patients with Medicaid, more severe HF and more baseline ADL impairment were more likely to have a hospitalization during home care while patients with a prior hospitalization were less likely. Patients who received frontloading were considerably less likely to have a hospitalization. Findings of this study may inform practice and policy. Nursing assessment on home care admission may assist nurses and managers to identify patients at higher risk for selected outcomes, including hospitalization. Future studies need to clarify and extend our knowledge about nursing sensitive outcomes of home care and the effect of frontloading on outcomes for heart failure and other home care patients.
Elizabeth Madigan, PhD (Committee Chair)
Siran Koroukian, PhD (Committee Member)
Shirley Moore, PhD (Committee Member)
Susan Tullai-McGuinness, PhD (Committee Member)
185 p.
Gerontology; Health Care; Nursing
home health care; skilled home care; home health care nursing; home care nursing; heart failure

Recommended Citations

Citations

  • Riggs, J. S. (2009). The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522

    APA Style (7th edition)

  • Riggs, Jennifer. The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes. 2009. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522.

    MLA Style (8th edition)

  • Riggs, Jennifer. "The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes." Doctoral dissertation, Case Western Reserve University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522

    Chicago Manual of Style (17th edition)

case1244663522
1,000
© 2009, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.