Martino, Francesca; Adıbelli, Z; Mason, G; Nayak, A; Ariyanon, W; Rettore, E; Crepaldi, Carlo; Rodighiero, Mariapia; Ronco, Claudio
Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up. This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient. The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study. The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=365168.
Wasik, Barbara Hanna; Roberts, Richard N.
This report on a survey of 224 home visitation programs that provide services for abused and neglected children and their families presents data on program characteristics, characteristics of home visits, credentials of home visitors, and program documentation procedures. Programs reported that training in parenting skills and parent coping were…
Full Text Available Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011.To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses.During the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother's adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers' self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother's education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child's language development.In this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families' urgent needs
... and Early Childhood Home Visiting Program Evaluation will meet for its first session on Wednesday... Administration for Children and Families Advisory Committee on the Maternal, Infant and Early Childhood Home...: Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation. Date and...
Chaiyachati, Barbara H; Gaither, Julie R; Hughes, Marcia; Foley-Schain, Karen; Leventhal, John M
Although home visiting has been used in many populations in prevention efforts, the impact of scaled-up home-visiting programs on abuse and neglect remains unclear. The objective of this study was to assess the impact of voluntary participation in an established statewide home-visiting program for socially high-risk families on child maltreatment as identified by Child Protective Services (CPS). Propensity score matching was used to compare socially high-risk families with a child born between January 1, 2008 and December 31, 2011 who participated in Connecticut's home-visiting program for first-time mothers and a comparison cohort of families who were eligible for the home-visiting program but did not participate. The main outcomes were child maltreatment investigations, substantiations, and out-of-home placements by CPS between January 1, 2008 and December 31, 2013. In the unmatched sample, families who participated in home-visiting had significantly higher median risk scores (P home visiting. First substantiations also occurred later in the child's life among home-visited families. There was a trend toward decreased out-of-home placement (HR 0.73, 95% CI 0.53-1.02, P = .06). These results from a scaled-up statewide program highlight the potential of home visiting as an important approach to preventing child abuse and neglect. Copyright © 2018 Elsevier Ltd. All rights reserved.
Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee
The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.
Bouman, A.; Rossum, E. van; Nelemans, P.; Kempen, G.I.J.M.; Knipschild, P.
BACKGROUND: Home visiting programs have been developed aimed at improving the health and independent functioning of older people. Also, they intend to reduce hospital and nursing home admission and associated cost. A substantial number of studies have examined the effects of preventive home visiting
Goldfeld, Sharon; Price, Anna; Kemp, Lynn
Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.
was conducted from the beginning of November 2008 and ended in March 2009. ... Program's Recipe for CSB porridge and modified for consistency and taste . The ... The community health workers questioned the mothers in Pular or French .... fuel to prepare the PSB compared with the CSB since the cooking time is ...
Leung, Cynthia; Tsang, Sandra; Heung, Kitty
Objectives: The study reported the pilot evaluation of the Healthy Start Home Visit Program for disadvantaged Chinese parents with preschool children, delivered by trained parent assistants. Home visiting was used to make services more accessible to disadvantaged families. Method: The participants included 21 parent-child dyads. Outcome measures…
McGinnis, Sandra; Lee, Eunju; Kirkland, Kristen; Miranda-Julian, Claudia; Greene, Rose
To examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high-risk population. A secondary analysis of program data from a statewide home visitation program. Thirty-six Healthy Families New York sites across New York State. A total of 3521 pregnant mothers at risk of poor child health and developmental outcomes. Home visitors deliver a multifaceted intervention that includes educating high-risk mothers on benefits of breastfeeding, encouraging them to breastfeed and supporting their efforts during prenatal and postnatal periods. Home visitor-reported content and frequency of home visits, participant-reported breastfeeding initiation and duration, and covariates (Kempe Family Stress Index, race and ethnicity, region, nativity, marital status, age, and education). Logistic regression. Breastfeeding initiation increased by 1.5% for each 1-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally, if a participant receives 1 more home visit during the third month, her likelihood of breastfeeding at 6 months increases by 11%. Effect sizes varied by months postpartum. Delivering a breastfeeding message consistently during regular home visits is important for increasing breastfeeding rates. Given that home visiting programs target new mothers least likely to breastfeed, a more consistent focus on breastfeeding in this supportive context may reduce breastfeeding disparities.
Roggman, Lori A; Cook, Gina A; Innocenti, Mark S; Jump Norman, Vonda; Boyce, Lisa K; Christiansen, Katie; Peterson, Carla A
Home-visiting programs aiming to improve early child development have demonstrated positive outcomes, but processes within home visits to individual families are rarely documented. We examined family-level variations in the home-visiting process (N = 71) from extant video recordings of home visits in two Early Head Start programs, using an observational measure of research-based quality indicators of home-visiting practices and family engagement, the Home Visit Rating Scales (HOVRS). HOVRS scores, showing good interrater agreement and internal consistency, were significantly associated with parent- and staff-reported positive characteristics of home visiting as well as with parenting and child language outcomes tested at program exit. When home-visiting processes were higher quality during the program, home visit content was more focused on child development, families were more involved in the overall program, and most important, scores on measures of the parenting environment and children's vocabulary were higher at the end of the program. Results showed that home visit quality was indirectly associated with child language outcomes through parenting outcomes. Observation ratings of home visit quality could be useful for guiding program improvement, supporting professional development, and increasing our understanding of the links between home-visiting processes and outcomes. © 2016 Michigan Association for Infant Mental Health.
Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V
To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Yasemin Gümüş Şekerci
Full Text Available Aim: To examine the impact of home visitation program on exercise behaviour of women with type 2 diabetes. Methods: The study was performed in a district in Ankara. Power analysis was done for the sampling and the study was completed with type 2 diabetes 63 women who were determined via convenience sampling method. In the study, experimental design was used. The data are gathered with description form, exercise knowledge form and exercise self-efficacy scale. In the study, the nurse helped change the exercise behaviour of women with type 2 diabetes through home visits for six months. For the research were taken written permissions from Provincial Directorate of Health Public, University Ethics Commission and the individuals who accepted to participate in the study. Results: Sixty-three females with type 2 diabetes between 20-49 years old affiliated to community health centre completed the study. The demographic characteristics (age, education, marital status, income, employment status of the women in intervention and control groups were similar (p>0.05. Outcomes in intervention group were significantly improved between the first and last visits included exercise knowledge, exercise self-efficacy and exercise duration (minute/day (p<0.05. Fasting glucose level, non-fasting glucose levels and hemoglobin A1c values of the women in the intervention group significantly decreased after the home visitation program. Conclusion: This home visitation program is helpful in exercise behaviour improving among women with type 2 diabetes.
Leung, Cynthia; Tsang, Sandra; Heung, Kitty
Purpose: The study reported the effectiveness of a home visit program for disadvantaged Chinese parents with preschool children, using cluster randomized controlled trial design. Method: Participants included 191 parents and their children from 24 preschools, with 84 dyads (12 preschools) in the intervention group and 107 dyads (12 preschools) in…
Janssens, W.; Rosemberg, C.
This paper provides a short-term impact evaluation of a home-visiting Early Child Development (ECD) program in the Caribbean aimed at vulnerable children from birth to three years. The analysis is based on a quasi-experimental research design including approximately four hundred children in
Maaike E. Muntinga
Full Text Available Outcomes of proactive home visit programs for frail, older people might be influenced by aspects of the caregiver–receiver interaction. We conducted a naturalistic case study to explore the interactional process between a nurse and an older woman during two home visits. Using an ethics of care, we posit that a trusting relationship is pivotal for older people to accept care that is proactively offered to them. Trust can be build when nurses meet the relational needs of older people. Nurses can achieve insight in these needs by exploring older people’s value systems and life stories. We argue that a strong focus on older people’s relational needs might contribute to success of proactive home visits for frail, older people.
Lee, Helen; Crowne, Sarah; Faucetta, Kristen; Hughes, Rebecca
The Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) is the largest random assignment study to date to examine the effectiveness of home visiting services on improving birth outcomes and infant and maternal health care use for expectant mothers. The study includes local home visiting programs that use one of…
Salvy, Sarah-Jeanne; de la Haye, Kayla; Galama, Titus; Goran, Michael I.
Background Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: 1) short duration and low intensity; 2) late timing of implementation, when children are already overweight or obese; 3) intervention delivery limiting their accessibility and sustainability; and 4) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. Objective This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. Conclusion The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (1) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health due to socio-economic and structural conditions; (2) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (3) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. PMID:27911984
Salvy, S-J; de la Haye, K; Galama, T; Goran, M I
Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: (i) short duration and low intensity; (ii) late timing of implementation, when children are already overweight or obese; (iii) intervention delivery limiting their accessibility and sustainability; and (iv) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (i) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health because of socio-economic and structural conditions; (ii) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (iii) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. © 2016 World Obesity Federation.
Jones, David E; Tang, Mei; Folger, Alonzo; Ammerman, Robert T; Hossain, Md Monir; Short, Jodie; Van Ginkel, Judith B
The aim of this study was to investigate the association between postnatal depression (PND) symptoms severity and structural neighborhood characteristics among women enrolled in a home visiting program. The sample included 295 mothers who were at risk for developing PND, observed as 3-month Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. Two neighborhood predictor components (residential stability and social disadvantage) were analyzed as predictors of PND symptom severity using a generalized estimating equation. Residential stability was negatively associated with PND symptom severity. Social disadvantage was not found to be statistically significantly. The findings suggest that residential stability is associated with a reduction in PND symptom severity for women enrolled in home visiting program.
Byrne, Fiona; Grace, Rebekah; Tredoux, Jaimie; Kemp, Lynn
Objective The aims of the present paper were to: (1) review the research literature that contributes to an understanding of the role of volunteer home visiting programs in supporting the health and well being of families with young children; and (2) propose a conceptual model outlining service pathways for families in need of additional support. Methods An integrative literature review method was used, with a mix of electronic and manual search methods for the period January 1980-January 2014. Forty-five studies were identified that met the inclusion criteria for review and were coded according to themes developed a priori. Results There is little formal research that has examined the effectiveness of volunteer home visiting programs for supporting family health and well being. The available research suggests that volunteer home visiting programs provide socioemotional support through structured social relationships; however, there is limited empirical evidence to explicate the factors that contribute to these outcomes. Conclusion In recognition of the importance of peer support for new parents, the not-for-profit sector has been involved in providing volunteer home visiting services to families for decades. However, the body of research to support this work is characterised by methodological limitations, and rigorous evidence is limited. What is clear anecdotally and qualitatively from the existing research is that parents who are in need of additional support value engagement with a community volunteer. These structured social relationships appear to fulfil a service need within the community, helping build bridges to support social networks, and thus complementing professional services and relationships. Overall, structured social relationships in the form of volunteer home visiting programs appear to provide an important pathway to support family health and well being. Findings from the existing research are mixed and often characterised by methodological
Kidman, Rachel; Nice, Johanna; Taylor, Tory; Thurman, Tonya R
Home visiting is a popular component of programs for HIV-affected children in sub-Saharan Africa, but its implementation varies widely. While some home visitors are lay volunteers, other programs invest in more highly trained paraprofessional staff. This paper describes a study investigating whether additional investment in paraprofessional staffing translated into higher quality service delivery in one program context. Beneficiary children and caregivers at sites in KwaZulu-Natal, South Africa were interviewed after 2 years of program enrollment and asked to report about their experiences with home visiting. Analysis focused on intervention exposure, including visit intensity, duration and the kinds of emotional, informational and tangible support provided. Few beneficiaries reported receiving home visits in program models primarily driven by lay volunteers; when visits did occur, they were shorter and more infrequent. Paraprofessional-driven programs not only provided significantly more home visits, but also provided greater interaction with the child, communication on a larger variety of topics, and more tangible support to caregivers. These results suggest that programs that invest in compensation and extensive training for home visitors are better able to serve and retain beneficiaries, and they support a move toward establishing a professional workforce of home visitors to support vulnerable children and families in South Africa.
Ammerman, Robert T.; Putnam, Frank W.; Teeters, Angelique R.; Van Ginkel, Judith B.
Research indicates that up to half of mothers in home visiting experience clinically significant levels of depression during their participation in services. Depression alters maternal life course, negatively impacts child development, and contributes to poorer home visiting outcomes. This article describes the Moving Beyond Depression (MBD)…
Nabagiez, John P; Shariff, Masood A; Molloy, William J; Demissie, Seleshi; McGinn, Joseph T
A physician assistant home care (PAHC) program providing house calls was initiated to reduce hospital readmissions after adult cardiac surgery. The purpose of our study was to compare 30-day PAHC and pre-PAHC readmission rate, length of stay, and cost. Patients who underwent adult cardiac surgery in the 48 months from September 2008 through August 2012 were retrospectively reviewed using pre-PAHC patients as the control group. Readmission rate, length of stay, and health care cost, as measured by hospital billing, were compared between groups matched with propensity score. Of the 1,185 patients who were discharged directly home, 155 (13%) were readmitted. Total readmissions for the control group (n = 648) was 101 patients (16%) compared with the PAHC group (n = 537) total readmissions of 54 (10%), a 38% reduction in the rate of readmission (p = 0.0049). Propensity score matched groups showed a rate reduction of 41% with 17% (62 of 363) for the control compared with 10% (37 of 363) for the PAHC group (p = 0.0061). The average hospital bill per readmission was $39,100 for the control group and $56,600 for the PAHC group (p = 0.0547). The cost of providing home visits was $25,300 for 363 propensity score matched patients. The PAHC program reduced the 30-day readmission rate by 41% for propensity score matched patients. Analysis demonstrated a savings of $977,500 at a cost of $25,300 over 2 years, or $39 in health care saved, in terms of hospital billing, for every $1 spent. Therefore, a home visit by a cardiac surgical physician assistant is a cost-effective strategy to reduce readmissions after cardiac surgery. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
W. Kathy Tannous PhD
Full Text Available Objective: The purpose of this study is to examine the association between home visit programs and emergency preparedness among elderly vulnerable people in New South Wales, Australia. Method: The study used data acquired from an intervention program run by emergency agencies and consisted of 370 older people. Seven emergency outcome measures were examined by adjusting for key demographic factors, using a generalized estimating equation model, to examine the association between home visit programs and emergency preparedness. Results: The study revealed that knowledge demonstrated by participants during visits and post home visits showed significant improvements in the seven emergency outcome measures. The odds of finding out what emergencies might affect one’s area were significantly lower among older participants who were born outside Australia and those who were women. Discussion: The findings suggest that the intervention via home visits and periodic reminders post these visits may be a useful intervention in improving emergency preparedness among older people, especially among men and those who were born outside of Australia. In addition, other reminders such as safety messaging via mobile or landline telephone calls may also be a supplementary and useful intervention to improve emergency preparedness among older people.
Segre, Lisa S.; Taylor, Darby
Maternal depression, although prevalent in low-income women, is not an inevitable consequence of poverty. Nevertheless, depression is a double burden for impoverished women: compromising infant development and diminishing mothers' ability to benefit from or effectively use home visiting services. Without universal screening, depression is often…
Li, S A; Jack, S M; Gonzalez, A; Duku, E; MacMillan, H L
Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.
Fowler, Cathrine; Dunston, Roger; Lee, Alison; Rossiter, Chris; McKenzie, Jo
This paper reports on a small exploratory study that investigates the place and role of reciprocal learning within a partnership-based home visiting program for mothers experiencing depression. The study is one important example of an increased focus on reciprocal learning within practice that has significant implications for the development of…
Casillas, Katherine L; Fauchier, Angèle; Derkash, Bridget T; Garrido, Edward F
In recent years there has been an increase in the popularity of home visitation programs as a means of addressing risk factors for child maltreatment. The evidence supporting the effectiveness of these programs from several meta-analyses, however, is mixed. One potential explanation for this inconsistency explored in the current study involves the manner in which these programs were implemented. In the current study we reviewed 156 studies associated with 9 different home visitation program models targeted to caregivers of children between the ages of 0 and 5. Meta-analytic techniques were used to determine the impact of 18 implementation factors (e.g., staff selection, training, supervision, fidelity monitoring, etc.) and four study characteristics (publication type, target population, study design, comparison group) in predicting program outcomes. Results from analyses revealed that several implementation factors, including training, supervision, and fidelity monitoring, had a significant effect on program outcomes, particularly child maltreatment outcomes. Study characteristics, including the program's target population and the comparison group employed, also had a significant effect on program outcomes. Implications of the study's results for those interested in implementing home visitation programs are discussed. A careful consideration and monitoring of program implementation is advised as a means of achieving optimal study results. Copyright © 2015 Elsevier Ltd. All rights reserved.
Isaac, Michael R; Chartier, Mariette; Brownell, Marni; Chateau, Dan; Nickel, Nathan C; Martens, Patricia; Katz, Alan; Sarkar, Joykrishna; Hu, Milton; Burland, Elaine; Goh, ChunYan; Taylor, Carole
Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children. Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles. Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03-1.08) and 1.10 (95 % CI 1.05-1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00-1.02) and 1.00 (95 % CI 1.00-1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile. Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.
Chu, Mary Man-Lai; Fong, Kenneth Nai-Kuen; Lit, Albert Chau-Hung; Rainer, Timothy Hudson; Cheng, Stella Wai-Chee; Au, Frederick Lap-Yan; Fung, Henry Kwok-Kwong; Wong, Chit-Ming; Tong, Hon-Kuan
To investigate the effects of an occupational therapy fall reduction home visit program for older adults admitted to the emergency department (ED) for a fall and discharged directly home. Single-blind, multicenter, randomized, controlled trial. EDs in three acute care hospitals in Hong Kong. Individuals aged 65 and older who had fallen (N = 311). After screening for eligibility, 204 consenting individuals were randomly assigned to an intervention group (IG) and received a single home visit from an occupational therapist (OT) within 2 weeks after discharge from the hospital or a control group (CG) and received a well-wishing visit from a research assistant not trained in fall prevention. Both groups were followed for 12 months through telephone calls made every 2 weeks by blinded assessors with a focus on the frequency of falls. Another blinded assessor followed up on their status with telephone calls 4, 8, and 12 months after ED discharge. Prospective fall records on hospital admissions were retrieved from electronic databases; 198 individuals were followed for 1 year on an intention-to-treat basis. The percentage of fallers over 1 year was 13.7% in the IG (n = 95) and 20.4% in the CG (n = 103). There were significant differences in the number of fallers (P = .03) and the number of falls (P = .02) between the two groups over 6 months. Significant differences were found in survival analysis for first fall at 6 months (log-rank test 5.052, P = .02) but not 9 or 12 months. One OT visit after a fall was more effective than a well-wishing visit at reducing future falls at 6 months. A booster OT visit at 6 months is suggested. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Bouman, A.; Rossum, E. van; Evers, S.; Ambergen, T.; Kempen, G.; Knipschild, P.
BACKGROUND: Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services. The results of trials have been inconsistent and their cost-effectiveness uncertain. Home visits for a high-risk population
Heany, Julia; Torres, Jennifer; Zagar, Cynthia; Kostelec, Tiffany
Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan's Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study's evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.
