Patient Safety and Quality in Home Health Care

Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Home health care services include nursing care; physical, occupational, and speech-language therapy; and medical social services.1 The goals of home health care services are to help individuals to improve function and live with greater independence; to promote the client’s optimal level of well-being; and to assist the patient to remain at home, avoiding hospitalization or admission to long-term care institutions.2–4 Physicians may refer patients for home health care services, or the services may be requested by family members or patients.

The Centers for Medicare and Medicaid Services (CMS) estimates that 8,090 home health care agencies in the United States provide care for more than 2.4 million elderly and Best home health agencies in Bensenville disabled people annually.5 To be eligible for Medicare reimbursement Best home health agencies in Chicago, home health care services must be deemed medically necessary by a physician and provided to a home-bound patient. In addition, the care must be provided on an intermittent and noncontinuous basis.5 Medicare beneficiaries who are in poor health, have low incomes, and are 85 years of age or older have relatively high rates of home health care use.6 Common diagnoses among home health care patients include circulatory disease (31 percent of patients), heart disease (16 percent), injury and poisoning (15.9 percent), musculoskeletal and connective tissue disease (14.1 percent), and respiratory disease.

Delivering Health Care in the Home

The home health care environment differs from hospitals and other institutional environments where nurses work. For example, home health care nurses work alone in the field with support resources available from a central office. The nurse-physician work relationship involves less direct physician contact, and the physician relies to a greater degree on the nurse to make assessments and communicate findings. Home health care nurses spend more time on paperwork than hospital nurses and more time dealing with reimbursement issues.8, 9 Certain distinctive characteristics of the home health care environment influence patient safety and quality of outcomes: the high degree of patient autonomy in the home setting, limited oversight of informal caregivers by professional clinicians, and situational variables unique to each home.

Respect for patient autonomy is valued in hospital-based care. Nonetheless, many decisions are made by clinicians on behalf of hospitalized patients. In home health care, clinicians recognize that the care setting—the home—is the inviolable domain of the patient. Therefore, compared to the hospitalized patient, the home health care patient often has a greater role in determining how and even if certain interventions will be implemented. For example, in a hospital, nurses, physicians, and pharmacists may all play a role in ensuring that the patient receives antibiotics at therapeutically appropriate intervals. At home, however, the patient may choose to take the medication at irregular times, despite advice about the importance of a regular medication schedule. Thus, interventions to promote patient safety and quality care must account for the fact that patients will sometimes choose to act in ways that are inconsistent with the relevant evidence, and the clinician’s best efforts may not result in desired outcomes.

In addition to deliberate choices made by informed and capable patients regarding their care, individual patient variables may also influence home-based outcomes in ways that are different from those patients who are hospitalized. Ellenbecker and colleagues10, 11 reported that reading skill, cognitive ability, and financial resources all affect the ability of home health care patients to safely manage their medication regimens. Yet, none of these variables may play a meaningful role in the safe administration of medications to hospitalized patients.


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