Researchers at Boston University's School of Public Health propose to conduct a study to facilitate the development of home health care for persons with AIDS by developing a patient classification system to predict the length of home health visits to persons with AIDS. The system, which will also apply to other persons requiring lengthy visits and to the general home health population, can be used by home health agencies to manage patient care and by public and private payers to develop prospective payment systems for home health care. The project addresses the need for information of home health utilization by persons with AIDS, for patient classification systems and reimbursement policies which reflect the increasingly complex and time intensive home health case mix. The study builds on previous work by the researchers on factors predicting the length of home health visits and by others on home health patient classification systems. Previously developed instruments will be modified, based on recommendations of nurse focus groups and an Advisory Group, to include the factors influencing AIDS' clients home health utilization. Data on 3,755 home health visits will be collected prospectively by nurses from 14 participating Massachusetts home health agencies over a 12-month period, using a data collection instrument specially developed for the study. Models to predict intensity (skilled provider time in minutes) and visit-related costs will be developed using regression analysis, with characteristics of the client, nurse, agency, and visit as the independent variables. Descriptive information and measures of variability will be compared across categories of patients. Visit length will be compared to length predicted by the Patient Classification System for Home Nursing. Each client included in the study will be classified using two case-mix systems currently under development for use by the federal government for home health care prospective payment systems. The performance of the systems in predicting resource needs of persons with AIDS, and the implications for agency reimbursement, will be explored. The project is significant because of growing AIDS/HIV population; the growing need for home health services for persons with AIDS; and the need for tested, valid and reliable patient classification and reimbursement systems to reflect the resource need for tested, valid and reliable patient classification and reimbursement systems to reflect the resource needs of persons with AIDS. The research team has relevant and demonstrated experience to complete the project, which has received enthusiastic support from home health agencies and from national and state home health associations.