Munns, Ailsa; Watts, Robin; Hegney, Desley; Walker, Roz
Designing child and family health services to meet the diverse needs of contemporary families is intended to minimize impacts of early disadvantage and subsequent lifelong health and social issues. Innovative programs to engage families with child and family support services have led to interest in the potential value of peer-led home visiting from parents in local communities. There is a range of benefits and challenges identified in a limited number of studies associated with home visiting peer support. The objective of the review is to identify: INCLUSION CRITERIA PARTICIPANTS: Families/parents with one or more children aged zero to four years, peer support workers and their supervisors. Peer-led home visiting parenting support programs that use volunteer or paraprofessional home visitors from the local community compared to standard community maternal-child care. The phenomenon of interest will be the relationships between participants in the program. Quantitative studies: randomized control trials (RCTs). Qualitative studies: grounded theory and qualitative descriptive studies. Parental attitudes and beliefs, coping skills and confidence in parenting, parental stress, compliance with child health checks/links with primary healthcare services, satisfaction with peer support and services and the nature of the relationship between parents and home visitors. The search strategy will include both published and unpublished studies. Seven journal databases and five other sources will be searched. Only studies published in the English language from 2000 to 2015 will be considered. Studies were assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) as appropriate. Both quantitative and qualitative data were independently extracted by two reviewers
Segal, Leonie; Sara Opie, Rachelle; Dalziel, Kim
Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment. We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis. Having a stated objective of reducing child maltreatment-a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change-considerably increased the chance of success. We found that only seven of fifty-three programs demonstrated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Programs with a partial match had an intermediate success rate. The relationship between program success and full, partial or no match was statistically significant. Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic framework provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory
Full Text Available BACKGROUND: Nearly half of births in low-income countries occur without a skilled attendant, and even fewer mothers and babies have postnatal contact with providers who can deliver preventive or curative services that save lives. Community-based maternal and newborn care programs with postnatal home visits have been tested in Bangladesh, Malawi, and Nepal. This paper examines coverage and content of home visits in pilot areas and factors associated with receipt of postnatal visits. METHODS: Using data from cross-sectional surveys of women with live births (Bangladesh 398, Malawi: 900, Nepal: 615, generalized linear models were used to assess the strength of association between three factors - receipt of home visits during pregnancy, birth place, birth notification - and receipt of home visits within three days after birth. Meta-analytic techniques were used to generate pooled relative risks for each factor adjusting for other independent variables, maternal age, and education. FINDINGS: The proportion of mothers and newborns receiving home visits within three days after birth was 57% in Bangladesh, 11% in Malawi, and 50% in Nepal. Mothers and newborns were more likely to receive a postnatal home visit within three days if the mother received at least one home visit during pregnancy (OR2.18, CI1.46-3.25, the birth occurred outside a facility (OR1.48, CI1.28-1.73, and the mother reported a CHW was notified of the birth (OR2.66, CI1.40-5.08. Checking the cord was the most frequently reported action; most mothers reported at least one action for newborns. CONCLUSIONS: Reaching mothers and babies with home visits during pregnancy and within three days after birth is achievable using existing community health systems if workers are available; linked to communities; and receive training, supplies, and supervision. In all settings, programs must evaluate what community delivery systems can handle and how to best utilize them to improve postnatal care
Holmberg, John R.; Olds, David L.
Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707
Full Text Available Postnatal maternal depression (PND is a significant risk factor for infant mental health. Although often targeted alongside other factors in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed.This study evaluates the impact on PND symptomatology of a multifocal perinatal home-visiting intervention using psychologists in a sample of women presenting risk factors associated with infant mental health difficulties.440 primiparous women were recruited at their seventh month of pregnancy. All were future first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. The intervention consisted of intensive multifocal home visits through to the child's second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS.At three months postpartum, mean (SD EPDS scores were 9.4 (5.4 for the control group and 8.6 (5.4 for the intervention group (p = 0.18. The difference between the mean EPDS scores was 0.85 (95% CI: 0.35; 1.34. The intervention group had significantly lower EPDS scores than controls in certain subgroups: women with few depressive symptoms at inclusion (EPDS <8: difference = 1.66 (95%CI: 0.17; 3.15, p = 0.05, adjusted for baseline EPDS score, women who were planning to raise the child with the child's father: difference = 1.45 (95%CI: 0.27; 2.62, p = 0.04 (adjusted; women with a higher educational level: difference = 1.59 (95%CI: 0.50; 2.68 p = 0.05 (adjusted.CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in terms of primary prevention and in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology for young, first-time mothers presenting additional
Haire-Joshu, Debra L; Schwarz, Cynthia D; Peskoe, Sarah B; Budd, Elizabeth L; Brownson, Ross C; Joshu, Corinne E
Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program. A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months). When compared to the control group, BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption
... specified in the Affordable Care Act (such as maternal and child health status, school readiness, and domestic violence, among others); (b) the effectiveness of such programs on different populations...
Greacen, Tim; Welniarz, Bertrand; Purper-Ouakil, Diane; Wendland, Jaqueline; Dugravier, Romain; Saïas, Thomas; Tereno, Susana; Tubach, Florence; Haddad, Alain; Guedeney, Antoine
Individual supervision of home-visiting professionals has proved to be a key element for perinatal home-visiting programs. Although studies have been published concerning quality criteria for supervision in North American contexts, little is known about this subject in other national settings. In the context of the CAPEDP program (Compétences parentales et Attachement dans la Petite Enfance: Diminution des risques liés aux troubles de santé mentale et Promotion de la résilience; Parental Skills and Attachment in Early Childhood: Reducing Mental Health Risks and Promoting Resilience), the first randomized controlled perinatal mental health promotion research program to take place in France, this article describes the results of a study using the Delphi consensus method to identify the program supervisors' points of view concerning best practice for the individual supervision of home visitors involved in such programs. The final 18 recommendations could be grouped into four general themes: the organization and setting of supervision sessions; supervisor competencies; relationship between supervisor and supervisee; and supervisor intervention strategies within the supervision process. The quality criteria identified in this perinatal home-visiting program in the French cultural context underline the importance of clinical supervision and not just reflective supervision when working with families with multiple, highly complex needs. © 2017 Michigan Association for Infant Mental Health.
Parker, Carlo; Warmuskerken, Geene; Sinclair, Lorna
We planned and implemented an evidence-based program to screen for jaundice and to try to increase the proportion of women breastfeeding for 6 months. The program involved home visitation by a registered nurse to provide education on and support of breastfeeding, and to perform physical assessment of both mothers and newborns, including screening for neonatal jaundice. Quantitative data showed increased breastfeeding rates at 6 months. In addition, readmission rates for jaundice were higher when compared to regional benchmarks. However, the average length of stay for treatment of jaundice was shorter than regional benchmarks. Qualitative data indicated that the program was effective at achieving its goals and was valued by participants. © 2015 AWHONN.
Gonçalves Judite; Weaver France
This study estimates the effects of formal home care on hospitalizations and doctor visits. We compare the effects of medically- and non-medically-related home care and investigate heterogeneous effects by age group and informal care availability. Two-part models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into cantons (i.e. states). The endogeneity of home care is addressed by using instrumental variables, canton and time fixed effec...
Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip
There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.
Clapham, Kathleen; Bennett-Brook, Keziah; Hunter, Kate
Aboriginal Australian children experience higher rates of injury than other Australian children. However few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of NSW. Delivered by Aboriginal Family Workers the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This paper reports on the qualitative interviews which explored the ways in which clients, IAMS staff, and external service providers experienced the program and assessed its delivery by the Aboriginal Family Workers. A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by Aboriginal Family Workers to vulnerable families. Clients, IAMS staff, and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. SO WHAT?: This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Beasley, Lana O; Ridings, Leigh E; Smith, Tyler J; Shields, Jennifer D; Silovsky, Jane F; Beasley, William; Bard, David
Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study's findings.
Nait Aicha, A.; Englebienne, G.; Kröse, B.
Assistive technologies for elderly often use ambient sensor systems to infer activities of daily living (ADL). In general such systems assume that only a single person (the resident) is present in the home. However, in real world environments, it is common to have visits and it is crucial to know
Nait Aicha, Ahmed; Englebienne, Gwenn; Kröse, B.J.A.
Assistive technologies for elderly often use ambient sensor systems to infer activities of daily living (ADL). In general such systems assume that only a single person (the resident) is present in the home. However, in real world environments, it is common to have visits and it is crucial to know
El Yaafouri-Kreuzer, Louise
Recalling her year as the "English-speaking unicorn" in a class of refugee and immigrant students representing a myriad of languages, the author tells how visiting students at their homes was the strategy that most helped her help students. From discovering that a betel-nut habit was causing one student's hyperactivity to seeing another…
McCabe, Bridget K; Potash, Dru; Omohundro, Ellen; Taylor, Cathy R
To describe the design and implementation of an evaluation system to facilitate continuous quality improvement (CQI) and scientific evaluation in a statewide home visiting program, and to provide a summary of the system's progress in meeting intended outputs and short-term outcomes. Help Us Grow Successfully (HUGS) is a statewide home visiting program that provides services to at-risk pregnant/post-partum women, children (0-5 years), and their families. The program goals are to improve parenting skills and connect families to needed services and thus improve the health of the service population. The evaluation system is designed to: (1) integrate evaluation into daily workflow; (2) utilize standardized screening and evaluation tools; (3) facilitate a culture of CQI in program management; and, (4) facilitate scientifically rigorous evaluations. The review of the system's design and implementation occurred through a formative evaluation process (reach, dose, and fidelity). Data was collected through electronic and paper surveys, administrative data, and notes from management meetings, and medical chart review. In the design phase, four process and forty outcome measures were selected and are tracked using standardized screening and monitoring tools. During implementation, the reach and dose of training were adequate to successfully launch the evaluation/CQI system. All staff (n = 165) use the system for management of families; the supervisors (n = 18) use the system to track routine program activities. Data quality and availability is sufficient to support periodic program reviews at the region and state level. In the first 7 months, the HUGS evaluation system tracked 3,794 families (7,937 individuals). System use and acceptance is high. A successful implementation of a structured evaluation system with a strong CQI component is feasible in an existing, large statewide program. The evaluation/CQI system is an effective mechanism to drive modest change in management
Sairenji, Tomoko; Wilson, Stephen A; D'Amico, Frank; Peterson, Lars E
Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.
Stewart, Tanya Charyk; Clark, Andrew; Gilliland, Jason; Miller, Michael R; Edwards, Jane; Haidar, Tania; Batey, Brandon; Vogt, Kelly N; Parry, Neil G; Fraser, Douglas D; Merritt, Neil
The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. Therapeutic/care management study
Hendy, Helen M.
Compared effects of different visiting programs (people, people and pets, pets, no visit) on behaviors of nursing home residents. Found all three visiting programs increased behaviors of smiling and alertness in comparison to control conditions. Close proximity to person-alone visitor was associated with greatest number of positive resident…
Tohara, Haruka; Iida, Takatoshi; Inoue, Motoharu; Sato, Mitsuyasu; Wada, Satoko; Sanpei, Ryuichi; Okada, Takeshi; Shimano, Takaya; Ebihara, Katsuko; Ueda, Koichiro
Dysphagia can cause aspiration pneumonia. The condition of dysphagia is difficult to evaluate from outside. Therefore, a careful examination is necessary to grasp the state of swallowing of a patient accurately. However, it has been a difficult situation for a patient who cannot come to hospital for some reason to be examined by video fluoroscopy or video endoscopy. In recent years, a usefulness of video endoscopy in visiting home examination for dysphagia has been reported several times. And this video endoscopy examination is a valuable tool to detect a discrepancy between swallowing function and nutritional intake of the patient. Cooperative rehabilitation with such a careful examination is an important issue to be successful in dysphagia rehabilitation.
Ammerman, Robert T.; Peugh, James L.; Putnam, Frank W.; Van Ginkel, Judith B.
Home visiting is a child abuse prevention strategy that seeks to optimize child development by providing mothers with support, training, and parenting information. Research has consistently found high rates of depression in mothers participating in home visiting programs and low levels of obtaining mental health treatment in the community.…
Hiratsuka, Vanessa Y; Parker, Myra E; Sanchez, Jenae; Riley, Rebecca; Heath, Debra; Chomo, Julianna C; Beltangady, Moushumi; Sarche, Michelle
The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities. © 2018 Michigan Association for Infant Mental Health.
Peterson, Carla A.; Roggman, Lori A.; Green, Beth; Chazan-Cohen, Rachel; Korfmacher, Jon; McKelvey, Lorraine; Zhang, Dong; Atwater, Jane B.
Variations in dosage, content, and family engagement with Early Head Start (EHS) home visiting services were examined for families participating in the EHS Research and Evaluation Project. Families were grouped by characteristics of maternal age, maternal ethnicity, and level of family risk. All home visiting variables were related differentially…
aspiration, prenatal drug exposure, anemia , sickle cell trait, or identification of any other adverse health condition to include premature birth...p=.840), preeclampsia (LBW: χ 2 = .034, df= 1, p=.967; Premature: χ 2 =.087, df= 1, p=.920), placenta previa (LBW: χ 2 = .173, df= 1, p=.845...interdisciplinary approaches to research and practice (1st ed.). San Francisco, CA: Jossey-Bass. HOME VISITATION & BIRTH OUTCOMES 29 Fry-Johnson, Y . W
Hawes, Emily M; Lambert, Erika; Reid, Alfred; Tong, Gretchen; Gwynne, Mark
Results of a study evaluating quality-of-care, financial, and patient satisfaction outcomes of pharmacist-conducted telehealth visits for diabetes management and warfarin monitoring are reported. A retrospective pre-post study was conducted to determine the impact of an electronic visit (e-visit) program targeting 2 groups of outpatients: adults with uncontrolled diabetes and warfarin-treated adults performing patient self-testing (PST) for monitoring of International Normalized Ratio (INR) values. A total of 36 patients participated in the e-visit program during the 2-year study period. Among warfarin-treated patients, the percentage of INR values in the desired range increased relative to preenrollment values (from 62.5% to 72.7%, p = 0.07), and the frequency of extreme INR values (values of 5.0) decreased (from 4.8% to 0.01%, p = 0.01); the margin per patient was $300 during the first year and $191 annually thereafter. In the diabetes group, a decrease from baseline in glycosylated hemoglobin values of 3.4 percentage points was observed at 5.7 months after enrollment ( p management of diabetes through e-visits, often in combination with in-person visits, generated revenue while significantly improving clinical outcomes. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
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Kyzer, Angela; Whiteside-Mansell, Leanne; McKelvey, Lorraine; Swindle, Taren
The purpose of this study was to examine the feasibility and usefulness of a universal screening tool, the Family Map Inventory (F MI), to assess family strengths and needs in a home visiting program. The FMI has been used successfully by center-based early childcare programs to tailor services to family need and build on existing strengths. Home visiting coordinators (N = 39) indicated the FMI would provide useful information, and they had the capacity to implement. In total, 70 families who...
Goyal, Neera K; Rome, Martha G; Massie, Julie A; Mangeot, Colleen; Ammerman, Robert T; Breckenridge, Jye; Lannon, Carole M
Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.
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Ammerman, Robert T; Putnam, Frank W; Altaye, Mekibib; Teeters, Angelique R; Stevens, Jack; Van Ginkel, Judith B
Depression is prevalent in mothers receiving home visiting. Little is known about the impact of treatment on associated features of maternal depression in this population. The purpose of this study was to examine the impact of a novel, adapted treatment for depressed mothers in home visiting on psychological distress and social functioning. In-Home Cognitive Behavioral Therapy (IH-CBT) was developed to treat depressed mothers in home visiting. A randomized clinical trial design was used in which subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visiting (n = 47) or standard home visiting (SHV; n = 46) in which they received home visitation alone and could obtain treatment in the community. Measures of psychological distress, social support, and social network were measured at pre-treatment, post-treatment, and three-month follow-up. Clinical features of depression and home visiting parameters were examined as potential moderators. Subjects receiving IH-CBT reported decreased psychological distress at post-treatment (ES = 0.77) and follow-up (ES = 0.73). Examination of types of psychological distress indicated broad improvements at both time points. Those receiving IH-CBT reported increased social support over time relative to those in the SHV condition. Effect sizes were modest at post-treatment (ES = 0.38) but increased at follow-up (ES = 0.65). Improvements were seen in affiliative and belonginess aspects of social support, in contrast to tangible support which was statistically non-significant. Findings were not moderated by clinical features of depression or home visiting parameters. No group differences were found in size of and involvement with social networks. IH-CBT is effective in reducing psychological distress and improving perceived social support in depressed mothers receiving home visiting. To the extent that mothers are better
Anne Marie Lunde Husebø
Full Text Available Background. This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits. Design. An integrative literature review. Method. Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience. Results. Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found. Conclusions. The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.
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Zarakit, Mohamad; Nors Hansen, Louise; Evron, Lotte Orr
with participant observation of three selected screen visits with older patients with a minority ethnic background. Analysis: thematic analysis based on a hermeneutic approach. Primarily results indicate that older patients with a minority ethnic background are screened out during the recruitment phase for digital...
Yonemoto, Naohiro; Dowswell, Therese; Nagai, Shuko; Mori, Rintaro
Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules
Although the home is the most common place where social work goes on, research has largely ignored the home visit. Drawing on a participant observation study of child protection work, this article reveals the complex hidden practices of social work on home visits. It is argued that home visits do not simply involve an extension of the social work organisation, policies and procedures into the domestic domain but the home constitutes a distinct sphere of practice and experience in its own right. Home visiting is shown to be a deeply embodied practice in which all the senses and emotions come into play and movement is central. Through the use of creativity, craft and improvisation practitioners 'make' home visits by skilfully enacting a series of transitions from the office to the doorstep, and into the house, where complex interactions with service users and their domestic space and other objects occur. Looking around houses and working with children alone in their bedrooms were common. Drawing upon sensory and mobile methods and a material culture studies approach, the article shows how effective practice was sometimes blocked and also how the home was skilfully negotiated, moved around and creatively used by social workers to ensure parents were engaged with and children seen, held and kept safe.
Sadler, Lois S; Condon, Eileen M; Deng, Shirley Z; Ordway, Monica Roosa; Marchesseault, Crista; Miller, Andrea; Alfano, Janet Stolfi; Weir, Alison M
The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby ® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed. © 2017 Wiley Periodicals, Inc.
The importance of home-school relationships between parents and practitioners in early childhood settings is widely accepted. This article discusses the effects of the level of involvement and the nature of practitioner-parent relationships in early years settings in England on the basis of a two part study that examined parents' experience of…
The Pew Home Visiting Campaign was launched in 2009 by the Pew Center on the States to guide state policymakers toward smart investments in quality, voluntary home-based programs for new and expectant families. In light of the federal development and pressing needs of states, the campaign will assist states in several ways, including policy…
Hendriksen, C; Vass, M
During the last 20 years several randomised controlled trials have been published about preventive home visits to old people, but the benefit of the visits is still controversial and under debate. Based on a state law from the Ministry of Social Affairs in 1998, the municipalities in Denmark are ......, manageable and ongoing educational intervention towards professionals working with preventive home visits is feasible and improves older people's functional mobility.......During the last 20 years several randomised controlled trials have been published about preventive home visits to old people, but the benefit of the visits is still controversial and under debate. Based on a state law from the Ministry of Social Affairs in 1998, the municipalities in Denmark...... are obliged to offer home visits twice a year to all citizens 75 years and older. After six years with this law, there is still variation of how the law is managed and implemented. About 60% of the elderly people accept and receive the visits. Less than 50% of the municipalities have made specific guidelines...
Duggan, Anne K.; Berlin, Lisa J.; Cassidy, Jude; Burrell, Lori; Tandon, S. Darius
Home visiting programs for at-risk mothers and their infants have proliferated nationally in recent years, yet experimental studies of home visiting have yielded mixed findings. One promising strategy for explicating the effects of early home visiting is to examine moderators of program impacts. This study assessed the roles of maternal depression…
Data including information on patient age, gender, who initiated the visit and call classification was collected during office hours from 12 G.P. rural teaching practices with a combined GMS patient population of 24,720, over a 2 month period. There were a total of 603 home visits, giving an annual visiting rate of 143\\/1000. Visiting rates varied between practices from 45 to 305\\/1000 per year. When high visiting practices (>210\\/1000\\/year) were compared to low visiting rate practices (>90\\/1000\\/year), patients tended to be older (79.7 v. 74.5 years) and calls were 12 times more likely to be doctor initiated (16.6% v. 1.4%) or classified as routine( 50.7% v. 44.9%). The variation between practices was related in part to patient age but appears largely due to differences in doctor home visiting behaviour. There are no recent figures on home visiting in Ireland.
Pibernat, Artur Dalfó; Vidal, Jessica Rosell; Pibernat, Enric Dalfó; Rodríguez, Francisco Javier Pelegrina; Colomer, Gerard; Cid, Maria Feijoo
This article will explore a clinical case study of a home visit carried out by the case manager nurse. In this case, we will discuss the dilemma of finding the balance between autonomy and beneficence from the perspective of principlist ethics, virtue ethics and the 'ethics of care'. The main conflict in this case study deals with all proposals are unsuitable and it is not necessary for a nurse to pay him a home visit, whereas for the healthcare system it is considered necessary. We could conclude that, during the home visit, the case manager aspires to achieve excellence, and throughout his clinical relationship with Francesc, searches for a series of virtues, respecting certain fundamental principles. In this way, the case managers ensure that Jaume's care is more humanised. The case has been anonymised and confidentiality maintained.
