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

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.

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

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

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

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

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

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.

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.

Transition of Risk from Payer

to Provider

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.

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

Omaha System

 Is an example of point-of-care terminology.

 More than 9000 interprofessional clinicians, educators,

and researchers use the Omaha System.

Description of the Omaha

System

 Consists of the:

 Problem Classification Scheme

 Intervention Scheme

 Problem Rating Scale for Outcomes

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

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

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

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

Home health and community system

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