Nov 12, 2018 in Informative

Introduction 

Timeliness in healthcare delivery is a critical area in regard to healthcare improvement across various healthcare settings. Despite the fact that delays in health care services may result in negative effects for a diversity of healthcare issues in different practical settings, there is little information on the impact of health care delays in home care settings. This study is focused on analyzing effects of delayed home health care services after hospital discharge. In particular, the study compares hemodynamic differences between post-discharged members who received home health services and those who did not. 

Background to the Study

  Being discharged after hospitalization is a critical step to recovery. However, this road may take on a risky turn, which may be a serious issue with some medications. This is a common phenomenon, which many people experience within some days upon leaving hospital. Studies have pointed out that even involvement of a medical practitioner in home health services may not be effective in preventing or avoiding medical errors. In most cases, transition from hospital to home may appear tricky and can be derailed by both patients and the healthcare system.

On the side of the healthcare system, patients may be discharged with medication regimens that may not be aligned with the kind of medications they were taking prior to arriving. It should be considered that in most cases medical practitioners do not write medical instructions in a clear way. Moreover, hospital practitioners may not be too concerned about communicating with the team in primary care. Physicians may not follow up on the patient’s recovery while in the home health care environment.

Despite the fact that patients are relegated with responsibilities of adhering to a specified medication, many of them happen not to understand medication/discharging instructions and are not bothered about asking for more clarification on what such instructions mean. Moreover, there are others who are not concerned with following medication instructions once they get home. It is not uncommon for patients to miss some doses or continue with the medication they have been taking before. More still, there are those who do not report or monitor side effects accrued from taking prescribed medication.

 In essence, the aspect of timeliness in health care delivery is an area of interest for efforts related to healthcare improvement across various contexts. Though delays in healthcare service delivery are related to the negative impact and different health disorders across various practical settings, knowledge between delays in instigation of home-based care systems and patient clinical outcome is essential. However, this study is focused on identifying exact literature that presents information in relation to such aspects. 

Objectives

The main objectives for this study include:

    1. To find out how patients managed medical reconciliation while in their homecare settings,
    2. To determine whether patients are satisfied in their homecare settings,
    3. To establish the quality of services in home health services, 
    4. To analyze transition of care between hospital discharge and home health care and finally to establish the risk involved,
    5. Readmission to hospital. 

Methodology

Qualitative and desk approach will be used to find literature in relation to the topic and objectives of the study. The literature will be accessed from different research findings, organizations, and government agencies that have made studies on the same field. Additionally, such peer-reviewed journals as JSTOR, Academic Search Premier, and Business Source Premier will be helpful in researching the topic under study. The method used for finding these studies, journals, and information will consist in using key search words related to the topic in the identified databases and websites. After the articles are accessed, they will be stratified according to the questions they address. Later, by relating the findings to the operations, analysis of the main themes will be conducted. Additionally, data from various healthcare settings will be employed in discussing effects of delayed home health services on patients. The results from this research are deemed helpful for various health care providers, policy makers, home caregivers, and patients. 

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Results

A survey conducted by the Consumer Analysis of Healthcare Systems and Providers in Home Healthcare in 2009 finds that, indeed, delays in commencement of healthcare services and medications have a significant negative effect on the outcome of patients. A timely access to emergency care for stroke, therapies, heart failure, as well as other urgent conditions is critical in minimizing potential risks of medical complications or death. Further, treatment delays, especially for patients with acute coronary syndromes, by as a little as 30 minutes may have an impact on treatment options such as development of thrombosis, which may subsequently lead to increased mortality. What is more, the survey has also established that long wait time, especially for ambulatory care appointments, is related to negative medical outcomes, which include higher mortality. 

Medical Reconciliation

Ziaeian, Araujo, Van Ness, and Horwitz have conducted an assessment regarding changes in intended medication on hospital discharge to determine accuracy of medication reconciliation and understanding of patients. The assessment has been done through comparison of lists in admission and discharge medication, as well as reviewing charts in resolving discrepancies. The scholars have classified changes in medication reconciliation, which do not appear intentional as anticipated provider errors. Further, the authors evaluate understanding of patients in regard to changes in intended medication through the use of post-discharge interviews. The scoring of understanding is done in terms of fullness, absent and partial. In addition, they study relation of relevancy of treatment to the basic diagnosis with accuracy in medication and understanding of patient, primary diagnosis, and medical teams as well as patient demographics. 

The study sample in this assessment included a total of 1377 patients. From this sample, 22.3% of patients in admission medication were either stopped or reduced immediately at discharge. Among these, 137 or (24.2%) were categorized as anticipated provider errors. Without including provider errors, more than half of patients, namely 205 (69.3%), did not understand what reduced medications were. In turn, 223 (81.6 %) stopped the medication upon being discharged from the hospital, while 62% of them decided to take new medications other than the ones prescribed by their hospitals. In general, 81.4% (307) of the patients in the sample had encountered a provider error or did not comprehend any changes in the intended medication. Apparently, providers had a higher likelihood of making an error that was nonetheless unrelated to the basic diagnosis than treatment associated with the basic diagnosis. In addition, the assessment revealed that patients had a probability of misunderstanding changes in medication that were not related to the basic diagnosis. 

These findings, therefore, imply that patient understanding and medical reconciliation were insufficient, especially in the discharge of older patients. Misunderstanding and errors are specifically common in therapies that are not related to basic diagnosis. In this perspective, it is therefore recommended that efforts in improving patient understanding and medical reconciliation ought not to be specified based on some disease, rather they should be focused on a patient as a whole. 

