Harvard Study Shows Value of Home Care Checklist
August 30, 2016 01:36 PM
A simple telephone-based checklist enabled caregivers to quickly identify changes in the condition of their home care patients, according to a new pilot study approved by the Harvard Medical School.
The study found that caregivers who use a short checklist about their patients’ conditions were able to report changes resulting in interventions that could prevent hospital readmissions, one of the costliest expenses in the entire health care system.
NAHC closely monitors and supports advances in telemedicine for the potential they offer patients to take greater control of their care and remain independent and in their own homes. It is a guiding principle of NAHC that home care allows people to get well and live to their potential in a comfortable setting.
“Millions of elderly Americans receive supportive home-care services each year, and many of them require frequent hospitalizations, so we set out to determine whether a simple real-time checklist could help improve outcomes and lower health care spending,” said study leaderDavid Grabowski, Ph.D., professor of health care policy at Harvard Medical School. Dr. Grabowski believes the results of this study are the first step toward answering that question.
The study, conducted over six months in early 2016, looked at 22 offices of Right at Home, a home health care company with over 300 offices in 45 states. Right at Home offers three levels of care – companion, personal care and skilled care.
The telephone-based checklist was administered when caregivers clocked out, asking them to answer questions about the health of the patient, such as, “Does the client seem different than usual? Has there ben a change in mobility, eating or drinking, toileting, skin condition or increase in swelling? Press 1 for yes and 2 for no.” If the caregiver presses 2, the checklist is completed, but if the caregiver presses 1, to indicate a change in condition, the caregiver is prompted to answer additional questions about the change or changes.
Whenever a change in condition is reported, the system automatically notifies the office’s care manager, who manages the change in condition. The care manager uses the information in the checklist to take further action, which could be anything from notifying a family member of the patient, speaking to the caregiver directly, notifying another health care professional or even calling 911, if necessary.
“Most interviewees suggested that changes in condition would not have been reported without the in-home checklist,” according to the study. “They also reported relatively few ‘false positives’ in that they felt that most of the tasks warranted attention.”
Caregivers involved in the study reported condition changes after two percent of all visits, for an average of 1.9 changes per patient over the course of the six-month study. Three hundred thirty patients were hospitalized during the pilot period, or about 14 percent of all care recipients.
The checklist system showed some promise for reducing hospitalizations. The owner of one Right at Home office mentioned a patient with diabetes mellitus whose caregiver used the checklist to report a minor foot injury. Under normal circumstances, the injury would not have been reported so quickly, but would have been relayed at the end of the week. However, because the caregiver reported the change immediately through the checklist, the office care manager was able contact the patient’s nurse, who quickly began treatment, preventing a potential hospitalization.
Some care managers said they already had a system in place to track changes in condition and found the In-Home system duplicative and unnecessary. Some staff also questioned using the checklist for tracking patients with chronic conditions that flare up occasionally because a predictable flare-up does not represent a true change in condition.
However, caregivers reported that the checklist was useful and felt “enthusiastic about the intervention,” according to the study. Caregivers also noted the checklist did not add much time to their clocking-out period and they were pleased with learning about the outcome of the changes they reported. Office owners appreciated the business case for preventing unnecessary trips to the hospital and allowing patients to remain in their homes.
The need for home care will only increase as the 78 million baby boomers reach their retirement years. Most baby boomers will prefer home care because it offers patients the opportunity to remain independent and keep their families together, seeking professional care when necessary. In addition, home care is also far more cost-effective than institutional alternatives and saves Medicare billions of dollars every year – something NAHC makes clear to the public and policymakers at every opportunity.
As NAHC President Val Halamandaris says: “There is a real premium in keeping people out of the hospitals.”