Samankasikorn, Wilaiporn; Pierce, Brittany; St Ivany, Amanda; Gwon, Seok Hyun; Schminkey, Donna; Bullock, Linda
Determine the extent that participation in Resource Mothers Program (RMP) home visiting improves maternal health at 3 months postpartum. A randomized controlled trial using RMPs in two urban and one rural location in a mid-Atlantic state. Community health workers from these RMPs enrolled teens into the study and the research team assigned participants to either the intervention group or telephone support control group using computerized randomization assignments. Data collection from baseline and 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) and the Prenatal Psychosocial Profile (PPP) is reported. The sample included 150 pregnant teens with a mean age of 17 years. Mean self-esteem scores between groups were not significantly different at baseline, but the RMP group self-esteem scores improved significantly at the 3 months postpartum interview (36.40 ± 5.63 for RMP vs. 34.10 ± 4.29 telephone control group, p = 0.049). Neither group was at risk for depression at baseline or 3 months postpartum. Because 60% of the total sample identified as Hispanic, post hoc analysis revealed significantly different baseline stress mean scores between Hispanic and non-Hispanic teens (p = 0.038); however, these differences were no longer significant by 3 months postpartum (p = 0.073). The EPDS scores by ethnicity were not different at baseline (p = 0.875) but were significantly different at 3 months (p = 0.007). The RMP home-visiting intervention can lead to improved self-esteem scores in teens, particularly in Hispanic teens. Improved self-esteem has been shown to lead to better parenting.
Ekmann, A; Vass, M; Avlund, K
Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home-dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate...... whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study......, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3...
Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.
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Huntington, Lee; Galano, Joseph
It is a common assumption that mothers who have had previous births would participate less fully and have poorer outcomes from early home visitation programs than would first-time mothers. The authors conducted a qualitative and quantitative study to test that assumption by measuring three aspects of participation: time in the program, the number…
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Lakin, Ashley; Sutter, Mary Beth; Magee, Susanna
The purpose of our study was to pilot a home visit program targeting neonates conducted by family medicine residents. While the literature shows that home visit programs are successful at preventing adverse outcomes for young children, such as improving parenting practices and promoting breastfeeding, no data exist about newborn home visits conducted by resident physicians. Residents conducted newborn home visits precepted by a family medicine faculty member from June 2012--May 2013. Subjects were recruited from the residency continuity practice and randomized to receive two home visits (which replaced two office visits) or routine office-based newborn care. All participants were surveyed using the validated WHOQOL-BREF quality of life scale and a patient satisfaction instrument. Metrics were also obtained from the electronic medical record. Mothers and resident physicians completed an open-ended questionnaire about their experience. All patients, whether receiving office-based or home-based care, rated their care highly. Significant differences were seen in usage of acute care in the first 6 months of life, and mothers in the home visit group trended toward initiating breastfeeding at a higher rate. The home visit group ranked their quality of life higher across all domains when compared to the control group, approaching statistical significance in two domains. Residents providing home visits reported increased connectedness to patients and improved confidence in anticipatory guidance delivery. Home visits are valuable for families with newborns, in terms of minimizing acute care service usage, breastfeeding promotion, and perhaps increasing maternal perceptions of well-being. A home visit program has the potential to enhance resident education and the doctor-patient relationship.
Savannah River Ecology Laboratory Herpetology Program Herp Home Research Publications Herps of SC /GA P.A.R.C. Outreach SREL Home powered by Google Search Herpetology at SREL The University of SREL herpetology research programs have always included faculty of the University of Georgia, post
Nait Aicha, A.; Englebienne, G.; Kröse, B.
Many algorithms on health monitoring from ambient sensor networks assume that only a single person is present in the home. We present an unsupervised method that models visit behaviour. A Markov modulated multidimensional non-homogeneous Poisson process (M3P2) is described that allows us to model
Hobbs, Janice E; Tschudy, Megan M; Hussey-Gardner, Brenda; Jennings, Jacky M; Boss, Renee D
When families transition from the neonatal intensive care unit (NICU) to the home, they become responsible for their infant's daily medical needs. Though neonatology physicians prepare families for hospital discharge, it is unclear how much clinicians understand about how their teaching and instructions translate into home care. The goal of this study was to evaluate the influence of a home visiting program on neonatology fellows' understanding of family needs soon after hospital discharge. Neonatology fellows conducted a home visit for an infant recently discharged. Before the visit, fellows reviewed their original discharge instructions, along with information about the family's neighborhood. During the home visit, fellows reviewed their discharge planning with families and discussed any challenges experienced. Afterwards, fellows completed a semi-structured interview; these transcriptions were manually coded for themes. Fellows identified several common women/family discharge challenges. These challenges fall into four domains: (1) inadequate discharge preparation, (2) medicalization of the home, (3) family adjustment to new "normal," and (4) the relevance of social context to discharge planning. Most (90%) fellows reported the home visit experience would affect their future NICU discharge practices and all agreed that home visits should be a part of neonatology training. Home visits allowed neonatology fellows to examine how their discharge preparation did, or did not, meet the family's needs. Incorporating home visits into neonatology training could help fellows learn about the relevance of social and community factors that are difficult to assess in the inpatient setting. © 2017 Wiley Periodicals, Inc.
Ammerman, Robert T; Peugh, James L; Teeters, Angelique R; Putnam, Frank W; Van Ginkel, Judith B
Child maltreatment contributes to depression in adults. Evidence indicates that such experiences are associated with poorer outcomes in treatment. Mothers in home visiting programs display high rates of depression and child maltreatment histories. In-Home Cognitive Behavioral Therapy (IH-CBT) was developed to treat maternal depression in home visiting. The purpose of this study was to examine the moderating effects of child maltreatment history on depression, social functioning, and parenting in mothers participating in a clinical trial of IH-CBT. Ninety-three depressed mothers in home visiting between 2 and 10 months postpartum were randomly assigned to IH-CBT (n = 47) plus home visiting or standard home visiting (SHV; n = 46). Mothers were identified via screening and then confirmation of major depressive disorder diagnosis. Measures of child maltreatment history, depression, social functioning, and parenting were administered at pre-treatment, post-treatment, and 3-month follow-up. Results indicated high rates of maltreatment in both conditions relative to the general population. Mixed model analyses found a number of main effects in which experiences of different types of trauma were associated with poorer functioning regardless of treatment condition. Evidence of a moderating effect of maltreatment on treatment outcomes was found for physical abuse and parenting and emotional abuse and social network size. Future research should focus on increasing the effectiveness of IH-CBT with depressed mothers who have experienced child maltreatment. © The Author(s) 2014.
Ammerman, Robert T; Altaye, Mekibib; Putnam, Frank W; Teeters, Angelique R; Zou, Yuanshu; Van Ginkel, Judith B
Research on older children and high-resource families demonstrates that maternal improvement in depression often leads to parallel changes in parenting and child adjustment. It is unclear if this association extends to younger children and low-income mothers. This study examined if In-Home Cognitive Behavioral Therapy (IH-CBT), a treatment for depressed mothers participating in home visiting programs, contributes to improvements in parenting and child adjustment. Ninety-three depressed mothers in home visiting between 2 and 10 months postpartum were randomly assigned to IH-CBT (n = 47) plus home visiting or standard home visiting (SHV; n = 46). Mothers were identified via screening and subsequent diagnosis of major depressive disorder (MDD). Measures of depression, parenting stress, nurturing parenting, and child adjustment were administered at pre-treatment, post-treatment, and 3 months follow-up. Results indicated that there were no differences between IH-CBT and controls on parenting and child adjustment. Low levels of depression were associated with decreased parenting stress and increased nurturing parenting. Improvement in depression was related to changes in parenting in low-income mothers participating in home visiting programs. IH-CBT was not independently associated with these improvements, although to the extent that treatment facilitated improvement; there were corresponding benefits to parenting. Child adjustment was not associated with maternal depression, a finding possibly attributed to the benefits of concurrent home visiting or measurement limitations. Future research should focus on longer-term follow-up, implications of relapse, and child adjustment in later years.
Yamada, Yukari; Vass, Mikkel; Hvas, Lotte
the visits were made. A collaborative relationship was predefined as a favourable change in behaviour seen in the visited person during the study period. Visitor characteristics were analysed from 248 records where 37 cases of collaborative relationships were documented. Results. The three most important...... on documented knowledge in health and social domains combined with an overall 'caring approach' and (iii) practical actions which imply an 'immediate concrete response to identified needs or problems' and 'individually tailored advice' to suit the older person's daily life. Conclusions. Preventive home visitor...
Alves, Filipe; Fernandes, Florbela P.; Pereira, Ana I.; Fernandes, Adília
In Portugal the population is ageing. Therefore, the provision of health care at patients' home is becoming an important social and health area; this health service is provided by professional teams (usually composed by nurses) of the Health Centers. Nowadays, the scheduling of the visits is made manually. The proposal of this work is to do the scheduling automatically in order to minimize the overall time spent by the professional teams in the visiting activity. In this work the genetic algorithm was used to solve the optimization problem. Some numerical results are presented.
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Perry, Deborah F.; Tandon, S. Darius; Edwards, Karen; Mendelson, Tamar
Home visiting (HV) programs serve women at high risk for developing postpartum depression because of factors such as poverty and low social support. Depression poses serious threats not only to mother-child attachment and healthy infant development but also to women's ability to engage with HV services and supports. The Mothers and Babies (MB)…
José Díaz Novás
Full Text Available Se hace un breve resumen de la historia de la visita médica al hogar en Cuba, y se señala su evolución en las diferentes formas organizativas de la atención primaria en la etapa revolucionaria. Se enumeran las ventajas de las visitas médicas al hogar, su necesidad como componente fundamental e insustituible de la atención a los pacientes, y como complemento necesario del trabajo en el consultorio. Se exponen los motivos de la visita al hogar: enfermedades agudas, procesos crónicos, discapacidades, evaluar el entorno familiar e higiénico-epidemiológico del paciente, los ingresos domiciliarios, las altas hospitalarias precoces, y los pacientes con enfermedades terminales o con afecciones dispensarizadas, entre otros Se presenta un grupo de orientaciones para el desarrollo exitoso de la visita médica al hogarA summary of the history of home visit in Cuba is made, stressing its evolution in the different organizative ways of primary care in the revolutionary stage. The advantages of home visits, their need as a fundamental and irreplaceable component of the patients' care and a necessary complement of the work in the office are given. The reasons of the visits are explained: acute diseases, chronic processes, disabilities, evaluation of the family and hygienic-epidemiological setting of the patient, home admissions, early hospital discharges, and patients with end-stage diseases, or with categorized diseases, among others. Some instructions for the success of home visit are exposed.
Alitz, Paige J; Geary, Shana; Birriel, Pamela C; Sayi, Takudzwa; Ramakrishnan, Rema; Balogun, Omotola; Salloum, Alison; Marshall, Jennifer T
Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction
Ekmann, A; Vass, M; Avlund, K
Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home-dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi-square tests, and bi- and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to 'letter with a proposed date', men had an odds ratio of 1.78 (95% CI: 1.16-2.74) for declining visits when 'telephone call' was used and an odds ratio 2.81 (95% CI: 1.79-4.40) when 'letter without a proposed date' was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91-1.68) and 1.87 (95% CI: 1.37-2.55), respectively. © 2010 Blackwell Publishing Ltd.
Berlin, Lisa J; Martoccio, Tiffany L; Appleyard Carmody, Karen; Goodman, W Benjamin; O'Donnell, Karen; Williams, Janis; Murphy, Robert A; Dodge, Kenneth A
US government-funded early home visiting services are expanding significantly. The most widely implemented home visiting models target at-risk new mothers and their infants. Such home visiting programs typically aim to support infant-parent relationships; yet, such programs' effects on infant attachment quality per se are as yet untested. Given these programs' aims, and the crucial role of early attachments in human development, it is important to understand attachment processes in home visited families. The current, preliminary study examined 94 high-risk mother-infant dyads participating in a randomized evaluation of the Healthy Families Durham (HFD) home visiting program. We tested (a) infant attachment security and disorganization as predictors of toddler behavior problems and (b) program effects on attachment security and disorganization. We found that (a) infant attachment disorganization (but not security) predicted toddler behavior problems and (b) participation in HFD did not significantly affect infant attachment security or disorganization. Findings are discussed in terms of the potential for attachment-specific interventions to enhance the typical array of home visiting services.
Sharps, Phyllis W; Bullock, Linda F; Campbell, Jacquelyn C; Alhusen, Jeanne L; Ghazarian, Sharon R; Bhandari, Shreya S; Schminkey, Donna L
Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.
Full Text Available Abstract Background Home visiting programs comprising intensive and sustained visits by professionals (usually nurses over the first two years of life show promise in promoting child health and family functioning, and ameliorating disadvantage. Australian evidence of the effectiveness of sustained nurse home visiting in early childhood is limited. This paper describes the method and cohort characteristics of the first Australian study of sustained home visiting commencing antenatally and continuing to child-age two years for at-risk mothers in a disadvantaged community (the Miller Early Childhood Sustained Home-visiting trial. Methods and design Mothers reporting risks for poorer parenting outcomes residing in an area of socioeconomic disadvantage were recruited between February 2003 and March 2005. Mothers randomised to the intervention group received a standardised program of nurse home visiting. Interviews and observations covering child, maternal, family and environmental issues were undertaken with mothers antenatally and at 1, 12 and 24 months postpartum. Standardised tests of child development and maternal-child interaction were undertaken at 18 and 30 months postpartum. Information from hospital and community heath records was also obtained. Discussion A total of 338 women were identified and invited to participate, and 208 were recruited to the study. Rates of active follow-up were 86% at 12 months, 74% at 24 months and 63% at 30 months postpartum. Participation in particular data points ranged from 66% at 1 month to 51% at 24 months postpartum. Rates of active follow-up and data point participation were not significantly different for the intervention or comparison group at any data point. Mothers who presented for antenatal care prior to 20 weeks pregnant, those with household income from full-time employment and those who reported being abused themselves as a child were more likely to be retained in the study. The Miller Early
Latimore, Amanda D; Burrell, Lori; Crowne, Sarah; Ojo, Kristen; Cluxton-Keller, Fallon; Gustin, Sunday; Kruse, Lakota; Hellman, Daniela; Scott, Lenore; Riordan, Annette; Duggan, Anne
The associations of family, home visitor and site characteristics with family engagement within the first 6 months were examined. The variation in family engagement was also explored. Home visiting program participants were drawn from 21 Healthy Families America sites (1707 families) and 9 Nurse-Family Partnership sites (650 families) in New Jersey. Three-level nested generalized linear mixed models assessed the associations of family, home visitor and site characteristics with family receipt of a high dose of services in the first 6 months of enrollment. A family was considered to have received a high dose of service in the first 6 months of enrollment if they were active at 6 months and had received at least 50% of their expected visits in the first 6 months. In general, both home visiting programs engaged, at a relatively high level (Healthy Families America (HFA) 59%, Nurse-Family Partnership (NFP) 64%), with families demonstrating high-risk characteristics such as lower maternal education, maternal smoking, and maternal mental health need. Home visitor characteristics explained more of the variation (87%) in the receipt of services for HFA, while family characteristics explained more of the variation (75%) in the receipt of services for NFP. At the family level, NFP may improve the consistency with which they engage families by increasing retention efforts among mothers with lower education and smoking mothers. HFA sites seeking to improve engagement consistency should consider increasing the flexible in home visitor job responsibilities and examining the current expected-visit policies followed by home visitors on difficult-to-engage families.
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Jucelia Salgueiro Nascimento
Full Text Available Objective: To analyze the domiciliary visit performed by nurses in the Family Health Strategy as an activity to promote health. Methods: Exploratory/descriptive study with qualitative approach. The subjects were nine nurses of the Primary Health Units from Health Districts in Maceió-AL. Data was collected through semi-structured interviews in the months from April to August 2012 and were analyzed using content analysis and in light of the theoretical framework of Health Promotion. Results: The nurses recognize that the domiciliary visit can be a way to promote the health of individuals, families and community, but, in daily life, action maintains focus on disease, with curative actions of individual character, which do not take into account the social context where the user and his family are inserted. Conclusion: It is considered that the use of home visits by nurses in the family health strategy as a health promotion activity is still incipient because, although the nurses recognize the need for change in the model of care, in practice, it is observed that the focus of this action is directed to the biological model. doi:http://dx.doi.org/10.5020/18061230.2013.p513
Catherine, Nicole L. A.; Gonzalez, Andrea; Boyle, Michael; Sheehan, Debbie; Jack, Susan M.; Hougham, Kaitlyn A.; McCandless, Lawrence; MacMillan, Harriet L.; Waddell, Charlotte
Background Nurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children. The program focuses on women who are parenting for the first time and experiencing socioeconomic disadvantage. Nurse visits start as early in pregnancy as possible and continue until the child reaches age two years. The program has proven effective in the United States ? improving children?s mental health and development and maternal wellbeing, and showing...
Olds, David L
This paper summarizes a 25-year program of research that has attempted to improve the early health and development of low-income mothers and children and their future life trajectories with prenatal and infancy home visiting by nurses. The program has been tested in two separate large-scale randomized controlled trials with different populations living in different contexts. The program has been successful in improving parental care of the child as reflected in fewer injuries and ingestions that may be associated with child abuse and neglect; and maternal life-course, reflected in fewer subsequent pregnancies, greater work force participation, and reduced use of public assistance and food stamps. In the first trial, the program also produced long-term effects on the number of arrests, convictions, emergent substance use, and promiscuous sexual activity of 15-year-old children whose nurse-visited mothers were low-income and unmarried when they registered in the study during pregnancy. Since 1996, the program has been offered for public investment outside of research contexts. Careful attention has been given to ensuring that the program is replicated with fidelity to the model tested in the scientifically controlled studies by working with community leaders to ensure that organization and community contexts are favorable for the program; by providing the nurses with excellent training and technical assistance and detailed visit-by-visit guidelines; and by providing organizations with a web-based clinical information system that creates a basis for monitoring program performance and continuous quality improvement.
Full Text Available Birth outcomes, such as preterm birth, low birth weight (LBW, and small for gestational age (SGA, are crucial indicators of child development and health.To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes.In this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14-19 years old, women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964, which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311 and included in the analysis. Data were analyzed between January and June 2014.In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98 and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92 compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5.Home visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.
Full Text Available ... Workforce Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative Issues Regulatory Issues Regulatory Issues Regulatory Issues Stop Overregulating My OR ... American Urological Association (AUA), Certified Enterostomal Therapy Nurses (CETN), and the United Ostomy Associations of America (UOAA). Program Overview The skills kit contains: A booklet with information on the operation, home skills such as emptying ...
Glicksman, Martin; Vanalstine, James
Marshall Space Flight Center pursues scientific research in the area of low-gravity effects on materials and processes. To facilitate these Government performed research responsibilities, a number of supplementary research tasks were accomplished by a group of specialized visiting scientists. They participated in work on contemporary research problems with specific objectives related to current or future space flight experiments and defined and established independent programs of research which were based on scientific peer review and the relevance of the defined research to NASA microgravity for implementing a portion of the national program. The programs included research in the following areas: protein crystal growth, X-ray crystallography and computer analysis of protein crystal structure, optimization and analysis of protein crystal growth techniques, and design and testing of flight hardware.
Nørmark, Kurt; Thomsen, Bent; Thomsen, Lone Leth
Mapping and visiting represent different programming styles for traversals of collections of data. Mapping is rooted in the functional programming paradigm, and visiting is rooted in the object-oriented programming paradigm. This paper explores the similarities and differences between mapping...... and visiting, seen across the traditions in the two different programming paradigms. The paper is concluded with recommendations for mapping and visiting in programming languages that support both the functional and the object-oriented paradigms....
