Field of Work: Improving quality in home health care
Problem Synopsis: There is a growing body of evidence-based knowledge on improving chronic care outcomes in various health care settings. But home health providers often are unclear about which part of the new knowledge applies to their work and how to put it into practice.
Synopsis of the Work: Learning collaboratives have emerged as a means for implementing existing knowledge and spreading innovation across institutions. From 2001 to 2007, project staff at the Center for Home Care Policy and Research engaged home health agencies in two different "learning collaborative" aimed at improving patient care. Project staff also hosted two conferences and commissioned papers synthesizing evidence-based knowledge on critical issues related to quality and performance in the home health setting.
Key Findings: Eight home care agencies participating in the 11-month-long Home Health Diabetes Learning Collaborative produced these changes in diabetes care:
- An increase of more than 50 percent of patients who received a comprehensive foot examination within 10 days of admission to home care.
- An increase of 34 percent of patients whose medications were reviewed for contraindications.
- An increase of 42 percent of patients with individualized glycemic control plans.
- An increase of 44 percent of patients testing their blood glucose according to their plans most or all of the time.
- An increase of 56 percent of patients receiving education about foot care.
More than 150 home health agencies participating in the Reducing Acute Care Hospitalization (ReACH) National Demonstration completed two waves of a learning collaborative over a two-year period. The following changes for patients identified as at risk for acute care hospitalizations were produced in Wave II:
- Home care episodes resulting in acute care hospitalization decreased 7 percent.
- Patients with completed risk assessments increased 41 percent.
- Patients with customized care plans specific to their own risks increased 44 percent.
- Patients identified as at risk of acute hospitalizations decreased by eight percent.
- The average number of home care visits in the first two weeks to patients identified as at risk of hospitalization increased by 1.9 (6.8 to 8.7 visits).
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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