The official journal of the National Association for Healthcare Quality

Using Patient Satisfaction Data to Improve Home Healthcare
David Keepnews, PhD JD RN FAAN
Abstract: Patient satisfaction surveys are used extensively by home health agencies for a wide variety of purposes, but their utilization is often limited by a variety of practical and methodological problems. This article explores current and potential uses of satisfaction data and outlines steps that home health agencies may take to focus their use of these data to improve quality of care.

Strengthening Condition-Specific Evidence-Based Home Healthcare Practice
Laura E. Peterson, BSN SM
Abstract: The home health industry has lagged in adopting evidence-based care but is now well positioned to adopt such practices. However, few clinical practice guidelines have been developed for the home healthcare setting. This paper reviews the existing evidence base for prevalent home healthcare diagnoses and
conditions and the progress made in applying those practices in home healthcare. Existing guidelines for congestive heart failure, diabetes, chronic obstructive pulmonary disease, falls, osteoarthritis, depression, and medication management could be modified for applicability to home healthcare. The evidence for a number of home healthcare practices is robust enough to argue for widespread dissemination and implementation.

Building a Home Healthcare Workforce to Meet the Quality Imperative
Julie Sochalski, PhD RN FAAN
Abstract: The 1990s brought shifts in the organization and financing of healthcare services and changes to the nursing workforce as well. These changes were pronounced in home healthcare, where growth in service use between 1988 and 1996 was followed by sharp
contractions in home healthcare users and visits after changes in Medicare reimbursement policy in 1997. This article examines how the nursing workforce has responded to these changes, explores the challenges posed by the nursing shortage, highlights the
gap in knowledge of the staffing-outcomes relationship and
its implications for quality, and offers recommendations on
ways to improve care.

An Informatics Infrastructure for Patient Safety and Evidence-Based Practice in Home Healthcare
Suzanne Bakken, DNSc RN FAAN; George Hripcsak, MD MS
Abstract: The informatics infrastructure for patient safety and evidence-based practice (EBP) in home healthcare comprises data acquisition methods, healthcare standards including standardized terminologies, data repositories and clinical event monitors, data-mining techniques, digital sources of evidence, and communication technologies. Although the components of an informatics infrastructure are available and applications that bring these components together to promote patient safety and enable EBP have demonstrated positive or promising results in the acute care setting, a number of challenges hinder implementation in home healthcare. Resolution of these challenges requires commitment and collaboration among key stakeholders.

Interview with a Quality Leader
Penny Feldman on Home Healthcare Quality and Research
Margaret P. Chu, MPA BSN RNC CCM CPHQ, Martha K. Stephan, MBA RN CPHQ FAHQ
Abstract: Penny Hollander Feldman, PhD, is Vice President for Research and Evaluation at the Visiting Nurse Service of New York (VNSNY) and Director of the Center for Home Care Policy and Research. Prior to joining VNSNY, Dr. Feldman served on the faculties of the Kennedy School of Government and the Department of Health Policy and Management at the Harvard School of Public Health. At the Center for Home Care Policy and Research, she directs projects focused on improving the quality, outcomes, and cost-effectiveness of home-based care, supporting informed policymaking by long-term care decision makers, and helping communities promote the health, well-being and independence of people with chronic illness or disability. The translation and implementation of research in both service and policy settings has been an issue of ongoing focus for Dr. Feldman. She also served as a member of the Institute of Medicine Committee on Improving the Quality of Long-Term Care, which issued its report in 2001.

A Case Study of Operational Failure in Home Healthcare
Anita L. Tucker, DBA MS
Abstract: Examination of operational failures in home healthcare could yield important insights into improving patient safety. This article presents a case study of work system breakdowns observed in the home healthcare setting. The findings suggest that the biggest areas of opportunity are failures stemming from (a) insufficient support from home health agencies and (b) inadequate coordination with patients and their families. Factors that impede organizations from learning from employees’ experiences with operational failures and steps that managers may take to overcome these hurdles are discussed.

Data, Information, and Quality Indicators for Home Healthcare: Rapid Implementation, What’s Next?
Richard H. Fortinsky, PhD; Elizabeth A. Madigan, PhD RN
Abstract: From 1999 to 2003, the home health industry in the United States moved from an environment with extremely diverse data collection protocols and little or no dissemination of quality-related information, to an environment in which uniformly collected clinical data are transformed into information and then into publicly available reports using federally mandated quality indicators. This speed to action has raised many questions about the adequacy of home healthcare data and their use as quality-monitoring tools. This article summarizes current evidence about the scientific and clinical adequacy of data currently used to measure home healthcare quality and discusses roles of a variety of policy stakeholders in implementing and refining data, information, and quality indicators that are now the cornerstones of federal home healthcare quality policy. The scientific adequacy of Outcome and Assessment Information Set data is acceptable but bears routine monitoring and review; efforts should be made to develop home healthcare quality indicators sensitive to nursing interventions and published clinical practice guidelines for specific medical conditions; and policy stakeholders should collaborate to maximize the utility of home healthcare quality reports now disseminated to consumers, providers, and insurers.