Monte, Scott V; Passafiume, Sarah N; Kufel, Wesley D; Comerford, Patrick; Trzewieczynski, Dean P; Andrus, Kenneth; Brody, Peter M
To provide experience on the methods and costs for delivering a large-scale community pharmacist home visit service. Independent urban community pharmacy, Buffalo, NY. Mobile Pharmacy Solutions provides traditional community pharmacy walk-in service and a suite of clinically oriented services, including outbound adherence calls linked to home delivery, payment planning, medication refill synchronization, adherence packaging, and pharmacist home visits. Pharmacist daily staffing included three dispensing pharmacists, one residency-trained pharmacist, and two postgraduate year 1 community pharmacy residents. A large-scale community pharmacy home visit service delivered over a 1-year period. Pharmacist time and cost to administer the home visit service as well as home visit request sources and description of patient demographics. A total of 172 visits were conducted (137 initial, 35 follow-up). Patients who received a home visit averaged 9.8 ± 5.2 medications and 3.0 ± 1.6 chronic disease states. On average, a home visit required 2.0 ± 0.8 hours, which included travel time. The percentages of visits completed by pharmacists and residents were 60% and 40%, respectively. The amounts of time to complete a visit were similar. Average home visit cost including pharmacist time and travel was $119 ($147 for a pharmacist, $77 for a resident). In this community pharmacy-based home visit service, costs are an important factor, with each pharmacist visit requiring 2 hours to complete. This experience provides a blueprint and real-world perspective for community pharmacies endeavoring to implement a home visit service and sets a foundation for future prospective trials to evaluate the impact of the service on important indicators of health and cost. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Clemson, Lindy; Lannin, Natasha A; Wales, Kylie; Salkeld, Glenn; Rubenstein, Laurence; Gitlin, Laura; Barris, Sarah; Mackenzie, Lynette; Cameron, Ian D
To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Randomized controlled trial. Acute and medical wards. Individuals aged 70 and older (N = 400). Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Occupational therapist recommendations differed significantly between groups (P occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Lippert, M; Semmens, S; Tacey, L; Rent, T; Defoe, K; Bucsis, M; Shykula, T; Crysdale, J; Lewis, V; Strother, D; Lafay-Cousin, L
The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.
Full Text Available Yi Li,1,2 Jing Feng,3,4 Yuechuan Li,2 Wei Jia,2 Hongyu Qian2 1Graduate School, Tianjin Medical University, 2Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, 3Respiratory Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 4Neuropharmacology Section, Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA Background: The benefit of pulmonary rehabilitation (PR for patients with COPD diminishes over time. We investigated a new strategy involving home-visit and phone contact and compared this to usual care in maintenance of PR benefits.Methods: A total of 172 stable COPD patients receiving 8-week PR program were recruited for this prospective study. Patients were allocated into usual care group (UC and PR maintenance group (PRMG randomly. Patients in PRMG participated in maintenance strategy at home under supervision through home-visit and phone contact. The 6-minute walking test (6MWT, COPD assessment test (CAT, and modified Medical Research Council scale (mMRC scores were evaluated every 3 months.Results: Of the total, 151 patients completed 8-week PR program with satisfactory PR results (p<0.001, and 104 patients finished the follow-up. The clinical improvements in 6MWT, CAT, and mMRC scores were maintained (p<0.001 in PRMG. In comparison, the benefit of PR diminished gradually in UC. The differences in 6MWT, CAT, and mMRC scores between groups were observed 6, 9, and 6 months after PR, respectively (p<0.05. Total frequency of exacerbations in PRMG was lower than UC (p=0.021.Conclusion: Maintenance strategy involving home-visit and phone contact is superior to usual care to preserve PR benefits, and reduces the acute COPD exacerbation rate. Keywords: COPD, pulmonary rehabilitation, 6-minute walking test, COPD assessment test, maintenance
Ensing, H.T.; Vervloet, M.; Dooren, A.A. van; Bouvy, M.L.; Koster, E.S.
Background With the shifting role of community pharmacists towards patient education and counselling, they are wellpositioned to conduct a post-discharge home visit which could prevent or solve drug-related problems. Gaining insight into the communication during these home visits could be valuable
Rasmussen, Matias Sevel; Justesen, Tor Fog; Dohn, Anders Høeg
In the Home Care Crew Scheduling Problem a staff of home carers has to be assigned a number of visits to patients’ homes, such that the overall service level is maximised. The problem is a generalisation of the vehicle routing problem with time windows. Required travel time between visits and time...... preference constraints. The algorithm is tested both on real-life problem instances and on generated test instances inspired by realistic settings. The use of the specialised branching scheme on real-life problems is novel. The visit clustering decreases run times significantly, and only gives a loss...... windows of the visits must be respected. The challenge when assigning visits to home carers lies in the existence of soft preference constraints and in temporal dependencies between the start times of visits.We model the problem as a set partitioning problem with side constraints and develop an exact...
Whitesell, Nancy Rumbaugh; Bolan, Marc; Chomos, Julianna C; Heath, Debra; Miles, Jon; Salvador, Melina; Whitmore, Corrie; Barlow, Allison
In this article, Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees share strategies they have developed and adopted to address the most common barriers to effective measurement (and thus to effective evaluation) encountered in the course of implementation and evaluation of their home-visiting programs. We identify key challenges in measuring outcomes in Tribal MIECHV Programs and provide practical examples of various strategies used to address these challenges within diverse American Indian and Alaska Native cultural and contextual settings. Notably, high-quality community engagement is a consistent thread throughout these strategies and fundamental to successful measurement in these communities. These strategies and practices reflect the experiences and innovative solutions of practitioners working on the ground to deliver and evaluate intervention programs to tribal communities. They may serve as models for getting high-quality data to inform intervention while working within the constraints and requirements of program funding. The utility of these practical solutions extends beyond the Tribal MIECHV grantees and offers the potential to inform a broad array of intervention evaluation efforts in tribal and other community contexts. © 2018 Michigan Association for Infant Mental Health.
Full Text Available ... Overview The skills kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...
Full Text Available ... kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...
Full Text Available This paper describes the development of a gait rehabilitation system with a locomotion interface (LI for home-visit rehabilitation. For this purpose, the LI should be compact, small, and easy to move. The LI has two 2 degree-of-freedom (DOF manipulators with footpads to move each foot along a trajectory. When the user stands on the footpads, the system can move his or her feet while the body remains stationary. The footpads can have various trajectories, which are prerecordings of the movements of healthy individuals walking on plane surfaces or slopes. The homes of stroke patients may have not only flat surfaces but also some slopes and staircases. The quadriceps femoris muscle is important for walking up and down slopes and staircases, and the eccentric and concentric contractions of this muscle are, in particular, difficult to train under normal circumstances. Therefore, we developed a graded-walking program for the system used in this study. Using this system, the user can undergo gait rehabilitation in their home, during visits by a physical therapist. An evaluation of the results of tests showed that the vastus medialis muscles of all the subjects were stimulated more than by walking on real slopes.
Iruka, Iheoma U.; Brown, Deborah; Jerald, Judith; Blitch, Kimberly
Background: Improving the home environment and parenting practices to support children's early development and learning is a key focus of many. Home visiting is one potential strategy to improve the home environment and parenting; however, more data about current programmatic efforts is needed, especially for children with multiple risks living in…
Guterman, Neil B; Bellamy, Jennifer L; Banman, Aaron
Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being. Copyright © 2017. Published by Elsevier Ltd.
Cheng, Jui-Fen; Huang, Xuan-Yi; Lin, Mei-Jue; Wang, Ya-Hui; Yeh, Tzu-Pei
To investigate a community-based and hospital-based home visit partnership intervention in improving caregivers' satisfaction with home service and reducing caregiver burden. The community-oriented mental healthcare model prevails internationally. After patients return to the community, family caregivers are the patients' main support system and they also take the most of the burden of caring for patients. It is important to assist these caregivers by building good community healthcare models. A longitudinal quasi-experimental quantitative design. The experimental group (n = 109) involved "partnership" intervention, and the control group (n = 101) maintained routine home visits. The results were measured before the intervention, 6 and 12 months after the partnership intervention. Six months after the partnership intervention, the satisfaction of the experimental group was higher than the control group for several aspects of care. Although the care burden was reduced in the experimental group, there was no significant difference between the two groups. This study confirms that the partnership intervention can significantly improve caregiver satisfaction with home services, without reducing the care burden. The community-based and hospital-based mental health home visit service partnership programme could improve the main caregiver's satisfaction with the mental health home visit services, while the reduction in care burden may need government policies for the provision of more individual and comprehensive assistance. © 2017 John Wiley & Sons Ltd.
Gehring, Nicole D; Ball, Geoff D C; Perez, Arnaldo; Holt, Nicholas L; Neuman, Daniel; Spence, Nicholas; Mercier, Laura; Jetha, Mary
Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits. We focused on children with obesity aged 2-17 who were enrolled in our tertiary-level clinic in Alberta, Canada. None had received a home visit. The families were interviewed face-to-face from October 2015 to October 2016, and we used a qualitative description methodological framework and manifest content analysis. The parents were the main interviewees. Of the 56 families, 89% were interested in a home visit, 82% wanted support from a dietician and 54% from an exercise specialist. The perceived benefits of home visits included comprehensive assessment (95%), convenience (86%), tailored care (29%) and family involvement (13%), while the costs and barriers included clinicians' potential judgmental attitudes (30%), loss of privacy (19%) and distractions (10%). Some thought clinicians would find home visits inconvenient (25%), with bureaucratic challenges (14%) and sustainability issues (5%). Families felt home visits were a convenient option for managing paediatric obesity and identified important benefits and barriers that could guide such interventions. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Sierau, Susan; Dähne, Verena; Brand, Tilman; Kurtz, Vivien; von Klitzing, Kai; Jungmann, Tanja
Based on the US Nurse-Family Partnership (NFP) program, the German home visiting program "Pro Kind" offered support for socially and financially disadvantaged first-time mothers from pregnancy until the children's second birthday. A multi-centered, longitudinal randomized controlled trial (RCT) was conducted to assess its effectiveness on mothers and children. A total of 755 women with multiple risk factors were recruited, 394 received regular home visits (treatment group), while 361 only had access to standard community services (control group). Program influences on family environment (e.g., quality of home, social support), maternal competencies (e.g., maternal self-efficacy, empathy, parenting style), and child development (e.g., cognitive and motor development) were assessed from mothers' program intake in pregnancy to children's second birthday based on self-reports in regular interviews and developmental tests. Generalized estimating equations (GEE) models showed small, but significant positive treatment effects on parental self-efficacy, and marginally significant effects on social support, and knowledge on child rearing. Maternal stress, self-efficacy, and feelings of attachment in the TG tend to show a more positive development over time. Subgroup effects were found for high-risk mothers in the TG, who reported more social support over time and, generally, had children with higher developmental scores compared to their CG counterparts. Post hoc analyses of implementation variables revealed the quality of the helping relationship as a significant indicator of treatment effects. Results are discussed in terms of implementation and public policy differences between NFP and Pro Kind.
Kellom, Katherine S; Matone, Meredith; Adejare, Aderinola; Barg, Frances K; Rubin, David M; Cronholm, Peter F
Objectives The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts. Methods As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for Implementation Research (CFIR) to describe the key elements mitigating implementation of multiple home visiting models. Results A primary advantage of co-location described by participants was the ability to increase the agency's base of eligible clients through the implementation of a model with different program eligibility (e.g. income, child age) than the existing agency offering. Model differences related to curriculum (e.g. content or intensity/meeting frequency) enabled programs to more selectively match clients to models. To recruit eligible clients, new models were able to build upon the existing service networks of the initial program. Co-location provided organizational opportunities for shared trainings, enabling administrative efficiencies and collaborative staff learning. Programs implemented strategies to build synergies with complementary model features, for instance using the additional program option to serve waitlisted clients and to transition services after one model is completed. Conclusions for Practice Considerable benefits are experienced when home visiting models co-locate. This research builds on literature encouraging collaboration among community agencies and provides insight on a specific facilitative approach. This implementation strategy informs policy across the social services spectrum and competitive funding contexts.
Full Text Available ... Medical Student Core Curriculum ACS/ASE Medical Student Simulation-Based Surgical Skills Curriculum Cancer Education Cancer Education ... Home Skills Kit supports patients with educational and simulation materials to learn and practice the skills needed ...
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Full Text Available ... skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma Practice Model Stoma supplies (measurement guide, marking ...
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Lykkegaard, Jesper; Larsen, Pia V; Paulsen, Maja S
Background:The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices' accessibility and quality of care.Aims:To investigate whether GPs' tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic...... obstructive pulmonary disease.Methods:All Danish patients first-time hospitalised with COPD during the years 2006-2008 were identified. The association between the GP's tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox...... been readmitted and 1.6% had died without readmission. A U-shaped dose-response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a general practice in which >20...
Conclusion: As the home visit services might be effective for providing health care for the aged people and increasing their quality of life, policymaking to spread these services seems to be crucial especially for Iran.
Giesen, Paul; van Lin, Nieke; Mokkink, Henk; van den Bosch, Wil; Grol, Richard
The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minutes decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance.
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This project consisted of hosting local Champaign-Urbana, Illinois home school students for a visit to : the Rail Transportation and Engineering Center (RailTEC) at the University of Illinois at Urbana- : Champaign (UIUC). Beyond visiting RailTEC, st...
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Denton, Margaret A; Zeytinoğlu, Işk Urla; Davies, Sharon
The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.
Full Text Available ... Workforce Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative ... Overview The skills kit contains: A booklet with information on the ... and home management. A DVD with demonstration of each skill Stoma ...
Full Text Available ... Workforce Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative ... supports the entire surgical team with quality, comprehensive education. The ... A booklet with information on the operation, home skills such as emptying ...
Full Text Available ... emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma Practice Model Stoma supplies (measurement guide, marking pen, scissors, sample pouch) Ostomy self-care checklist Evaluation (Complete the Ostomy Patient Survey . We ...
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Shenk, Chad E; Ammerman, Robert T; Teeters, Angelique R; Bensman, Heather E; Allen, Elizabeth K; Putnam, Frank W; Van Ginkel, Judith B
Home visiting is an effective preventive intervention that can improve parenting outcomes for at-risk, new mothers, thereby optimizing subsequent child development. A history of maltreatment in childhood is common in mothers participating in home visiting, yet the extent to which such a history is related to parenting outcomes during home visiting is unknown. The current study evaluated whether mothers with a history of maltreatment in childhood respond less favorably to home visiting by examining the direct and indirect pathways to subsequent parenting stress, a key parenting outcome affecting child development. First-time mothers (N = 220; age range = 16-42) participating in one of two home visiting programs, Healthy Families America or Nurse Family Partnership, were evaluated at enrollment and again at 9-and 18-month post-enrollment assessments. Researchers administered measures of maternal history of maltreatment in childhood, depressive symptoms, social support, and parenting stress. Maternal history of maltreatment in childhood predicted worsening parenting stress at the 18-month assessment. Mediation modeling identified two indirect pathways, one involving social support at enrollment and one involving persistent depressive symptoms during home visiting, that explained the relation between a history of maltreatment in childhood and parenting stress at the 18-month assessment. Ways to improve the preventive effects of home visiting for mothers with a history of maltreatment in childhood through the identification of relevant intervention targets and their ideal time of administration are discussed.
du Plessis, Emmerentia; Koen, Magdalene P; Bester, Petra
Within South Africa the Psychiatric Nursing Science curriculum in undergraduate Baccalaureate nursing education utilizes home visits as a service-learning opportunity. In this context faith communities are currently unexplored with regards to service-learning opportunities. With limited literature available on this topic, the question was raised as to what are these students' and family members' experience of home visits within a faith community. To explore and describe nursing students' and family members' experiences of home visits within a faith community. A qualitative approach was used that was phenomenological, explorative and descriptive and contextual in nature. The research was conducted within a faith community as service learning opportunity for Baccalaureate degree nursing students. This community was situated in a semi-urban area in the North-West Province, South Africa. Eighteen (n=18) final year nursing students from different cultural representations, grouped into seven groups conducted home visits at seven (n=7) families. Comprehensive reflective reporting after the visits, namely that the students participated in a World Café data collection technique and interviews were conducted with family members. Three main themes emerged: students' initial experiences of feeling overwhelmed but later felt more competent; students' awareness of religious and cultural factors; and students' perception of their role. Two main themes from the family members emerged: experiencing caring and growth. There is mutual benefit for nursing students and family members. Students' experiences progress during home visits from feeling overwhelmed and incompetent towards a trusting relationship. Home visits in a faith community seems to be a valuable service learning opportunity, and the emotional competence, as well as spiritual and cultural awareness of nursing students should be facilitated in preparation for such home visits. Copyright © 2012 Elsevier Ltd. All rights
Lim, Ji Young; Noh, Wonjung; Kim, Eunjoo; Choi, Kyung Won
The aim of this study was to describe the current state of home visit nursing services in the Korean context and to suggest future policy directions. First, the three home visit nursing services that have developed in Korea are compared using the analytic framework provided by Gilbert and Terrell in 2012. The framework is based on four dimensions of social welfare: users, services, source of funds, and service delivery process. Second, we perform a strength, weakness, opportunity, and threat analysis to suggest comprehensive and constructive home visit nursing service policies for the future. Specifically, we advocate the creation of an organization that steers the central government to operate an integrated management organization to distribute services and reduce redundancy for preventing the waste of both medical and state financial resources. This study also recommends the development of educational programs to improve the quality of services and service evaluation criteria for the objective assessment of those services. These policy guidelines may prove useful both for Korea and for other countries that intend to prepare or revise their home visit nursing service systems. © 2014 Wiley Periodicals, Inc.
Vass, M; Avlund, K; Hendriksen, C
older persons not normally seen in the health care system. In-home assessment is not just a health check, but also an opportunity to meet individual needs that may be of importance for older people to stay independent. Preventive home visits may be part of an overall culture and strategy to avoid...
Full Text Available Han Ju Lee,1 Linda Moneyham,2 Hee Sun Kang,3 Kyung Sun Kim41Department of Nursing, Sangmyung University, Cheonan-si, Chungcheongnam-do, South Korea; 2School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 3Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea; 4Gyeonggi Branch, Korean Alliance to Defeat AIDS, Anyang, Gyeonggi-do, South KoreaPurpose: This study's purpose was to explore the experiences of peer supporters regarding their work in a home visit program for people with HIV infection.Patients and methods: A qualitative descriptive study was conducted using focus groups. Participants were 12 HIV-positive peer supporters conducting home visits with people living with HIV/AIDS in South Korea. Thematic analysis was used to analyze the data.Results: Six major themes emerged: feeling a sense of belonging; concern about financial support; facing HIV-related stigma and fear of disclosure; reaching out and acting as a bridge of hope; feeling burnout; and need for quality education. The study findings indicate that although peer supporters experience several positive aspects in the role, such as feelings of belonging, they also experience issues that make it difficult to be successful in the role, including the position's instability, work-related stress, and concerns about the quality of their continuing education.Conclusion: The findings suggest that to maintain a stable and effective peer supporter program, such positions require financial support, training in how to prevent and manage stress associated with the role, and a well-developed program of education and training.Keywords: human immunodeficiency virus, qualitative research, workplace experience
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Kronborg, Hanne; Væth, Michael; Kristensen, Ingeborg
Objective: To assess if the absence of early home visits influenced the mothers’ breastfeeding duration and use of medical services. Design: Data from mothers who had given birth during a strike period were compared to data from a reference period with usual work practice. Sample: The study...... included 3834 newborn and 375 health visitors, 75 of whom worked during the strike period. Intervention: All families were offered non- standardized home visits after discharge in the reference period. During the strike, the service was based on individual risk assessment. Results: Overall, no difference....... The mothers’ needs for postnatal visits differed depending on parity: primiparae underlined uncertainty, multiparae underlined previous breastfeeding experience. Mothers had missed out on guidance on all areas of the health visitors’ service. Conclusion: Non-standardized home visits by health visitors were...
Full Text Available The purpose of preventive home visits is to promote overall health and wellbeing in old age. The aim of this paper was to describe the process of the development of evidence-based preventive home visits, targeting independent community-living older persons. The evidence base was generated from published studies and practical experiences. The results demonstrate that preventive home visits should be directed to persons 80 years old and older and involve various professional competences. The visits should be personalized, lead to concrete interventions, and be followed up. The health areas assessed should derive from a broad perspective and include social, psychological, and medical aspects. Core components in the protocol developed in this study captured physical, medical, psychosocial, and environmental aspects. Results of a pilot study showed that the protocol validly identified health risks among older people with different levels of ADL dependence.
Blondel, B; Bréart, G
This review of eight randomized controlled trials assessed two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications. In both categories, pregnancy outcome was not improved when women received home visits. The summary odds ratio for preterm delivery (better integration of hospital and home services might allow a more rational use of health services for women with complications. In addition, we need to define more precisely the content of home visits providing social support. For this, further research is required on how emotional support, health education, and advice influence the health of women and infants and mother-child interactions.
