Home health and community system
Chapter 9 Home Health and Related
Community-Based Systems
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Introduction
Home is the optimal location for diverse health and nursing services.
Home can be:
House
Apartment
Dormitory
Trailer
Boarding and care home
Hospice house
Assisted living facility
Shelter
Car
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Evolution and Milestones
1893: Henry Street Settlement House is opened.
Early 20th century: Public health departments are
established.
1965: Medicare legislation includes home health
services.
1970s: Hospice care is introduced.
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Practice Models
Home health
Delivery of intermittent health-related services in
patients’ places of residence with the goal of promoting
self-care and independence, rather than
institutionalization
Palliative care and hospice
Delivery of services by teams of interprofessional
clinicians for those who have exhausted curative
treatment measures or have life expectancies of
6 months or less
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Practice Models (Cont.)
Public health
Offers health services to individuals, families, and
communities to provide services and education to promote
wellness
Nurse-managed health centers
Primarily offers outpatient clinic and primary healthcare
and social services provided by nurses
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Practice Models (Cont.)
Other practice sites
Noninstitutional settings (eg, school, community)
Similarities among practice models
Interprofessional collaboration
Based on the consumer movement
Triple Aim for Health Care model
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Standardized Datasets
Outcome and Assessment Information Set (OASIS)
Standardized dataset that home health agency clinicians
complete with their patients
Continuity Assessment Record and Evaluation (CARE)
Standardized dataset that can predict the appropriate
level of care or care setting that supports optimal patient
outcomes at the lowest possible cost
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Standardized Datasets (Cont.)
Hospice quality measures
2008: Conditions of participation for hospice
2010: The Affordable Care Act
Patient experience surveys
Required in home health agencies and skilled nursing
facilities to measure the interpersonal value of healthcare
experienced by the patient
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8
Supporting Home Health with Electronic Health Records and Information Technology
Billing solutions
As financial systems and electronic capabilities advanced, bi-directional
exchange of claims information management became commonplace.
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9
Supporting Home Health with Electronic Health Records and Information Technology (Cont.)
Point-of-care solutions
Enable electronic capture of the service date and time for billing and payroll
purposes.
Value increased in 1998 with Prospective Payment System.
Use of standardized dataset changed payment methodology and improved the
quality of the services offered.
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10
Transition of Risk from Payer
to Provider
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Supporting Home Health with Electronic Health Records and Information Technology (Cont.)
Clinical decision support systems
Applications analyze data and help healthcare providers make clinical
decisions.
Approaches include the following:
Best and evidence-based practice options are presented to the clinician by finding
and displaying what is known about the patient to a knowledge base, using rule sets
and an interface engine.
Process of machine learning presents or displays best and evidence-based practice
options to the clinician as a result of analyzing the data entered and comparing it
with similar patterns or scenarios that exist in the system.
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Standardized Terminologies
American Nurses Association (ANA) recognizes 12
reference and point-of-care or interface terminologies.
Standardized terminologies are important for the
following two reasons:
Interoperability among systems
Interoperability with future systems
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Omaha System
Is an example of point-of-care terminology.
More than 9000 interprofessional clinicians, educators,
and researchers use the Omaha System.
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Description of the Omaha
System
Consists of the:
Problem Classification Scheme
Intervention Scheme
Problem Rating Scale for Outcomes
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Description of the Omaha
System (Cont.)
Problem Classification Scheme
Is a comprehensive, orderly, nonexhaustive, mutually
exclusive taxonomy designed to identify diverse patients’
health-related concerns
Intervention Scheme
Is a comprehensive, orderly, nonexhaustive, mutually
exclusive taxonomy designed for use with specific
problems
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Description of the Omaha
System (Cont.)
Problem Rating Scale for Outcomes Consists of three five-point, Likert-type scales for
measuring the entire range of severity for the concepts of
Knowledge, Behavior, and Status
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Description of the Omaha
System (Cont.)
Should demonstrate:
Patient-centered care and the power of the patient and
family
Evidence-based practice
Interprofessional practice
Practice and documentation using standardized
terminology
Practice, documentation, and information management
linkages
External monitoring and quality control
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Conclusion and Future
Directions
The evolution of the home health field takes into
consideration the goals of:
Supporting safe transitions among care settings
Effectively managing patient populations
Participating in accountable care organizations
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