Use of quality improvement strategies by home care agencies may reduce hospitalizations of home patients

Hospitalized patients are sometimes sent home with a need for home health care. A hurried discharge can result in conflicting or incomplete information to the home care agency, posing a potentially dangerous transition "gap" for vulnerable patients. Patient risk identification tools and other quality improvement (QI) strategies have the potential to address care transition problems and reduce acute care hospitalizations (ACHs) among home care patients, suggests an evaluation of the Reducing Acute Care Hospitalization (ReACH) National Demonstration Collaborative. The Collaborative provided risk identification tools and QI strategies, as well as assistance from ReACH staff and 16 QI organizations to help 177 home health agencies throughout the United States reduce ACHs among home care patients.

Home care accrediting bodies and the arrival of a new pay-for-performance reimbursement system make QI in home health care more an imperative. One component of home health pay-for-performance may be ACH rates, note Patricia Simino Boyce, R.N., M.A., Ph.D., and Penny Hollander Feldman, Ph.D., of the Visiting Nurse Service of New York. They conducted interviews with 17 of 65 agencies (whose baseline ACH rates ranged from 14 to 68.5 percent of patients) that participated in Wave 1 of ReACH.

Implementation challenges reported at the 4-month interview point included identifying and recruiting appropriate agency staff to participate in the Collaborative, finding time to devote to the project while dealing with competing demands, and getting past the learning curve of the data collection requirements of the Collaborative. Taking these challenges into account, most agencies considered their efforts to be "somewhat" successful to date. Some of the QI strategies used included implementing patient risk assessment procedures, introducing or increasing telemonitoring of patients at home, instituting emergency care plans with patient-focused recommendations, and frontloading visits for patients at greatest risk.

The Collaborative and the evaluation were supported in part by the Agency for Healthcare Research and Quality (HS13694).

See "ReACH national demonstration collaborative: Early results of implementation," by Drs. Boyce and Feldman, Home Health Care Service Quarterly 26(4), pp. 105-120, 2007.

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