The objective of this study was to estimate the environmental impact of a home energy visit programme, known as RE:NEW, that was delivered in London, in the United Kingdom. These home energy visits intended to encourage reductions in household carbon emissions and water consumption through the installation of small energy saving measures (such as radiator panels, in-home energy displays and low-flow shower heads), further significant energy saving measures (loft and cavity wall insulation) and behaviour change advice. The environmental impact of the programme was estimated in terms of carbon emissions abated and on average, for each household in the study, a visit led to an average carbon abatement of 146 kgCO 2 . The majority of this was achieved through the installation of small energy saving measures. The impact of the visits on the installation of significant measures was negligible, as was the impact on behaviour change. Therefore, these visits did not overcome the barriers required to generate behaviour change or the barriers to the installation of more significant energy saving measures. Given this, a number of recommendations are proposed in this paper, which could increase the efficacy of these home energy visits. - Highlights: • The environmental impact of the RE:NEW home energy visit programme is estimated. • Visits do not generate significant pro-environmental behaviour change. • Visits do not overcome the barriers to the installation loft and wall insulation. • Small energy saving measures yield carbon savings of 145 kgCO 2 /year. • The average carbon abatement per household was estimated to be 146 kgCO 2 /year
Raphael, Bram P; Schumann, Caitlin; Garrity-Gentille, Sara; McClelland, Jennifer; Rosa, Carolyn; Tascione, Christina; Gallotto, Mary; Takvorian-Bené, Melissa; Carey, Alexandra N; McCarthy, Patrick; Duggan, Christopher; Ozonoff, Al
Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016. We excluded patients with a history of HPN and strictly palliative care goals. Univariate analysis was performed for primary outcomes: Community-acquired CLABSI and 30-day readmission rate. Twenty-six families participated in the pilot initiative with median (interquartile range) patient age 1.5 (5.7) years old, diagnosis of short bowel syndrome in 16 (62%), and in-state residence in 17 (55%). Ishikawa (fishbone) diagram identified causes of post-discharge HPN complications. Areas of focus during telemedicine visit included central venous catheter care methods, materials, clinical concerns, and equipment. Compared to historical comparison group, the telemedicine group experienced CLABSI rates of 1.0 versus 2.7 per 1,000 line days and readmission rates of 38% versus 17% (p = 0.03, 0.02, respectively). Telemedicine visits identified opportunities for improvement for families newly discharged on HPN. In a small cohort of patients who experienced telemedicine visits, we found lower CLABSI rates alongside higher readmission rates compared with a historical comparison group. Further studies are needed to optimize telemedicine in delivering care to this high-risk population.
Kronborg, Christian; Vass, Mikkel; Lauridsen, Jørgen
We evaluated the cost effectiveness of preventive home visits to elderly persons in Denmark alongside a 3-year randomized controlled study. The main outcome measure was incremental costs per active life-year gained. The number of active life-years was defined as those during which the person...... is able independently to transfer, walk indoors, go outdoors, walk outdoors in both pleasant and poor weather, and climb stairs. In 17 of 34 municipalities health visitors and general practitioners were offered geriatric training, which focused on early signs of disability, physical activity......,455 to 744) in 75-year-olds and 694 euro (-2,684 to 4,071) in 80-year-olds. The discounted difference in mean active life-years was 0.034 (-0.058 to 0.125) and 0.197 (0.013 to 0.380), respectively. The study did not provide conclusive evidence on the cost effectiveness of the programs under consideration....
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Fukui, Sakiko; Yoshiuchi, Kazuhiro; Fujita, Junko; Ikezaki, Sumie
Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff
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Naruse, Takashi; Sakai, Mahiro; Watai, Izumi; Taguchi, Atsuko; Kuwahara, Yuki; Nagata, Satoko; Murashima, Sachiyo
The increasing number of elderly people has caused increased demand for home-visiting nurses. Nursing managers should develop healthy workplaces in order to grow their workforce. This study investigated the work engagement of home-visiting nurses as an index of workplace health. The aim of the present study was to reveal factors contributing to work engagement among Japanese home-visiting nurses. An anonymous, self-administered questionnaire was sent to 208 home-visiting nurses from 28 nursing agencies in three districts; 177 (85.1%) returned the questionnaires. The Job Demands-Resources model, which explains the relationship between work environment and employee well-being, was used as a conceptual guide. The authors employed three survey instruments: (i) questions on individual variables; (ii) questions on organizational variables; and (iii) the Utrecht Work Engagement Scale (Japanese version). Multiple regression analyses were performed in order to examine the relationships between individual variables, organizational variables, and work engagement. Nurse managers and nurses who felt that there was a positive relationship between work and family had significantly higher work engagement levels than others. The support of a supervisor was significantly associated with work engagement. Nurses in middle-sized but not large agencies had significantly higher work engagement than nurses in small agencies. Supervisor support and an appropriate number of people reporting to each supervisor are important factors in fostering work engagement among home-visiting nurses. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.
Full Text Available Objective: To develop a Home Visiting Nursing Service Need Assessment Form (HVNS-NAF to standardize the decision about the need for home visiting nursing service. Methods: The sample consisted of older adults who had received coordinated services by care managers. We defined the need for home visiting nursing service by elderly individuals as the decision of the need by a care manager so that the elderly can continue to live independently. Explanatory variables included demographic factors, medical procedure, severity of illness, and caregiver variables. Multiple logistic regression was carried out after univariate analyses to decide the variables to include and the weight of each variable in the HVNS-NAF. We then calculated the sensitivity and specificity of each cut-off value, and defined the score with the highest sensitivityand specificity as the cut-off value. Results: Nineteen items were included in the final HVNS-NAF. When the cut-off value was 2 points, the sensitivity was 77.0%, specificity 68.5%, and positive predictive value 56.8%. Conclusions: HVNS-NAF is the first validated standard based on characteristics of elderly clients who required home visiting nursing service. Using the HVNS-NAF may result in reducing the unmet need for home visiting nursing service and preventing hospitalization.
Olds, David L; Robinson, JoAnn; Pettitt, Lisa; Luckey, Dennis W; Holmberg, John; Ng, Rosanna K; Isacks, Kathy; Sheff, Karen; Henderson, Charles R
To examine the effects of prenatal and infancy home visiting by paraprofessionals and by nurses from child age 2 through age 4 years. We conducted, in public and private care settings in Denver, Colorado, a randomized, controlled trial with 3 arms, ie, control, paraprofessional visits, and nurse visits. Home visits were provided from pregnancy through child age 2 years. We invited 1178 consecutive, low-income, pregnant women with no previous live births to participate, and we randomized 735; 85% were unmarried, 47% Mexican American, 35% white non-Mexican American, 15% black, and 3% American Indian/Asian. Outcomes consisted of maternal reports of subsequent pregnancies, participation in education and work, use of welfare, marriage, cohabitation, experience of domestic violence, mental health, substance use, and sense of mastery; observations of mother-child interaction and the home environment; tests of children's language and executive functioning; and mothers' reports of children's externalizing behavior problems. Two years after the program ended, women who were visited by paraprofessionals, compared with control subjects, were less likely to be married (32.2% vs 44.0%) and to live with the biological father of the child (32.7% vs 43.1%) but worked more (15.13 months vs 13.38 months) and reported a greater sense of mastery and better mental health (standardized scores [mean = 100, SD = 10] of 101.25 vs 99.31 and 101.21 vs 99.16, respectively). Paraprofessional-visited women had fewer subsequent miscarriages (6.6% vs 12.3%) and low birth weight newborns (2.8% vs 7.7%). Mothers and children who were visited by paraprofessionals, compared with control subjects, displayed greater sensitivity and responsiveness toward one another (standardized score [mean = 100, SD = 10] of 100.92 vs 98.66) and, in cases in which the mothers had low levels of psychologic resources at registration, had home environments that were more supportive of children's early learning (score of
Hargreaves, Margaret; Cole, Russell; Coffee-Borden, Brandon; Paulsell, Diane; Boller, Kimberly
In recent years, increased focus on the effectiveness and accountability of prevention and intervention programs has led to greater government funding for the implementation and spread of evidence-based health and human service delivery models. In particular, attention has been paid to programs that require significant infrastructure investment…
This article address home visits and the professional development needs of teachers who perform visits. The author writes from a practitioner's point of view, focusing on training needs for providers. The author argues that training and preparation for conducting home visits is needed to equip professionals with the skills needed to execute this…
Jones, Aaron; Schumacher, Connie; Bronskill, Susan E; Campitelli, Michael A; Poss, Jeffrey W; Seow, Hsien; Costa, Andrew P
The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. © 2018 Joule Inc. or its licensors.
Miller, Ted R
Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on three more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8 %, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development; increase breast-feeding; and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand.
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Ensing, Hendrik T; Koster, Ellen S; Sontoredjo, Timothy A A; van Dooren, Ad A; Bouvy, Marcel L
Introducing a post-discharge community pharmacist home visit can secure continuity of care and prevent drug-related problems. Currently, this type of pharmaceutical care is not standard practice and implementation is challenging. Mapping the factors influencing the implementation of this new form of care is crucial to ensure successful embedding. To explore which barriers and facilitators influence community pharmacists' adoption of a post-discharge home visit. A mixed methods study was conducted with community pharmacists who had recently participated in a study that evaluated the effectiveness of a post-discharge home visit in identifying drug-related problems. Four focus groups were held guided by a topic guide based on the framework of Greenhalgh et al. After the focus groups, major barriers and facilitators were formulated into statements and presented to all participants in a scoring list to rank for relevance and feasibility in daily practice. Twenty-two of the eligible 26 pharmacists participated in the focus groups. Twenty pharmacists (91%) returned the scoring list containing 21 statements. Most of these statements were perceived as both relevant and feasible by the responding pharmacists. A small number scored high on relevance but low on feasibility, making these potential important barriers to overcome for broad implementation. These were the necessity of dedicated time for performing pharmaceutical care, implementing the home visit in pharmacists' daily routine and an adequate reimbursement fee for the home visit. The key to successful implementation of a post-discharge home visit may lay in two facilitators which are partly interrelated: changing daily routine and reimbursement. Reimbursement will be a strong incentive, but additional efforts will be needed to reprioritize daily routines. Copyright © 2016 Elsevier Inc. All rights reserved.
represent about one-third of all visits provided under the program. Family and friends altio provide similar services to the elderly and consequently...example, that the individual is to be confined to his or her home but that this does not necessarily mean that the patient is bedridden . At the same...34feebleness" and "insecurity" cannot be considered home- bound. We believe that in many cases (particularly for the elderly ) it would be extremely
McKelvey, Lorraine M; Fitzgerald, Shalese; Conners Edge, Nicola A; Whiteside-Mansell, Leanne
Objectives Improving family retention and engagement is crucial to the success of home visiting programs. Little is known about retaining and engaging depressed parents in services. The purpose of the study is to examine how home visit content moderates the association between depression and retention and engagement. Methods The sample (N = 1322) was served by Healthy Families America (n = 618) and Parents as Teachers (n = 704) between April 1, 2012 and June 30, 2016. Parents averaged 23 years (SD = 6). Nearly half of the parents were White (48%) and the majority was single (71%). Depression was screened with the Patient Health Questionnaire-2. Home visitors reported the percent of time focused on particular content and parent engagement at every home visit. Results Multilevel regression analyses showed the amount of time that home visitors spent supporting parent-child interaction moderated the association between depression and retention at 6 (B = .08, SE = .03, p = .003) and 12 (B = .1, SE = .03, p < .001) months, such that there was a stronger positive association for depressed parents. The main effects of child development focused content and retention at 6 (B = .07, SE = .01, p < .001) and 12 (B = .08, SE = .01, p < .001) months were positive, while effects of case management focused content at 6 (B = - .06, SE = .01, p < .001) and 12 (B = - .07, SE = .01, p < .001) months were negative. Conclusions Families were more likely to be retained when home visitors focused on child development and parent-child interaction, but less likely with more case management focus. Parents with positive depression screens were more likely to remain in services with more time spent focused on supporting parent-child interactions.
Post-partum depression affects 10-13% of Japanese women, but many do not receive appropriate treatment or support. This intervention study evaluated the effectiveness of home visits by mental health nurses for Japanese women with post-partum depression. Eighteen post-partum women met the inclusion criteria and were randomly allocated into the intervention (n = 9) or control (n = 9) group at 1-2 months after giving birth. The intervention group received four weekly home visits by a mental health nurse. Control group participants received usual care. Two women in the intervention group did not complete the study. Depressive symptoms and quality of life were measured at 1 and 6 weeks' postintervention. In addition, participants completed an open-ended questionnaire on satisfaction and meaning derived from the home visits. Women in the intervention group had significant amelioration of depressive symptoms over time and reported positive benefits from the home visits, but there were no statistically significant differences between groups. Significant differences (P post-partum depression. A larger trial is warranted to test this approach to care.
Kerkstra, A.; Castelein, E.; Philipsen, H.
This study aims at a description of the current position of preventive home visits to the elderly by community nurses in The Netherlands. Over a period of 8 weeks, a representative sample of 108 community nurses and 49 community nursing auxiliaries at 47 different locations paid a total number of
Butcher, Rebecca L.; Gersch, Irvine S.
This paper reports the results of research into parental experiences of the Somerset (UK) "Time Together" home visiting intervention, with regards to its impact on the parent-child relationship. The research was carried out using an Attachment Theory lens in order to understand the qualitative experiences of seven parents of children in…
Ruiz, Sarah; Snyder, Lynne Page; Rotondo, Christina; Cross-Barnet, Caitlin; Colligan, Erin Murphy; Giuriceo, Katherine
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population. Project HOPE—The People-to-People Health Foundation, Inc.
Winter, Karen; Cree, Viviene E
The home visit is at the heart of social work practice with children and families; it is what children and families' social workers do more than any other single activity (except for recording), and it is through the home visit that assessments are made on a daily basis about risk, protection and welfare of children. And yet it is, more than any other activity, an example of what Pithouse has called an 'invisible trade': it happens behind closed doors, in the most secret and intimate spaces of family life. Drawing on conceptual tools associated with the work of Foucault, this article sets out to provide a critical, chronological review of research, policy and practice on home visiting. We aim to explain how and in what ways changing discourses have shaped the emergence, legitimacy, research and practice of the social work home visit to children and families at significant time periods and in a UK context. We end by highlighting the importance for the social work profession of engagement and critical reflection on the identified themes as part of their daily practice.
Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A
Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.
Many public power systems have initiated home energy audit programs in response to the requests of their consumers. The manual provides smaller public power systems with the information and specific skills needed to design and develop a program of residential energy audits. The program is based on the following precepts: locally owned public systems are the best, and in many cases the only agencies available to organize and coordinate energy conservation programs in many smaller communities; consumers' rights to energy conservation information and assistance should not hinge on the size of the utility that serves them; in the short run, public power systems of all sizes should offer residential energy conservation assistance to their consumers, because such assistance is desirable, necessary, and in the public interest; and in the long run, such programs will complement national energy goals and will produce economic benefits for both consumers and the public power system. A detailed description of home audit program planning, organization, and management are given. (MCW)
Marissa Stroo BS
Full Text Available Worksite medical homes may be a good model for improving employee health. The aim of this study was to compare the likelihood of being seen in the emergency department (ED or being hospitalized by level of use (no use, occasional use, or primary care of a worksite medical home, overall and by type of user (employee, adult dependent, or pediatric dependent. This was a retrospective analysis of claims data, using covariate-adjusted logistic regression models for ED visits and inpatient hospitalizations. Secondary data for the years 2006 to 2008 from a company that offers an on-site health care center (HCC were used. Analyses were based on a data set that combines health plan claims and human resources demographic data. Overall, people who did not use the HCC were more likely to be seen in the ED (adjusted odds ratio [OR] = 1.20, 95% confidence interval or CI [1.06, 1.37], P = .005 or to be hospitalized (adjusted OR = 1.58; 95% CI [1.34, 1.86]; P < .0001 compared with those who used the HCC for primary care. Both ED visits and hospitalizations for employees and dependents in this study were lower among those who used the worksite medical home for primary care. Worksite medical homes can improve chronic disease management and thus reduce ED visits and hospitalizations. These findings contribute to growing evidence that worksite medical homes are potentially cost-effective.
Full Text Available This article reports upon an initiative to improve the timeliness of occupational therapy home visits for discharge planning by implementing technology solutions while maintaining patient safety. A community hospital in Queensland, Australia, hosted a process evaluation that examined which aspects of home visiting could be replaced or augmented by alternative technologies. Strategies were trialled, implemented and assessed using the number of home visits completed and the time from referral to completion as outcomes. A technology-enhanced solution called “Home Quick” was developed using technology to facilitate pre-discharge home visits. The implementation of Home Quick resulted in an increase in the number of home visits conducted prior to discharge (50% increase from 145 to 223 and significantly increased the number of patients seen earlier following referral (X2=69.3; p<0.001. The substitution of direct home visits with technology-enabled remote visits is suitable for a variety of home visiting scenarios traditionally performed by occupational therapists.
The Center for Global Development (CGD), located in Washington DC, is a globally preeminent think tank with unique networking and reach. Its Visiting Fellowship Program offers fellowships to scholars from think tanks and academic research institutions in Africa, Asia, and Latin America. Over the period from 2012 to2017, ...
The summary reports of activities under visiting research program in the Research Reactor Institute, Kyoto University, in fiscal year 1992 are included. In this report, 104 summaries of researches using the Kyoto University Reactor (KUR) and 9 summaries of the researches using the Kyoto University Critical Assembly (KUCA) are collected. (J.P.N.)
Naruse, Takashi; Taguchi, Atsuko; Kuwahara, Yuki; Nagata, Satoko; Sakai, Mahiro; Watai, Izumi; Murashima, Sachiyo
This study evaluated the effect of a skill-mix programme intervention on work engagement in home visiting nurses. A skill-mix programme in which home visiting nurses are assisted by non-nursing workers is assumed to foster home visiting nurses' work engagement. Pre- and post-intervention evaluations of work engagement were conducted using self-administered questionnaires. A skill-mix programme was introduced in the intervention group of home visiting nurses. After 6 months, their pre- and post-intervention work engagement ratings were compared with those of a control group. Baseline questionnaires were returned by 174 home visiting nurses (44 in the intervention group, 130 in the control group). Post-intervention questionnaires were returned by 38 and 97 home visiting nurses from each group. The intervention group's average work engagement scores were 2.2 at baseline and 2.3 at post-intervention; the control group's were 3.3 and 2.6. Generalised linear regression showed significant between-group differences in score changes. The skill-mix programme might foster home visiting nurses' work engagement by improving the quality of care for each client. Future research is needed to explain the exact mechanisms that underlie its effectiveness. In order to improve the efficiency of services provided by home visiting nurses and foster their work engagement, skill-mix programmes might be beneficial. © 2014 John Wiley & Sons Ltd.
Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of
Keske, Robyn R; Rees, Vaughan W; Behm, Ilan; Wadler, Brianna M; Geller, Alan C
Protection of workers from second-hand smoke (SHS) in occupational settings is an important policy priority, yet little attention has been given to SHS protection for home visitation health workers, who number almost 2 million in the USA. Self-reported SHS exposure, SHS mitigation strategies and suggestions for further SHS exposure reduction approaches were obtained from home visitation health workers in Massachusetts. A cross-sectional survey was conducted among Massachusetts Early Intervention workers (N=316) at their state-wide conference in April 2010. Eighty-three per cent of respondents reported at least 1 hour per month of SHS exposure, and 16% reported at least 11 hours per month. Nevertheless, only 22% of workers counselled clients on maintaining a smoke-free home. Fewer than 30% of workers had ever voiced concerns to their employing agency, and just 12% had raised their concerns directly with clients. Only 14% stated that their agency had rules designed to protect workers from SHS. SHS exposure occurs frequently among home visitation health workers. The data point to a substantial population who are not protected from SHS exposure by formal policies.
Ahn, Young-Mee; Kim, Mi-Ran
A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants. Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1 week after the discharge by mail. The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group. These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.
Ormand, C. J.; Manduca, C. A.; Macdonald, H.; Bralower, T. J.; Clemens-Knott, D.; Doser, D. I.; Feiss, P. G.; Rhodes, D. D.; Richardson, R. M.; Savina, M. E.