Patient Satisfaction

Patient satisfaction is a significant measure of outcome in assessing the quality of medical care. A study was undertaken by Abusalem, Myers, and Aljeesh in assessing the modern use of patient satisfaction measures in home health care as well as examining the validity and reliability of current measures determining patient satisfaction in home-based care. The methodology employed included the use of a review of literature. These sources of literature were retrieved from electronic databases, which were searched in a systematic manner so as to identify publications and studies that addressed and measured patient satisfaction as well as how the measurement could be incorporated in home health care. 

Findings from these reviews reveal that measures of patient satisfaction have been effectively employed in care programs such as rehabilitation programs, management practices, and care process. Further, patient satisfaction measures have also been used in evaluation of care treatments and protocols. 

The findings imply that healthcare agencies require reliable and valid satisfaction scales. However, it is apparent that patient satisfaction frameworks are still at a younger developmental stage. In essence, only limited variables associated with patient satisfaction could be explained. In this perspective, home care practitioners and researchers have to be considerate on the validity and reliability of tools and measures of patient satisfaction. 

Quality of Services

The National Conference of State Legislatures has established that homecare health services have virtually transformed the health care delivery system. This organization contents that most home-based health services have reduced the costs, while at the same time improving efficiency and quality through an innovative approach and through delivery of a comprehensive primary and preventive care that is patient-centered. 

In Patient Quality and Safety in Home Health Care, Ellenbecker, Samia, Cushman, & Alster have established that health care practitioners both in home-based care and other settings have a concern relating to the quality of care and patient safety. For instance, falls among patients may occur both in hospitals and at home. Furthermore, some of the measures and strategies for prevention of falls could be applicable both in the homecare and hospital settings. However, there are significant variations between home healthcare as well as other types of health care, which in most cases necessitate interventions that are tailored for home health care settings. 

In this study, the authors have found that one third of healthcare patients from elderly homes were taking a drug or drugs that were not appropriate for their conditions or age. To make it worse, these patients were more vulnerable to consequences related to medication errors since there may be no qualified personnel to direct them. In addition, patients were also found to undertake multiple medications for different commodities, which were prescribed by different providers. The majority of patients from older homes were found to take more than five medications, while others deviated from earlier prescribed drugs. Further, it has been found that the probability of medication errors among the population in home-based care is much greater than in other health care settings. Much of the reason is attributed to unique communication challenges and unstructured environment typical in the home health care system. 

Care Transitions

As documented by a study about hospital discharge challenges, care transitions from hospitals to home-based health care typically present challenges both to receiving and discharging facilities. The study has established that an estimated 42 percent of older Americans will at least spend one year of their lifetime in a home-based care or related facility. Another similar study has revealed that many hospitals have difficulty with finding nursing homes, which can accept patients who have complicated health care needs like chemotherapy, dialysis, wound vacuums, mental health needs, and radiation therapy. However, the study has not identified a reason as to why it is difficult to find placement for patients with these conditions. In order to overcome this knowledge gap, it is poignant to develop another survey from the perspective of home-based care that considers specific challenges, which patients face while transitioning from hospitals to home-based care. 

The finding of the survey describes perspectives of healthcare givers on challenges with transitions from health care facilities to home-based care. In more than 30 percent of home-based care contexts, patients were unable to adapt and were readmitted back to hospitals within 35 days and approximately 5 percent of the patients died within 30 days. Nevertheless, the analysis included patients who were hospitalized with psychiatric conditions, medical cancer treatment, or rehabilitation. However, the analysis excluded patients hospitalized for a psychiatric condition, rehabilitation, or medical cancer treatment. This therefore shows that patients moving from hospitals to home-based care experience a number of challenges related to coping with the new environment. Furthermore, there are those who even end up dying to inability to adapt to changing environments.

Readmission Risk

A study conducted by Penn Medicine finds that the quality of home care may not have an influence on the probability of patients being readmitted to hospital or dying within one month after being discharged from hospital. Researchers from Penn Medicine have been interested in establishing what happens in a home care facility when patients are discharged from hospitals. Interestingly, it has been established in this study that some assumptions concerning the effect of the quality in the nursing home on outcomes may have been exaggerated. It has been found in this study that though readmissions to hospitals are common phenomena, they are in most cases costly and can be prevented. In light of this, caregivers and hospital staff need to understand factors necessary for ensuring that patients get the best outcome following hospital discharge. 

The team of researchers has found out that readmission risk or death within one month is usually lower in home care environment where a nurse or healthcare practitioner is available and that has healthcare facilities. Further, readmission rate is lower in homes for patients with acute delirium and severe and moderate pain.

Conclusion

 In summary, the study has found that care delay has an impact on utilization outcome in a negative manner. In regards to medical reconciliation, the study proves that patient understanding and medical reconciliation are insufficient, especially in the discharge of older patients. Concerning patient satisfaction, it has been established that clinicians and healthcare providers in homecare environment have to incorporate effective tools and mechanisms to determine if patients are satisfied in these systems. On the quality of services, most home care systems do not harbor good environmental settings to cater for patients. It is also common for patients discharged from hospital to home-based care to face a number of challenges related to transitions. The majority of these challenges as revealed by the study are related to adaptability and lack of qualified personnel to direct the services. 

In the assessment of existing studies, the author has found out important information for all variables under investigation. However, the studies have been few and that there are still many questions that have not been answered. Similar studies are focused on other health care settings other than home care. Hence, studies that focus on home care specific matters are required for supporting clinical decisions that are evidence-based. 

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