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Chapter 2. Effectiveness: Nursing Home and Home Health Care
Importance and Measures
Demographics
- According to the latest available national data, there were 1.6 million current nursing home residents in 1999 and 2.5 million discharges from nursing homes in 1998-991.
- There were more than 1.4 million current home health patients and 7.8 million discharges from home health agencies in 20002.
- Assuring quality for this frail and expanding population has been a significant challenge and longstanding concern3-6.
Cost
- Nursing home and home health services accounted for at least $139.3 billion, or 9%, of national health expenditures in 20027.
Measures
- Nursing home care'Based on the recommendations of the National Quality Forum consensus panel, nine new nursing home measures were selected for the 2004 NHQR; five measures were retained from the 2003 NHQR. There are separate measures for the two major populations that reside in nursing homes: one set for postacute care residents and one set for chronic care residentsi. Some measures are common to both populations. This section highlights the following:
- Prevalence of pain among postacute and chronic care residents
- Use of physical restraints among chronic care residents
- Presence of pressure ulcers among postacute and chronic care residents
- Home health care'Performance measures for home health show the portion of patients whose conditions improved or declined during the course of their care from a certified home health agency (the measures are the same as in the 2003 NHQR). Based on national dataii for the measures reported here, statistically significant improvement or decline did occur between 2001 and 2003. Quality of home health care is highlighted in this section in two general areas:
- Improvement in getting around
- Acute-care hospitalization of home health patients
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