The Building Strong Geoscience Departments project focuses on helping geoscience departments adapt and prosper in a changing and challenging environment. From 2005-2009, the project offered workshop programs on topics such as student recruitment, program assessment, preparing students for the workforce, and strengthening geoscience programs. Participants shared their departments' challenges and successes. Building on best practices and most promising strategies from these workshops and on workshop leaders' experiences, from 2009-2011 the project ran a visiting workshop program, bringing workshops to 18 individual departments. Two major strengths of the visiting workshop format are that it engages the entire department in the program, fostering a sense of shared ownership and vision, and that it focuses on each department's unique situation. Departments applied to have a visiting workshop, and the process was highly competitive. Selected departments chose from a list of topics developed through the prior workshops: curriculum and program design, program elements beyond the curriculum, recruiting students, preparing students for the workforce, and program assessment. Two of our workshop leaders worked with each department to customize and deliver the 1-2 day programs on campus. Each workshop incorporated exercises to facilitate active departmental discussions, presentations incorporating concrete examples drawn from the leaders' experience and from the collective experiences of the geoscience community, and action planning to scaffold implementation. All workshops also incorporated information on building departmental consensus and assessing departmental efforts. The Building Strong Geoscience Departments website complements the workshops with extensive examples from the geoscience community. Of the 201 participants in the visiting workshop program, 140 completed an end of workshop evaluation survey with an overall satisfaction rating of 8.8 out of a possible 10
Mejdoubi, J.; van den Heijkant, S.C.C.M.; van Leerdam, F.J.M.; Heymans, M.W.; Hirasing, R.A.; Crijnen, A.A.M.
Background:Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV). The nurse-family partnership (NFP) is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect
Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Allegheny Home Improvement Loan Program (AHILP) is the most affordable way for eligible Allegheny County residents to rehabilitate and improve their homes....
Mary Jane Rotheram-Borus
Full Text Available Interventions are needed to reduce poor perinatal health. We trained community health workers (CHWs as home visitors to address maternal/infant risks.In a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to 1 the control, healthcare at clinics (n = 12 neighbourhoods; n = 594 women, or 2 a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks (by the Philani Maternal, Child Health and Nutrition Programme, in addition to clinic care (n = 12 neighbourhoods; n = 644 women. Participants were assessed during pregnancy (2% refusal and 92% were reassessed at two weeks post-birth, 88% at six months and 84% at 18 months later. We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal random effects regressions. A binomial test for correlated outcomes evaluated overall effectiveness over time. The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received.Benefits were found on 7 of 32 measures of outcomes, resulting in significant overall benefits for the intervention compared to the control when using the binomial test (p = 0.008; nevertheless, no effects were observed when only the 18 month outcomes were analyzed. Benefits on individual outcomes were related to the number of home visits received. Among women living with HIV, intervention mothers were more likely to implement the PMTCT regimens, use condoms during all sexual episodes (OR = 1.25; p = 0.014, have infants with healthy weight-for-age measurements (OR = 1.42; p = 0.045, height-for-age measurements (OR = 1.13, p<0.001, breastfeed exclusively for six months (OR = 3.59; p<0.001, and breastfeed longer (OR = 3.08; p<0.001. Number of visits was positively associated with infant birth weight ≥2500 grams (OR = 1.07; p = 0
Schubert, Erin C; Duininck, Megan; Shlafer, Rebecca J
We describe an evaluation of a prison visiting program, Extended Visiting (EV), for incarcerated mothers and their children. Mothers ( N = 24) and caregivers ( N = 19) were interviewed regarding experiences with the program. Mothers identified benefits including maintaining a relationship with children, physical contact, motivation, privacy, peer support, and personal growth. Caregivers echoed mothers' appreciation for the opportunity to maintain mother-child relationships and physical contact. Mothers identified barriers including desire for overnight visits and more age-appropriate activities. Caregivers perceived travel time and costs and children's adverse reactions as barriers. When comparing EV to typical visiting, participants unanimously preferred EV.
Thodberg, Karen; Sørensen, Lisbeth Uhrskov; Christensen, Janne Winther
.5 years; [79; 90]) from four nursing homes were randomly assigned to receive biweekly visits for 6 weeks from a person accompanied by either a dog, a robot seal (PARO), or a soft toy cat. Sleep patterns were measured using actigraphy technology before, during (the third and sixth week), and after...... by a dog rather than the robot seal or soft toy cat (dog: 610 ± 127 min; seal: 498 ± 146 min; cat: 540 ± 163 min; F2,37 = 4.99; P = 0.01). No effects were found in the sixth week or after the visit period had ended. We found that visit type had no effect on weight (F2,88 = 0.13; P > 0.05), body mass index...
Full Text Available Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.Ten databases including CENTRAL and Medline searched through December 2012.Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge.Two authors independently extracted data. Outcomes were pooled using random effects.Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]. There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18] or hospitalized (RR = 0.96 [0.91 to 1.01]. There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01], but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01] and physical functioning (SMD = -0.10 [-0.17 to -0.03] respectively, but these may not be clinically important.Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting
Trojahn, Melina Maria; Ruschel, Karen Brasil; Nogueira de Souza, Emiliane; Mussi, Cláudia Motta; Naomi Hirakata, Vânia; Nogueira Mello Lopes, Alexandra; Rabelo-Silva, Eneida Rejane
This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care. PMID:24083023
Kristensen, Dorte V; Sundler, Annelie J; Eide, Hilde; Hafskjold, Linda; Ruud, Iren; Holmström, Inger K
To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective. The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial. A descriptive design with a qualitative inductive approach was used. Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being. The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students. Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication. © 2017 John Wiley & Sons Ltd.
Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H
Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.
Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi
Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.
Jack, Susan M; Ford-Gilboe, Marilyn; Davidov, Danielle; MacMillan, Harriet L
To develop strategies for the identification and assessment of intimate partner violence in a nurse home visitation programme. Nurse home visitation programmes have been identified as an intervention for preventing child abuse and neglect. Recently, there is an increased focus on the role these programmes have in addressing intimate partner violence. Given the unique context of the home environment, strategies for assessments are required that maintain the therapeutic alliance and minimise client attrition. A qualitative case study. A total of four Nurse-Family Partnership agencies were engaged in this study. Purposeful samples of nurses (n = 32), pregnant or parenting mothers who had self-disclosed experiences of abuse (n = 26) and supervisors (n = 5) participated in this study. A total of 10 focus groups were completed with nurses: 42 interviews with clients and 10 interviews with supervisors. The principles of conventional content analysis guided data analysis. Data were categorised using the practice-problem-needs analysis model for integrating qualitative findings in the development of nursing interventions. Multiple opportunities to ask about intimate partner violence are valued. The use of structured screening tools at enrolment does not promote disclosure or in-depth exploration of women's experiences of abuse. Women are more likely to discuss experiences of violence when nurses initiate nonstructured discussions focused on parenting, safety or healthy relationships. Nurses require knowledge and skills to initiate indicator-based assessments when exposure to abuse is suspected as well as strategies for responding to client-initiated disclosures. A tailored approach to intimate partner violence assessment in home visiting is required. Multiple opportunities for exploring women's experiences of violence are required. A clinical pathway outlining a three-pronged approach to identification and assessment was developed. © 2016 John Wiley & Sons Ltd.
Peterson Janey C
likely to require Home F/U. In addition, those in the Home F/U group were more likely to have sustained 2 or more complications (p=0.05. Conclusions Home visits are an effective approach to reduce attrition and improve accuracy of study outcome reporting. Trial results may be influenced by this method of reducing attrition. Older participants, those with greater medical burden and those who sustain multiple complications are at higher risk for attrition.
Brodribb, Wendy; Miller, Yvette
Although home visiting in the early post partum period appears to have increased, there are limited data defining which women receive a visit and none that include Queensland. We aimed to investigate patterns of post partum home visiting in the public and private sectors in Queensland. Data were collected via a retrospective cross-sectional survey of women birthing in Queensland between 1 February and 31 May 2010 at 4 months post partum (n = 6948). Logistic regression was used to assess associations between receiving a home visit and sociodemographic, clinical and hospital variables. Analyses were stratified by public and private birthing sector because of significant differences between sectors. Public sector women were more likely to receive a visit from a nurse or midwife (from the hospital or child health sector) within 10 days of hospital discharge (67.2%) than private sector women (7.2%). Length of hospital stay was associated with home visiting in both sectors. Some vulnerable subpopulations in both sectors were more likely to be visited, whereas others were not. Home visiting in Queensland varies markedly between the public and private sector and is less common in some vulnerable populations. Further consideration to improving the equity of community post partum care in Queensland is needed.
Two teachers from the town of San Pedro de Atacama, in the northern desert of the South American nation of Chile, arrive in Magdalena, New Mexico, Sunday, January 28, for a two-week visit that is part of a Sister Cities program sponsored by Associated Universities, Inc. (AUI), the nonprofit research corporation that operates the National Radio Astronomy Observatory (NRAO). They will be accompanied by their town's mayor. Myriam Nancy Rivera Mercado, Head of the high school in San Pedro, Gabriela Fernanda Rodriguez Moraleda, a tourism teacher there, and San Pedro Mayor Sandra Berna Martinez will begin a visit that includes classroom observations in the Magdalena schools, a reception hosted by the Magdalena Village Council, and a Mayor's Breakfast with Magdalena Mayor Jim Wolfe. They also will meet local residents, tour the Bosque del Apache National Wildlife Refuge with a second-grade class, visit an area ranch, tour the Very Large Array (VLA) radio telescope, and see Socorro's Community Arts Party. "These teachers will learn much about New Mexico, the United States, and our educational system, and will take this new knowledge back to their students and their community," said NRAO Education Officer Robyn Harrison. The visit is part of a Sister Cities program initiated and funded by AUI, which operates the NRAO for the U.S. National Science Foundation. Radio astronomy is a common link between San Pedro de Atacama and Magdalena. San Pedro is near the site of the Atacama Large Millimeter/submillimeter Array (ALMA), an international telescope project now under construction with funding by major partners in North America, Europe, and Japan. Magdalena is near the site of NRAO's VLA radio telescope. In Magdalena, the Village Council and Mayor Wolfe formalized their participation in the Sister Cities program last September, and San Pedro ratified the program in December. In San Pedro, the ceremony ratifying the agreement was attended by U.S. Ambassador to Chile Craig K
Ito, Shinya; Hashimoto, Mari; Aduma, Saori; Yasumura, Seiji
Locomotion training in a home visit-type preventive-care program has been reported elsewhere. However, continuation of appropriate exercises in a home setting is difficult, and few reports are available on locomotion training in a home setting. The objective of this study was to evaluate the effectiveness of locomotion training over 3 months in a home visit-type preventive-care program for improvement of motor function among elderly people. Nine hundred and fifty-eight elderly people in Tendo City in Japan who were not currently attending any preventive-care program were invited to participate in the study, and 87 were enrolled. In the pre-intervention and post-intervention assessments, we administered an interview survey (the Kihon Checklist), the timed one-leg standing test with eyes open and the sit-to-stand test, at the participants' homes. The intervention involved one set of training exercises with the participants standing on each leg for 1 min and squatting five or six times. The participants were asked to repeat one set of the exercises three times a day at home. In addition, the participants were regularly asked over the telephone about their performance of the exercises. Physical strength, cognitive function, and total scores of the Kihon Checklist were significantly lower after the intervention than before. In addition, the one-leg standing test time was significantly longer after the intervention (mean ± SD, 23.9 ± 35.4) than before (15.7 ± 20.5), and the sit-to-stand test time was significantly shorter after the intervention (13.0 ± 6.2) than before (14.8 ± 8.3). Locomotion training in a home-visit preventive-care program with telephone support effectively improved the motor function of elderly people who were not currently attending any preventive-care program organized by the long-term care insurance system.
Schulc, Eva; Pallauf, Martin; Them, Christa; Wildbahner, Tanja
In the interest of preventing or postponing dependency on care and assistance for as long as possible, preventive home visits to people aged over 70 years living at home were conducted by registered nurses. Assessment of the functional health of people over 70 years of age and counseling or information carried out based on the identified problem areas and resources. A multidimensional nursing assessment through self-evaluation was applied for 345 people aged over 70 years. The sample of people investigated showed a high level of competence in self-care; however, a large number of functional health impairments could be identified that are reflected in the high requirement for counseling and information. It became evident that recruiting of study participants was difficult and that care by family members was an important resource for people aged over 70 years. From this it was recommended that in the future sustainable advertising efforts should be conducted and special attention needs to be given to counseling and information for family members in preventive home visits.
Full Text Available In this essay we aim to emphasize the role of documentary visits in continuous training programs of library professionals. As alternative form of continuous training, the "Carol I" Central University Library runs an annual program of documentary visits to Bucharest museums, in order to identify from the historical, biographical, literary, artistic and scientific perspective, the manner in which evolved Romanian spirituality nationally and beyond. As a form of initial training for national inheritance understanding, the professional visits to cultural institutions allows the discovery of the categories of collections, the structure and their pedagogical value in learning, teaching and training.
Stamuli, Eugena; Richardson, Gerry; Duffy, Steven; Robling, Michael; Hood, Kerry
A systematic review of the economic evidence on home visitation programmes for young or vulnerable pregnant women was undertaken to provide a summary of the existing literature of these interventions. Relevant studies were identified from a number of sources including large databases, free text search on Google Scholar as well as hand-searching of the obtained references. The search yielded a large number of papers, of which 12 were considered appropriate to be included in the review. These were either full or partial economic evaluations: four studies were cost-benefit analyses, three were cost-effectiveness analyses and the remaining were costing studies. The review highlighted the paucity of good quality economic evaluations in the area of home visiting programmes for young or vulnerable pregnant women. Methods varied substantially between the studies spanning from differing data sources (e.g. single randomized trials or meta-analyses) to different perspectives taken, cost items and outcomes included in the analysis. It is difficult to establish a coherent body of economic evidence for these interventions and draw a firm conclusion on their value for money. Home visiting programmes are complex interventions, with impact on the lives of mothers and their children. The funding of such interventions should be based on rigorous effectiveness and economic evidence. There is a need for well-designed economic evaluations which will follow the appropriate methodological guidelines and also take into account the complexity of such interventions. These analyses should preferably consider multiple perspectives and allow for the fact that the majority of the benefits accrue in the long-term future. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Full Text Available Abstract Background Child and infant malnourishment is a significant and growing problem in the developing world. Malnourished children are at high risk for negative health outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve childhood nourishment. The objective of this study is to evaluate whether the Philani program can rehabilitate malnourished children in a timely manner. Methods Mentor Mothers were trained to conduct home visits. Mentor Mothers went from house to house in assigned neighborhoods, weighed children age 5 and younger, and recruited mother-child dyads where there was an underweight child. Participating dyads were assigned in a 2:1 random sequence to the Philani intervention condition (n = 536 or a control condition (n = 252. Mentor Mothers visited dyads in the intervention condition for one year, supporting mothers' problem-solving around nutrition. All children were weighed by Mentor Mothers at baseline and three, six, nine and twelve month follow-ups. Results By three months, children in the intervention condition were five times more likely to rehabilitate (reach a healthy weight for their ages than children in the control condition. Throughout the course of the study, 43% (n = 233 of 536 of children in the intervention condition were rehabilitated while 31% (n = 78 of 252 of children in the control condition were rehabilitated. Conclusions Paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk.
Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael
OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958
Full Text Available Objectives: The aim of follow-up visits by the general practitioner and district nurse (within a week after discharge from hospital is to reduce hospital readmissions and improve the overall wellbeing of the patient. There is strong evidence that these programmes are effective, but are difficult to implement because of a number of organizational obstacles, including co-ordination between the organizations involved in the process. In this paper we look at the factors that affect motivation to participate in a cross-sectoral programme in Copenhagen, Denmark, implementing follow-up home visits to elderly persons. Theory and methods: The analysis is based on inter-organisational network theory in an attempt to explain the role of motivation in network formation between organizational systems. The empirical findings are based on focus groups and in-depth interviews with hospital staff, general practitioners, and district nurses. Results: Care providers are motivated to collaborate by a number of factors. The focus of collaboration needs to be clearly defined and agreed upon, there needs to be a high degree of equality between the professionals involved, and there has to be a will to co-operate based on a shared understanding of values and learning potentials. Conclusions: The study concludes that we need to focus on specific care fields and actors to reduce complexity in the area and more fully understand what motivates care providers to participate in cross-sectoral activities such as a follow-up home visit programme. One lesson for current policy is that motivational factors need to be addressed in future collaborative programs in order to fully exploit the potential health benefits.
Full Text Available Objectives: The aim of follow-up visits by the general practitioner and district nurse (within a week after discharge from hospital is to reduce hospital readmissions and improve the overall wellbeing of the patient. There is strong evidence that these programmes are effective, but are difficult to implement because of a number of organizational obstacles, including co-ordination between the organizations involved in the process. In this paper we look at the factors that affect motivation to participate in a cross-sectoral programme in Copenhagen, Denmark, implementing follow-up home visits to elderly persons.Theory and methods: The analysis is based on inter-organisational network theory in an attempt to explain the role of motivation in network formation between organizational systems. The empirical findings are based on focus groups and in-depth interviews with hospital staff, general practitioners, and district nurses.Results: Care providers are motivated to collaborate by a number of factors. The focus of collaboration needs to be clearly defined and agreed upon, there needs to be a high degree of equality between the professionals involved, and there has to be a will to co-operate based on a shared understanding of values and learning potentials.Conclusions: The study concludes that we need to focus on specific care fields and actors to reduce complexity in the area and more fully understand what motivates care providers to participate in cross-sectoral activities such as a follow-up home visit programme. One lesson for current policy is that motivational factors need to be addressed in future collaborative programs in order to fully exploit the potential health benefits.
Cunningham, Kerrie [Univ. of Minnesota, St. Paul, MN (United States). NorthernSTAR Building America Partnership; Hannigan, Eileen [Univ. of Minnesota, St. Paul, MN (United States). NorthernSTAR Building America Partnership
To explore ways to reduce customer barriers and increase home retrofit completions, several different existing home retrofit models have been implemented in the state of Wisconsin. This study compared these programs' performance in terms of savings per home and program cost per home to assess the relative cost-effectiveness of each program design. However, given the many variations in these different programs, it is difficult to establish a fair comparison based on only a small number of metrics. Therefore, the overall purpose of the study is to document these programs' performance in a case study approach to look at general patterns of these metrics and other variables within the context of each program. This information can be used by energy efficiency program administrators and implementers to inform home retrofit program design. Six different program designs offered in Wisconsin for single-family energy efficiency improvements were included in the study. For each program, the research team provided information about the programs' approach and goals, characteristics, achievements and performance. The program models were then compared with performance results-program cost and energy savings-to help understand the overall strengths and weaknesses or challenges of each model.
Cunningham, K.; Hannigan, E.
To explore ways to reduce customer barriers and increase home retrofit completions, several different existing home retrofit models have been implemented in the state of Wisconsin. This study compared these programs' performance in terms of savings per home and program cost per home to assess the relative cost-effectiveness of each program design. However, given the many variations in these different programs, it is difficult to establish a fair comparison based on only a small number of metrics. Therefore, the overall purpose of the study is to document these programs' performance in a case study approach to look at general patterns of these metrics and other variables within the context of each program. This information can be used by energy efficiency program administrators and implementers to inform home retrofit program design. Six different program designs offered in Wisconsin for single-family energy efficiency improvements were included in the study. For each program, the research team provided information about the programs' approach and goals, characteristics, achievements and performance. The program models were then compared with performance results -- program cost and energy savings -- to help understand the overall strengths and weaknesses or challenges of each model.
Garner, Andrew S
Home visiting is an important mechanism for minimizing the lifelong effects of early childhood adversity. To do so, it must be informed by the biology of early brain and child development. Advances in neuroscience, epigenetics, and the physiology of stress are revealing the biological mechanisms underlying well-established associations between early childhood adversity and suboptimal life-course trajectories. Left unchecked, mediators of physiologic stress become toxic, alter both genome and brain, and lead to a vicious cycle of chronic stress. This so-called "toxic stress" results a wide array of behavioral attempts to blunt the stress response, a process known as "behavioral allostasis." Although behaviors like smoking, overeating, promiscuity, and substance abuse decrease stress transiently, over time they become maladaptive and result in the unhealthy lifestyles and noncommunicable diseases that are the leading causes of morbidity and mortality. The biology of toxic stress and the concept of behavioral allostasis shed new light on the developmental origins of lifelong disease and highlight opportunities for early intervention and prevention. Future efforts to minimize the effects of childhood adversity should focus on expanding the capacity of caregivers and communities to promote (1) the safe, stable, and nurturing relationships that buffer toxic stress, and (2) the rudimentary but foundational social-emotional, language, and cognitive skills needed to develop healthy, adaptive coping skills. Building these critical caregiver and community capacities will require a public health approach with unprecedented levels of collaboration and coordination between the healthcare, childcare, early education, early intervention, and home visiting sectors.
