SHHC agencies are in a unique position to identify and address patient safety risks during the COVID-19 pandemic. SHHC providers are among the few personnel conducting in-person clinical evaluations and treatment during the pandemic. There are numerous challenges providing care in home environments, and pandemic- related guidance has focused on hospital or institutional settings. SHHC agencies need data characterizing changes to care transitions patterns, data on best practices, and guidance tailored to home health settings, SHHC organizational structures, and the specific needs of older adults to quickly identify and address patient safety during care transitions in the COVID-19 era. The goal of the supplement is to identify how the SARS-CoV-2 pandemic has impacted (1) care transitions experiences of older adults and home health providers' after coming home from the hospital, and (2) organizational structure and processes of participating SHHC agencies in two geographic areas impacted differently by the pandemic. The supplement leverages the expertise of grant personnel and study staff at the largest not-for-profit SHHC agency in the US located in New York City, and a large SHHC agency serving urban and suburban populations located in Baltimore, Maryland. Sub-aim 1d: Characterize the impact of the COVID-19 pandemic on older adults' care transitions patterns in two geographic regions impacted differently by the pandemic. We will collect the following measures at two large SHHC agencies serving as study sites in the parent study (Baltimore, Maryland, and New York City, New York) for a period of one year before and after the beginning of the pandemic: (1) changes in volume, acuity, characteristics, and 30-day ED visit or hospitalization of older adults being referred to SHHC, and (2) frequency and characteristics of patients refusing SHHC services. Sub-aim 1e: Compare and contrast best practices in SHHC agency and SHHC professionals' responses to patient safety threats across the two study sites. We will leverage our expertise with qualitative and human factors methods to conduct semi-structed interviews with SHHC administrators, staff, and front-line providers at the two study sites to (1) identify novel threats to older adults' safety during care transitions during the pandemic, and (2) identify best practices for how SHHC agencies and providers can adapt and respond to these threats. Study findings will allow for comparison across geographic sites, rapid identification of unmet needs and for development and dissemination of best practices to SHHC agencies for ensuring patient safety during the hospital-to-home health transition in the era of COVID-19. Findings will also provide critical knowledge regarding how SHHC agencies have adjusted care delivery, management, decision-making, and operations in response to the pandemic. This knowledge can inform future SHHC operations and care transitions improvement efforts.

Public Health Relevance

Many older adults are at high risk of returning to the hospital shortly after coming home. Older adults are greatly affected by the COVID-19 pandemic, which may further increase risk of hospitalization. The overall goal of the proposed study is to understand the impact of the pandemic on older adults' hospital-to-home experiences and identify best practices to address risks to older adult safety when they return home from the hospital.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Special Emphasis Panel (ZHS1)
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Haugstetter, Monika
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Johns Hopkins University
Schools of Medicine
United States
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