Nursing Science, Evidence, and Policy Recommendations for Creating a Culture of Health in Home Care

In the largest study of its kind, a University of Pennsylvania School of Nursing (Penn Nursing) investigation shows that home health agencies providing organizational support to their nurses get better outcomes. The best outcomes for patients, including fewest hospitalizations and transfers to nursing homes, are achieved by home health agencies that provide supportive work environments, enabling nurses to focus on patient care.

The study, “Home Health Agency Work Environments and Hospitalizations,” is published in the October issue of the leading scientific journal Medical Care. Home health is one of the nation’s fastest-growing healthcare sectors serving approximately 4.5 million patients annually. The study of 118 Medicare-certified home health agencies in 3 states investigated rates of hospitalizations and success in maintaining patients in community living arrangements.

The study’s findings are especially important as the home health industry absorbs a 14% cut in Medicare payments (3.5% for each year 2014-2017). Designed to correct overpayment, the cut is so large that the Center for Medicare and Medicaid (CMS) has calculated it will leave 40 percent of home health providers operating at a net loss by 2017. Home health agencies that reduce costs through increasing nurse workloads may be diminishing the quality of patient care.

According to the lead author, Dr. Olga Jarrín of Penn Nursing’s Center for Health Outcomes and Policy Research, “Home health care nursing is meant to help patients recover from illness and safely remain in their homes, but home care nurses are often so burdened with non-care responsibilities that patients and their families fail to receive the help they need. Home health agencies should be incentivized to enable nurses to practice to the highest level of their training and maximize time with patients, thus optimizing patient outcomes and reducing unnecessary use of expensive hospital and institutional care.”

The study received funding from the National Institute of Nursing Research (NINR), part of the National Institutes of Health, and the Agency for Healthcare Research and Quality (AHRQ).

This study establishes a mechanism for why some home health agencies have better outcomes, and is relevant to hospital and home health administrators, as well as policy makers.

The full paper can be accessed free by using the link below:http://journals.lww.com/lww-medicalcare/Fulltext/2014/10000/Home_Health_Agency_Work_Environments_and.4.aspx

Olga Jarrin Bio: http://www.nursing.upenn.edu/faculty/profile.asp?pid=5646