Byrd, Mary E
The purpose of this paper was to develop a nursing-focused use of social exchange theory within the context of maternal-child home visiting. The nature of social exchange theory, its application to client-nurse interaction, and its fit with an existing data set from a field research investigation were examined. Resources exchanged between the nurse and clients were categorized and compared across the patterns of home visiting, nursing strategies based on exchange notions were identified, and variations in exchange were linked with client outcomes. The nurse provided resources within the categories of information, status, service, and goods. Clients provided time, access to the home, space within the home to conduct the visit, opportunities to observe maternal-child interaction, access to the infant, and information. The ease and breadth of resource exchange varied across the patterns of home visiting. The social exchange perspective was useful in categorizing resources, specifying and uncovering new resource categories, understanding nursing strategies to initiate and maintain the client-nurse relationship, and linking client-nurse interactive phenomena with client outcomes. Social exchange theory is potentially useful for understanding client-nurse interaction in the context of maternal-child home visits.
This report is published any time by summarizing in the form of an interim report the data required for research and experiment such as the results of the functional test on various experimental facilities, the test results of the products manufactured for trial, the state of radiation control and waste management, and the report of study meetings in the Research Reactor Institute, Kyoto University, the conspicuous results obtained halfway in research, new techniques, discussion on other papers and reports and others. In this report, the gists of 71 papers on the research activities under visiting research program performed in the second half of 1984 are collected, and the subject number, the title of research reporters, and the summary of report for each research are given. (Kako, I.)
Finigan-Carr, Nadine M; Copeland-Linder, Nikeea; Haynie, Denise L; Cheng, Tina L
Interventions targeting parents of young children have shown effectiveness, but research is lacking about best practices for engaging parents of early adolescents. Low levels of enrollment and attendance in parenting interventions present major problems for researchers and clinicians. Effective and efficient ways to engage and collaborate with parents to strengthen parenting practices and to promote healthy development of early adolescents are needed. This exploratory mixed methods study examined the feasibility of three methods of engaging parents in positive parenting activities. Participants were parents of youth ages 11-13 enrolled in three urban, public middle schools in neighborhoods characterized by high rates of community violence. Families ( N = 144) were randomized into one of three interventions: six home sessions, two home sessions followed by four group sessions, or six group sessions. The majority of parents were single, non-Hispanic, African American mothers. Urban parents of middle school students were more likely to participate in home visits than in group sessions; offering a combination did not increase participation in the group sessions. As only 34% of those who consented participated in the intervention, qualitative data were examined to explain the reasons for non-participation.
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...
Full Text Available Abstract Background Studies have shown that a proportion of children as young as two years are already overweight. This indicates that obesity prevention programs that commence as early as possible and are family-focused are needed. This Healthy Beginnings Trial aims to determine the efficacy of a community-based randomized controlled trial (RCT of a home visiting intervention in preventing the early onset of childhood overweight and obesity. The intervention will be conducted over the first two years of life to increase healthy feeding behaviours and physical activity, decrease physical inactivity, enhance parent-child interaction, and hence reduce overweight and obesity among children at 2 and 5 years of age in the most socially and economically disadvantaged areas of Sydney, Australia. Methods/design This RCT will be conducted with a consecutive sample of 782 first time mothers with their newborn children. Pregnant women who are expecting their first child, and who are between weeks 24 and 34 of their pregnancy, will be invited to participate in the trial at the antenatal clinic. Informed consent will be obtained and participants will then be randomly allocated to the intervention or the control group. The allocation will be concealed by sequentially numbered, sealed opaque envelopes containing a computer generated random number. The intervention comprises eight home visits from a specially trained community nurse over two years and pro-active telephone support between the visits. Main outcomes include a duration of breastfeeding measured at 6 and 12 months, b introduction of solids measured at 4 and 6 months, c nutrition, physical activity and television viewing measured at 24 months, and d overweight/obesity status at age 2 and 5 years. Discussion The results of this trial will ascertain whether the home based early intervention is effective in preventing the early onset of childhood overweight and obesity. If proved to be effective, it
Winthereik, Anna K; Hjertholm, Peter; Neergaard, Mette Asbjoern
BACKGROUND: Previous studies of associations between home visits by general practitioners and end-of-life care for cancer patients have been subject to confounding. AIM: To analyse associations between general practitioners' propensity to pay home visits and the likelihood of hospitalisation...... and dying out of hospital among their cancer patients. DESIGN: A national register cohort study with an ecological exposure. Standardised incidence rates of general practitioner home visits were calculated as a measure for propensity. Practices were grouped into propensity quartiles. Associations between...... propensity groups and end-of-life outcomes for cancer patients aged 40 or above were calculated. SETTING/PARTICIPANTS: Danish general practitioners and citizens aged 40 or above were included from 2003 to 2012. RESULTS: We included 2670 practices with 2,518,091 listed patients (18,364,679 person...
Naruse, Takashi; Sakai, Mahiro; Nagata, Satoko
Home-visiting nursing agencies are required to foster staff nurse's work engagement; thus, the factors related to work engagement require identification. This study examined relational coordination among colleagues and agency span of control on the work engagement of home-visiting nurses. Cross-sectional data from 93 staff nurses in 31 home-visiting nursing agencies were collected via a survey and analyzed using mixed linear regression. There was no significant main effect of relational coordination among nurse colleagues on work engagement. In large agencies with a large span of control, relational coordination among nursing colleagues predicted work engagement. Nursing managers' relational coordination was found to be positively associated with staff nurse work engagement. Agency span of control is a moderating factor on the positive effect of relational coordination with nursing colleagues on staff nurse work engagement. © 2016 Japan Academy of Nursing Science.
... review efficiency and quality, and the quality of its regulatory efforts and interactions, by providing... tissue establishments. The visits may include packaging facilities, quality control and pathology...
Full Text Available Health and social inequality are tightly linked and still pose an important public health problem. However, vulnerable and disadvantaged populations are difficult to reach for health-related interventions. Given the long-lasting effects of an adverse, particular nutrition-related, intrauterine and neonatal environment on health development (perinatal programming, an early and easy access is essential for sustainable interventions. The goal of this explorative study was therefore to elucidate whether an existing access of family midwives (FMs to families in need of support could be an option to implement effective public health and nutrition interventions. To that end three research objectives were formulated: (1 to determine whether a discernible impact of home visits by FMs can be described; (2 to identify subgroups among these families in need of more specific interventions; (3 to determine how relevant nutrition-related topics are for both FMs and the supported families. For addressing these objectives a mixed methods design was used: Routine documentation data from 295 families visited by a family midwife (FM were analyzed (secondary analysis, and structured expert interviews with FMs were conducted and analyzed. Study reporting followed the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology statement. Based on the FMs reports, a significant improvement (p < 0.001 regarding psycho-social variables could be determined after the home visits. Single mothers, however, seemed to benefit less from the FMs service compared to their counterparts (p = 0.015. Nutritional counseling was demanded by 89% of the families during the home visits. In addition, nutrition-related topics were reported in the interviews to be of high interest to both families and the FMs. Based on the obtained results it is concluded that FMs home visits offer a promising access to vulnerable and disadvantaged families for implementing nutrition
Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F
Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.
Dini, Lorena; Sarganas, Giselle; Heintze, Christoph; Braun, Vittoria
Shortages and maldistribution of primary care physicians (PCPs) are affecting many countries today, including in Germany. As has been suggested, the ensuing problems might be alleviated by delegating some medical tasks to physicians' assistants (PAs). This was tried in three regions of the German state of Mecklenburg-Western Pomerania under a pilot project entitled AGnES (Arztentlastende gemeindenahe E-Health-gestützte Systemische Intervention, i.e., a community-based, e-health-assisted, systemic intervention to reduce physicians' workloads). We conducted a survey of all practicing PCPs in the state to assess their overall attitude toward the delegation of home visit tasks, and to determine what they would prefer as the job description and type of employment contract for a PA who would be hired to assist them. All PCPs practicing in Mecklenburg-Western Pomerania were asked in a quantitative survey about their willingness to delegate home visits, their perceived barriers to and benefits of home visit delegation to a qualified assistant, the skills they would require of a PA who would be hired to carry out home visits, and their preferred type of employment contract for the PA. 47% of the PCPs (515/1096) responded to the survey. 46% of the respondents were already informally delegating home visit tasks to qualified PAs. Female PCPs were more likely to do so (odds ratio [OR] 1.70), as were PCPs practicing in rural areas (OR 1.63) and those working in individual practice (OR 1.94). Most PCPs were in favor of delegating home visits to qualified PAs (77%). Main advantages were seen in reducing physicians' workloads (70%) and in increasing their job satisfaction (48%). 34% of PCPs said they would not cover the cost of training PAs. Acceptance of home visit delegation among PCPs in the state of Mecklenburg-Western Pomerania is high, mainly among the younger physicians. Perceived barriers and benefits of delegation of home visits to qualified PAs should be taken into
This report contains summary reports of activities under visiting research program, 1995 carried out in the Research Reactor Institute, Kyoto University in 1995. As cooperative activities of KUR, 9 projects and 91 ordinary researches are described in their summaries, with 10 ordinary researches in KUCA cooperative activities. Titles of the 9 projects are development of biological effect analysis of monochromatic neutron spectrum field, study on optimization of bottle condition in ultra cold neutron fission experiment, feature improvement of KUR-ISOL and nuclear spectroscopy and nuclear physics using it, fundamental study on development of new compound for thermal neutron trapping therapy and expansion of its adopting illness, study on properties of synthetic metal using nuclear procedure, neutron diffraction of magnetic substances under the extreme conditions (high pressure, high magnetic field), study on movement in environment of harmful substances, fundamental study on radiation protection against controllable radiation in KUR, and dynamic property study of metal materials using low speed neutron scattering method. (G.K.)
Technical Report of the Research Reactor Institute, Kyoto University, is published any time as a prompt report as occasion requires. In this report, the title, names of reporters and summary of each of 53 researches which were carried out under the visiting research program in the first half of 1983 are given. The titles are, for example, a mechanism for the anodic oxidation of GaAs, gamma-gamma perturbed angular correlation study of relaxation phenomena, the studies on the genesis of volcanic rocks by partition of trace elements, neutron activation analysis of geochemical standard rock samples, studies on the changes of elements in the fur of rats with various disease, neutron activation analysis on glacier ice strata and glaciegla lake sediments in Nepal Himalayas, low temperature irradiation effects on bcc metals, organ and its subcellular distribution of manganese ion in animals, structure analysis of orthorhombic BaTiO 3 by profile analysis method, regional distribution of Mn, Zn and Cu in human brain, neutron diffraction study of Mn-Ni alloy, structural change of KCoF 3 in the vicinity of the critical region, activation analysis of trace elements in tumor tissues (thyroid) and so on. (Kako, I.)
Now the summary report of activities under visiting research program in the Research Reactor Institute, Kyoto University, in fiscal year 1991 has been put in order and published. As compared with the past reports, in the report of this year, pages increased and the style changed, but this is due to the change of the method of adopting researches to that throughout one year from fiscal year 1991. So far one page was allotted to every subject, but this limit was relaxed according to the contents. This style is not yet fixed. As well known, discussion is going on about the way the research reactor and the Research Reactor Institute should be. As for this summary report, in order to receive the international evaluation, it was decided to publish the report in English from fiscal year 1992, and the Progress Report on the research by the Institute personnel is included in it. In this report, 98 summaries of the researches using the KUR and 15 summaries of the researches using the KUCA are collected. One summary which was not reported in fiscal year 1990 is added. (K.I.)
Background We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases. Methods Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records. Results Median age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02). Conclusions Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing. PMID:22044683
Kashiwagi, Masayo; Tamiya, Nanako; Murata, Masako
The purpose of the present study was to identify characteristics of visiting nurse agencies (VNA) in Japan with high home death rates by a prefecture-wide survey. A cross-sectional study of visiting nurse agencies (n = 101) in Ibaraki Prefecture, Japan, was completed. Data included the basic characteristics of each VNA, the type of services provided, level of coordination with other service providers, total number of VNA patients who died per year and place of death and contractual relationship with home-care supporting clinics providing end-of-life care services in the home 24 h a day. The VNA characteristics were analyzed by logistic regression, using the home death rate per VNA as a dependent variable. A total 69 agencies, excluding those that did not report number of deaths (n = 14) and those without deaths during the year (n = 6), were analyzed. The median home death rate of the 69 VNA was 29.8%. The results of logistic regression analysis showed that higher home death rate was significantly associated with lack of attachment to a hospital, existence of a contractual relationship with home-care supporting clinics and existence of an interactive information exchange through telephone/face-to-face communication with attending physicians. In order to increase the home death rate of people using VNA, policymakers must consider establishing home-based service systems within the community that can provide home end-of-life care services 24 h a day, and support the interactive exchange of information between the visiting nurse and the attending physician. © 2014 The Authors. Geriatrics & Gerontology International published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Geriatrics Society.
Rotheram-Borus, Mary Jane; Le Roux, Karl; Le Roux, Ingrid M; Christodoulou, Joan; Laurenzi, Christina; Mbewu, Nokwanele; Tomlinson, Mark
Concurrent epidemics of HIV, depression, alcohol abuse, and partner violence threaten maternal and child health (MCH) in South Africa. Although home visiting has been repeatedly demonstrated efficacious in research evaluations, efficacy disappears when programs are scaled broadly. In this cluster randomized controlled trial (RCT), we examine whether the benefits of ongoing accountability and supervision within an existing government funded and implemented community health workers (CHW) home visiting program ensure the effectiveness of home visiting. In the deeply rural, Eastern Cape of South Africa, CHW will be hired by the government and will be initially trained by the Philani Programme to conduct home visits with all pregnant mothers and their children until the children are 2 years old. Eight clinics will be randomized to receive either (1) the Accountable Care Condition in which additional monitoring and accountability systems that Philani routinely uses are implemented (4 clinics, 16 CHW, 450 households); or (2) a Standard Care Condition of initial Philani training, but with supervision and monitoring being delivered by local government structures and systems (4 clinics, 21 CHW, 450 households). In the Accountable Care Condition areas, the CHW's mobile phone reports, which are time-location stamped, will be monitored and data-informed supervision will be provided, as well as monitoring growth, medical adherence, mental health, and alcohol use outcomes. Interviewers will independently assess outcomes at pregnancy at 3, 6, 15, and 24 months post-birth. The primary outcome will be a composite score of documenting maternal HIV/TB testing, linkage to care, treatment adherence and retention, as well as child physical growth, cognitive functioning, and child behavior and developmental milestones. The proposed cluster RCT will evaluate whether routinely implementing supervision and accountability procedures and monitoring CHWs' over time will improve MCH outcomes
Barlow, Allison; Mullany, Britta; Neault, Nicole; Goklish, Novalene; Billy, Trudy; Hastings, Ranelda; Lorenzo, Sherilynn; Kee, Crystal; Lake, Kristin; Redmond, Cleve; Carter, Alice; Walkup, John T
The Affordable Care Act provides funding for home-visiting programs to reduce health care disparities, despite limited evidence that existing programs can overcome implementation and evaluation challenges with at-risk populations. The authors report 36-month outcomes of the paraprofessional-delivered Family Spirit home-visiting intervention for American Indian teen mothers and children. Expectant American Indian teens (N=322, mean age=18.1 years) from four southwestern reservation communities were randomly assigned to the Family Spirit intervention plus optimized standard care or optimized standard care alone. Maternal and child outcomes were evaluated at 28 and 36 weeks gestation and 2, 6, 12, 18, 24, 30, and 36 months postpartum. At baseline the mothers had high rates of substance use (>84%), depressive symptoms (>32%), dropping out of school (>57%), and residential instability (51%). Study retention was ≥83%. From pregnancy to 36 months postpartum, mothers in the intervention group had significantly greater parenting knowledge (effect size=0.42) and parental locus of control (effect size=0.17), fewer depressive symptoms (effect size=0.16) and externalizing problems (effect size=0.14), and lower past month use of marijuana (odds ratio=0.65) and illegal drugs (odds ratio=0.67). Children in the intervention group had fewer externalizing (effect size=0.23), internalizing (effect size=0.23), and dysregulation (effect size=0.27) problems. The paraprofessional home-visiting intervention promoted effective parenting, reduced maternal risks, and improved child developmental outcomes in the U.S. population subgroup with the fewest resources and highest behavioral health disparities. The methods and results can inform federal efforts to disseminate and sustain evidence-based home-visiting interventions in at-risk populations.
Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson
The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.
Yamada, Yukari; Ekmann, Anette Addy; Nilsson, Charlotte Juul
Preventive home visits are offered to community dwelling older people in Denmark aimed at maintaining their functional ability for as long as possible, but only two thirds of older people accept the offer from the municipalities. The purpose of this study is to investigate 1) whether socioeconomic...... status was associated with acceptance of preventive home visits among older people and 2) whether municipality invitational procedures for the preventive home visits modified the association....
McFarlane, Elizabeth; Burrell, Lori; Duggan, Anne; Tandon, Darius
Objectives To assess the effectiveness of a 6-week, cognitive behavioral therapy (CBT) group-based enhancement to home visiting to address stress and prevent depression as compared with home visiting as usual in low income mothers of young children. Methods We conducted a randomized controlled trial with 95 low-income mothers of young children to assess the effectiveness of a 6-week, cognitive behavioral group-based enhancement to Healthy Families America and Parents as Teachers home visiting (HV/CBT = 49) to address stress and prevent depression as compared with home visiting as usual (HV = 46). Booster sessions for the HV/CBT group were offered at 3 and 6 months. Participants completed measures of coping, stress and depression at three points: baseline prior to randomization, post-intervention, and 6 months post-intervention. Parent child interaction was also measured at 6 months. Results Intent-to-treat analyses found improved coping and reduced stress and depression post-intervention. While impacts on these outcomes were attenuated at 6 months, positive impacts were observed for selected aspects of mothers' interactions with their children. Maternal characteristics at baseline were associated with participation in the intervention and with post-intervention and 6-month outcomes. Mothers with lower levels of stress and those with fewer children were more likely to attend intervention sessions. Mothers with lower levels of stress had more favorable post intervention outcomes. Conclusions CBT group-based enhancement to home visiting improved maternal coping, reduced stress and depression immediately post intervention but not at 6 months, suggesting more work is needed to sustain positive gains in low-income mothers of young children.
Moraes, Edilaine; Campos, Geraldo M; Figlie, Neliana B; Laranjeira, Ronaldo; Ferraz, Marcos B
The purpose of this study was to compare the cost-effectiveness of conventional outpatient treatment for alcoholic patients (CT) with this same conventional treatment plus home visits (HV), a new proposal for intervention within the Brazilian outpatient treatment system. A cost-effectiveness evaluation alongside a 12-week randomized clinical trial was performed. We identified the resources utilized by each intervention, as well as the cost according to National Health System (SUS), Brazilian Medical Association (AMB) tables of fees, and others based on 2005 data. The incremental cost-effectiveness ratio (ICER) was estimated as the main outcome measure - abstinent cases at the end of treatment. There were 51.8% abstinent cases for HV and 43.1% for CT, a clinically relevant finding. Other outcome measures, such as quality of life, also showed significant improvements that favored HV. The baseline scenario presented an ICER of USD 1,852. Sensitivity analysis showed an ICER of USD 689 (scenario favoring HV) and USD 2,334 (scenario favoring CT). The HV treatment was found to be cost-effective according to the WHO Commission on Macroeconomics and Health. 2009 S. Karger AG, Basel.
