Home health care (HHC) is the fastest growing segment of U. S. health care. Yet in any patient diagnostic group the number and type (home visit, telephone call) of contacts vary widely, and there is little empirical evidence on which to base decisions. At the same time, home health care is under increasing pressure from payers to provide evidence that their care is effective with one measure of effectiveness being the rate of rehospitalization. While rehospitalization has been studied in various populations, here is little evidence on what leads to rehospitalization of HHC patients with chronic obstructive pulmonary disease (COPD).
The aim of this study is to provide a model for developing evidence-based profiles of the number, type, and timing of contacts needed to prevent rehospitalization. This phase of the work will target patients with COPD because of their vulnerable health and need for frequent and high cost home health and hospital care. The proposed study will examine patient signs and symptoms preceding rehospitalization and compare perceptions of patients, family members, physicians, and HHC nurses regarding the number, type, and timing of contacts needed to prevent a subsequent rehospitalization. Based on these data, an expert panel will determine the number, type and timing of contacts perceived most efficient and effective in preventing rehospitalization. Finally, there will be a comparison of the expert consensus on contacts with the actual contacts provided to patients. Using a triangulated design, this study will collect information from 30 respondent groups (patients, family members, physicians, and HHC nurses) in three states-Ohio, West Virginia, and Florida-using open-ended questions and chart data. The open-ended data will be analyzed using the content analysis approach presented by Miles and Huberman (1994). The long-term goal of this research is to develop a model to reduce rehospitalization in chronically ill patients with improved use of HHC services.
