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Press Release
Team-Managed Home Care Boosts Satisfaction for Patients, Caregivers
For immediate release December 5, 2000
An innovative model of home health care used by Department of Veterans Affairs (VA) hospitals—featuring a greater hands-on role for doctors and close cooperation among nurses, social workers and other team members—yields more satisfaction for patients and family caregivers than private-sector home care, according to a study published in the Dec. 13 Journal of the American Medical Association.
In a study of nearly 2,000 home-care patients, most of them severely disabled or terminally ill, researchers from VA, the University of Illinois at Chicago, and Northwestern University tested VA’s "Team-Managed Home-Based Primary Care" model against non-VA home-care at 16 sites. While death rate and physical functioning did not differ between the two groups of patients, VA patients and their caregivers overall expressed more satisfaction with their care. Terminally ill patients in the VA sample gave higher marks to their care in six of eight quality-of-life measures, including emotional functioning, bodily pain and mental health. Caregivers in the VA group reported less "burden," translating into reduced caregiver stress and burnout.
The study is among the first large-scale evaluations of home care to consider the burden on family members and their emotional well-being. Previous research has shown that informal home-based family caregiving costs the nation nearly $200 billion per year, compared to around $30 billion for formal home health care.
"This is the first home-care effectiveness study, to our knowledge, to assess impact on caregiver health-related quality of life, caregiver satisfaction with the patient’s care, and caregiver burden," wrote the authors. "Consistent benefits [for the VA home-care group] were observed on these outcomes."
One of the authors of the study, Frances M. Weaver, Ph.D., said the VA model allows for greater physician involvement in patient care—even to the point where physicians make home visits when needed. In the study, about 15 percent of VA patients were visited by a doctor at home, compared to 0 percent for the Medicare group.
"Since [VA home-care physicians] have a defined amount of time allocated to home care, they are not constrained by administrative and billing issues," noted Dr. Weaver, a researcher with the Midwest Center for Health Services and Policy Research at Hines VA Medical Center in Hines, Ill., and the Institute for Health Services and Policy Research at Northwestern University. "The physician is free to work with the patient directly or with the team on the patient’s behalf. This flexible arrangement can be viewed as adding value and benefit to the patient."
The authors concluded that the VA hospital-based model of home care promotes better communication between the physician and other team members—nurses, physician assistants, therapists, dietitians, social workers. Study author Susan L. Hughes, D.S.W., of the University of Illinois at Chicago and formerly with VA, says that in the private sector, where it is up to individual home-care agencies to maintain contact with the primary-care physician, "the quality and quantity of communication can be quite variable. Our interpretation is that when the primary-care physician is working closely with the home-care team—per the ‘Team-Managed Home Based Primary Care’ model—continuity of care is enhanced, improving patient and caregiver satisfaction with care."
The four-year study was funded by VA’s Health Services Research and Development Service and Cooperative Studies Program. Collaborating with Dr. Weaver and Dr. Hughes were Anita Giobbie-Hurder, M.S., of the Cooperative Studies Program (CSP) Coordinating Center at the Hines VA Medical Center; Larry Manheim, Ph.D., of Northwestern University and the Midwest Center for Health Services and Policy Research (MCHSPR) at the Hines VA Medical Center; William Henderson, Ph.D., of VA’s CSP Coordinating Center; Joseph D. Kubal, M.A., of VA’s MCHSPR; Joan Cummings, M.D., of Veterans Integrated Services Network 12; and Alec Ulasevich, Ph.D., formerly with VA.
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