Catherine, Nicole L A; Gonzalez, Andrea; Boyle, Michael; Sheehan, Debbie; Jack, Susan M; Hougham, Kaitlyn A; McCandless, Lawrence; MacMillan, Harriet L; Waddell, Charlotte
Nurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children. The program focuses on women who are parenting for the first time and experiencing socioeconomic disadvantage. Nurse visits start as early in pregnancy as possible and continue until the child reaches age two years. The program has proven effective in the United States - improving children's mental health and development and maternal wellbeing, and showing long-term cost-effectiveness. But it is not known whether the same benefits will be obtained in Canada, where public services differ. The British Columbia Healthy Connections Project therefore involves a randomized controlled trial evaluating Nurse-Family Partnership's effectiveness compared with existing (usual) services in improving children's mental health and early development and mother's life circumstances. The trial's main aims are to: reduce childhood injuries by age two years (primary outcome indicator); reduce prenatal nicotine and alcohol use; improve child cognitive and language development and behaviour at age two years; and reduce subsequent pregnancies by 24 months postpartum. Potential explanatory factors such as maternal mental health (including self-efficacy) are also being assessed, as is the program's impact on exposure to intimate-partner violence. To inform future economic evaluation, data are also being collected on health and social service access and use. Eligible and consenting participants (N = 1040) are being recruited prior to 28 weeks gestation then individually randomized to receive existing services (comparison group) or Nurse-Family Partnership plus existing services (intervention group). Nurse-Family Partnership is being delivered following fidelity guidelines. Data are being collected during in person and telephone interviews at: baseline; 34-36 weeks gestation; and two, 10, 18 and 24 months postpartum. Additional data will be obtained via
Full Text Available The necessity is emphasized to distinguish between the traditional model of data acquisition reported by a patient in doctor’s office and the more valuable and desired model to become acquainted with the core of the problem by going to a patient’s domicile. In the desired model it is possible to come across various determinants of health during home visits. Family members can be approached and there is a possibility to evaluate the relationships between the patient and his loved ones. One can visually assess one’s living conditions and predictable environmental hazard. For several years, the desired model has been put into practice by general practitioners and home health care nurses. Recently this model is also promoted by “health care therapists” who are members of “teams of home health care”. The authors, being convinced of the merits of “home and environmental model” of practical medicine, have developed a method of recording and illustrating data collected during visits in patient’s home. The elaborated tool helps to communicate and exchange information among general practitioners, home health care nurses, social workers of primary health care centers and specialists. The method improves the formulation of the plan of further therapeutic steps and remedial interventions in psycho-social relations and living conditions of patients.
Riedel-Heller Steffi G
Full Text Available Abstract Background Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial. Methods The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1 geriatric assessment, (2 consultation, (3 booster session. The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160. Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective. Discussion To the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to
Hermanns, J.M.A.; Asscher, J.J.; Zijlstra, B.J.H.; Hoffenaar, P.J.; Deković, M.
Background: The intervention Home-Start is a wide spread program in a number of countries, among which the Netherlands. In Home-Start, trained volunteers visit families with young children in need of support once or twice a week to help them to deal with problems in family life and parenting. Little
Hjelmar, U; Hendriksen, Carsten; Hansen, K
to implement because of a number of organizational obstacles, including co-ordination between the organizations involved in the process. In this paper we look at the factors that affect motivation to participate in a cross-sectoral programme in Copenhagen, Denmark, implementing follow-up home visits to elderly...... persons. Theory and methods: The analysis is based on inter-organizational network theory in an attempt to explain the role of motivation in network formation between organizational systems. The empirical findings are based on focus groups and in-depth interviews with hospital staff, general practitioners...... understanding of values and learning potentials. Conclusions: The study concludes that we need to focus on specific care fields and actors to reduce complexity in the area and more fully understand what motivates care providers to participate in cross-sectoral activities, such as a follow-up home visit...
Full Text Available Abstract Background With a growing trend for those with advanced cancer to die at home, there is a corresponding increase in need for primary medical care in that setting. Yet those with lower incomes and in rural regions are often challenged to have their health care needs met. This study examined the association between patient income and residence and the receipt of Family Physician (FP home visits during the end-of-life among patients with cancer. Methods Data Sources/Study Setting. Secondary analysis of linked population-based data. Information pertaining to all patients who died due to lung, colorectal, breast or prostate cancer between 1992 and 1997 (N = 7,212 in the Canadian province of Nova Scotia (NS was extracted from three administrative health databases and from Statistics Canada census records. Study Design. An ecological measure of income ('neighbourhood' median household income was developed using census information. Multivariate logistic regression was then used to assess the association of income with the receipt of at least one home visit from a FP among all subjects and by region of residency during the end-of-life. Covariates in the initial multivariate model included patient demographics and alternative health services information such as total days spent as a hospital inpatient. Data Extraction Methods. Encrypted patient health card numbers were used to link all administrative health databases whereas the postal code was the link to Statistics Canada census information. Results Over 45% of all subjects received at least one home visit (n = 3265. Compared to those from low income areas, the log odds of receiving at least one home visit was significantly greater among subjects who reside in middle to high income neighbourhoods (for the highest income quintile, adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.15, 1.64; for upper-middle income, adjusted OR = 1.19, 95%CI = 1.02, 1.39; for middle income
Nakamura, Masumi; Kishita, Yoshie; Asada, Miyako; Otsuka, Megumi; Takeshita, Sachiko; Hama, Norihisa; Hayashi, Seigo; Ito, Tomoki; Nishio, Masayuki; Nakamura, Masaki
We conducted a survey of the background of 41 patients who received management and guidance from an in-home visiting pharmacy service and of the contents of support by the pharmacist, using patients' medical records from May 2016 to March 2017. Support comprised delivery of medicine to alleviate a burden to caregiver, suggesting medication, adjusting remaining medicines, and providing support during hospitalization. Out of 285 visits, there were 32 visits for which a medical fee could not be claimed. The main reasons for this were delivery of medicine on the day of visiting medical care, management of prescribed medicine at home, and delivery of temporal medicines. We used SWOT analysis to examine the problems and to consider improvements. The results showed that the different method for calculating medical fees is disadvantage for the hospital pharmacy, compared with the health insurance pharmacy. On the other hand, an advantage for the hospital pharmacist is that he or she can refer to the patient's medical records and support them during hospitalization.
van der Voordt, Theo
In October 2004 I had the opportunity to visit Cornell University in Ithaca, New York. The purpose of my visit was to learn more about the International Workplace Studies Program (IWSP) that was launched in 1989 by Franklin Becker and William (Bill) Sims. Frank is the present chair (Bill the former)
Stevens, Penelope; Kepros, John P; Mosher, Benjamin D
Clinical staff members all recognize the importance of attaining high patient satisfaction scores. Although there are many variables that contribute to patient satisfaction, implementation of a dog visitation program has been shown to have positive effects on patient satisfaction in total joint replacement patients. This innovative practice had not previously been studied in trauma patients. The purpose of this quasi-experimental study was to determine whether dog visitation to trauma inpatients increased patient satisfaction scores with the trauma physicians. A team consisting of a dog and handler visited 150 inpatients on the trauma service. Patient satisfaction was measured using a preexisting internal tool for patients who had received dog visitation and compared with other trauma patients who had not received a visit. This study demonstrated that patient satisfaction on four of the five measured scores was more positive for the patients who had received a dog visit.
Full Text Available Abstract Background Several studies suggest that the number of risk factors rather than their nature is key to mental health disorders in childhood. Method and design The objective of this multicentre randomized controlled parallel trial (PROBE methodology is to assess the impact in a multi-risk French urban sample of a home-visiting program targeting child mental health and its major determinants. This paper describes the protocol of this study. In the study, pregnant women were eligible if they were: living in the intervention area; able to speak French, less than 26 years old; having their first child; less than 27 weeks of amenorrhea; and if at least one of the following criteria were true: less than twelve years of education, intending to bring up their child without the presence of the child’s father, and 3 low income. Participants were randomized into either the intervention or the control group. All had access to usual care in mother-child centres and community mental health services free of charge in every neighbourhood. Psychologists conducted all home visits, which were planned on a weekly basis from the 7th month of pregnancy and progressively decreasing in frequency until the child’s second birthday. Principle outcome measures included child mental health at 24 months and two major mediating variables for infant mental health: postnatal maternal depression and the quality of the caring environment. A total of 440 families were recruited, of which a subsample of 120 families received specific attachment and caregiver behaviour assessment. Assessment was conducted by an independent assessment team during home visits and, for the attachment study, in a specifically created Attachment Assessment laboratory. Discussion The CAPEDP study is the first large-scale randomised, controlled infant mental health promotion programme to take place in France. A major specificity of the program was that all home visits were conducted by
Tubach, Florence; Greacen, Tim; Saïas, Thomas; Dugravier, Romain; Guedeney, Nicole; Ravaud, Philippe; Tereno, Susana; Tremblay, Richard; Falissard, Bruno; Guedeney, Antoine
Several studies suggest that the number of risk factors rather than their nature is key to mental health disorders in childhood. The objective of this multicentre randomized controlled parallel trial (PROBE methodology) is to assess the impact in a multi-risk French urban sample of a home-visiting program targeting child mental health and its major determinants. This paper describes the protocol of this study. In the study, pregnant women were eligible if they were: living in the intervention area; able to speak French, less than 26 years old; having their first child; less than 27 weeks of amenorrhea; and if at least one of the following criteria were true: less than twelve years of education, intending to bring up their child without the presence of the child's father, and 3) low income. Participants were randomized into either the intervention or the control group. All had access to usual care in mother-child centres and community mental health services free of charge in every neighbourhood. Psychologists conducted all home visits, which were planned on a weekly basis from the 7th month of pregnancy and progressively decreasing in frequency until the child's second birthday. Principle outcome measures included child mental health at 24 months and two major mediating variables for infant mental health: postnatal maternal depression and the quality of the caring environment. A total of 440 families were recruited, of which a subsample of 120 families received specific attachment and caregiver behaviour assessment. Assessment was conducted by an independent assessment team during home visits and, for the attachment study, in a specifically created Attachment Assessment laboratory. The CAPEDP study is the first large-scale randomised, controlled infant mental health promotion programme to take place in France. A major specificity of the program was that all home visits were conducted by specifically trained, supervised psychologists rather than nurses
Mejdoubi, Jamila; van den Heijkant, Silvia C C M; van Leerdam, Frank J M; Heymans, Martijn W; Hirasing, Remy A; Crijnen, Alfons A M
Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV). The nurse-family partnership (NFP) is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. A random sample of 460 eligible disadvantaged women births, was randomized. Women in the control group (C; n=223) received usual care; women in the intervention group (I; n=237) received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%), physical assault level 1 (C: 58% vs. I: 40%) and level 2 (C: 31% vs. I: 20%), and level 1 sexual coercion (C: 16% vs. I: 8%). Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%), level 1 physical assault (C: 65% vs. I: 52%), and level 1 injury (C: 27% vs. I: 17%). At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%), and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%). Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.
Mahiro, Sakai; Takashi, Naruse; Satoko, Nagata
Nurses with higher levels of work engagement tend to be highly efficient in their work and more willing to keep working and to provide patient-centred care. However, whether more engaged nurses provide end-of-life care more proactively has not been examined in the home-care setting. This study aimed to examine work engagement among home-visiting nurses in Japan and its relationship with their attitudes toward caring for dying patients and their families. A total of 343 nurses working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. The authors performed multiple regression analysis to explore the relationships between home-visiting nurses' work engagement and attitudes. Data from 184 nurses (53.6%) was analysed. Work engagement was significantly positively related to the nurses' attitudes toward caring for dying patients and their families. As more engaged nurses tend to have more positive attitudes toward caring for dying patients and their families, further research is needed to identify the factors that might help nursing managers to enhance their staff's engagement and perhaps thereby improve their attitudes, with the ultimate aim of achieving better outcomes for patients and families.
Larsen, Simon Bo; Clemensen, Jane; Ejskjær, Niels
We tested the feasibility of Universal Mobile Telephone System (UMTS) mobile phones for video consultations in the home. Five patients with diabetic foot ulcers were included in the study. Each of them was offered three video consultations instead of visits to the hospital outpatient clinic....... The consultations took from 5 to 18 min. In all 15 consultations, the hospital experts were able to assess the ulcer in cooperation with the visiting nurse and to decide on the treatment. However, technical problems sometimes made it difficult for them. Connectivity problems occurred in seven of the 15...... consultations. Also, the audio signal was rather unstable at times. In all situations except one, however, the clinicians were able to reach a decision that the expert felt confident about, and after all consultations the atmosphere and participants' attitudes were very positive....
Russell, David; Rosenfeld, Peri; Ames, Sylvia; Rosati, Robert J
There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not-for-profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation. © 2010 National Association for Healthcare Quality.
Barboza, Madelene; Kulane, Asli; Burström, Bo; Marttila, Anneli
Health inequities among children in Sweden persist despite the country's well-developed welfare system and near universal access to the national child health care programme. A multisectoral extended home visiting intervention, based on the principles of proportionate universalism, has been carried out in a disadvantaged area since 2013. The present study investigates the content of the meetings between families and professionals during the home visits to gain a deeper understanding of how it relates to a health equity perspective on early childhood development. Three child health care nurses documented 501 visits to the families of 98 children between 2013 and 2016. A qualitative data-driven conventional content analysis was performed on all data from the cycle of six visits per child, and a general content model was developed. Additional content analysis was carried out on the data from visits to families who experienced adverse situations or greater needs. The analysis revealed that the home visits covered three main categories of content related to the health, care and development of the child; the strengthening of roles and relations within the new family unit; and the influence and support located in the broader external context around the family. The model of categories and sub-categories proved stable over all six visits. Families with extra needs received continuous attention to their additional issues during the visits, as well as the standard content described in the content model. This study on home visiting implementation indicates that the participating families received programme content which covered all the domains of nurturing care as recommended by the WHO Commission on Social Determinants of Health and recent research. The content of the home visits can be understood to create enabling conditions for health equity effects. The intervention can be seen to represent a practical example of proportionate universalism.
This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).
Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul
To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.
Full Text Available Background: Adolescence pregnancy is high risk both for mother and child. This systematic review aimed to determine the effect of home visiting on maternal and neonatal outcomes in adolescent mothers.Materials and Methods: This systematic review was performed by searching English databases including Cochran library, PubMed, Google scholar, Scopus, web of science, Embase, Ovid and Persian databases including SID, Magiran, and Barakat Knowledge Network System without time limitation. The search terms included "adolescent or teen pregnancy", "adolescent or teen mothers", "home visiting", "home visitation" and "home visit". Results: According to databases search, 967 papers were found that among them 913 papers were not related. Among 54 related papers, 44 abstracts and 10 full texts were studied. At the end, 7 RCT included in this systematic review. The meta-analysis result done on 375 person indicated that mental health in the home visiting group was significantly better than the control group (routine care or cares except considered intervention (standard mean difference: -0.33; 95%CI: -0.57 to -0.10; p=0.006, I2=0%. Also, meta-analysis done on 185 persons showed that there was no significant difference between two groups in terms of repeat pregnancy (odds ratio: 0.83; 95% CI: 0.33 to 2.03; p=0.67; I2=50% and repeat birth (odds ratio: 0.90; 95%CI: 0.35 to 2.31; P= 0.820, I2=0%. Conclusion: Results indicates that home visiting can improve mental health but does not have any effect on repeat pregnancy and repeat birth. Clinical trials with accurate methodology by controlling effect of number and duration of home visiting are recommended.
Izzo, Theresa Eleanor
Sixty-four third-grade pupils who were underachieving in reading participated in a study to determine the effect of parental home instruction in reading. A four-cell experimental design was used with two treatment factors: programmed home reading instruction given by mothers trained to administer the program versus no instruction, and mother's…
Full Text Available BACKGROUND: Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV. The nurse-family partnership (NFP is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. METHODS: A random sample of 460 eligible disadvantaged women <26 years, with no previous live births, was randomized. Women in the control group (C; n=223 received usual care; women in the intervention group (I; n=237 received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. RESULTS: At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%, physical assault level 1 (C: 58% vs. I: 40% and level 2 (C: 31% vs. I: 20%, and level 1 sexual coercion (C: 16% vs. I: 8%. Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%, level 1 physical assault (C: 65% vs. I: 52%, and level 1 injury (C: 27% vs. I: 17%. At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%, and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%. Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. CONCLUSION: VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. TRIAL REGISTRATION: Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.
Celia Maria Sivalli Campos
Full Text Available Objective Identify nurses’ emancipatory practices in primary care, to contribute to the improvement of health care. Method A case study type social research of qualitative nature, in which nurses of a primary health care service unit in São Paulo were interviewed. Results The home visit was identified as a nursing practice possible to be expanded in order to identify social determinants of health, triggering emancipatory practices in the service. This expansion occurred because the design of health care labour intended by the service team changed its focus from the traditional object of health services, the disease. Conclusion First, it is advocated that social policies lead projects with the purpose of improving health needs. On the other hand, the daily labour needs to provide opportunities for reflection and discussion of healthcare projects, leading workers to propose labour-processes targeted to both the social determinants of health and people’s illness.
Celia Maria Sivalli Campos
Full Text Available Objective Identify nurses’ emancipatory practices in primary care, to contribute to the improvement of health care. Method A case study type social research of qualitative nature, in which nurses of a primary health care service unit in São Paulo were interviewed. Results The home visit was identified as a nursing practice possible to be expanded in order to identify social determinants of health, triggering emancipatory practices in the service. This expansion occurred because the design of health care labour intended by the service team changed its focus from the traditional object of health services, the disease. Conclusion First, it is advocated that social policies lead projects with the purpose of improving health needs. On the other hand, the daily labour needs to provide opportunities for reflection and discussion of healthcare projects, leading workers to propose labour-processes targeted to both the social determinants of health and people’s illness.
Full Text Available This paper argues that the burgeoning sub-discipline of carceral geography needs to pay particular attention to context when theorising carceral space, and that the specific context of Finland offers a new and valuable perspective. Much of the work within this new area of human geography originates in or pertains to the highly incarcerative, or ‘hypercarcerative’ contexts of the US, the UK and the Russian Federation, raising questions over the transferability of theorisations of the carceral to other less carcerative, or actively ‘de-carcerative’ settings. By focussing specifically on one such setting, the low imprisonment context of Finland, this paper discusses Goffman’s ‘total institution’ thesis with reference to the system of ‘furloughs’ or home visits for prisoners. In this paper we explore the extent to which this practice destabilises the inside/outside binary of the ‘total institution’, through the notion of heterotopia.
Odendaal, Willem; van Niekerk, Ashley; Jordaan, Esme; Seedat, Mohamed
The continued high mortality and morbidity rates for unintentional childhood injuries remain a public health concern. This article reports on the influence of a home visitation programme (HVP) on household hazards associated with unintentional childhood injuries in a South African low-income setting. A randomised controlled trial (n=211 households) was conducted in a South African informal settlement. Community members were recruited and trained as paraprofessional visitors. Four intervention visits were conducted over 3 months, focusing on child development, and the prevention of burn, poison, and fall injuries. The HVP, a multi-component intervention, included educational inputs, provision of safety devices, and an implicit enforcement strategy. The intervention effect (IE) was measured with a standardised risk assessment index that compared post-intervention scores for intervention and control households. A significant reduction was observed in the hazards associated with electrical and paraffin appliances, as well as in hazards related to poisoning. Non-significant changes were observed for burn safety household practices and fall injury hazards. This study confirmed that a multi-component HVP effectively reduced household hazards associated with electrical and paraffin appliances and poisoning among children in a low-income South African setting.
Naruse, Takashi; Matsumoto, Hiroshige; Fujisaki-Sakai, Mahiro; Nagata, Satoko
Home care service demands are increasing in Japan; this necessitates improved service allocation. This study examined the relationship between home visit nursing (HVN) service use and the proportion of elderly people living within 10 min' travel of HVN agencies. The population of elderly people living within reach of HVN agencies for each of 17 municipalities in one low-density prefecture was calculated using public data and geographic information systems. Multilevel logistic analysis for 2641 elderly people was conducted using medical and long-term care insurance claims data from October 2010 to examine the association between the proportion of elderly people reachable by HVNs and service usage in 13 municipalities. Municipality variables included HVN agency allocation appropriateness. Individual variables included HVN usage and demographic variables. The reachable proportion of the elderly population ranged from 0.0 to 90.2% in the examined municipalities. The reachable proportion of the elderly population was significantly positively correlated with HVN use (odds ratio: 1.938; confidence interval: 1.265-2.967). Residents living in municipalities with a lower reachable proportion of the elderly population are less likely to use HVN services. Public health interventions should increase the reachable proportion of the elderly population in order to improve HVN service use.
Garcia, Carolyn; Hermann, Denise; Bartels, Anna; Matamoros, Pablo; Dick-Olson, Linda; Guerra de Patino, Janeth
As the Latino population in the United States experiences rapid growth, the well-being of Latino adolescents is a growing concern because of their high rates of mental health problems. Latino adolescents have higher rates of mental health problems than their peers, including depressive symptoms, suicide attempts, and violence. Sophisticated, realistic health promotion efforts are needed to reduce these risk behaviors and enhance protective factors. Parents and schools can be key protective factors, or assets, in adolescents' lives. This article details the steps undertaken to develop Project Wings Home Visits, a collaborative school-based, community-linked mental health promotion intervention for Latino adolescents and their families. Core to the intervention is the use of a community health worker model to provide home-based outreach and education to parents of Latino adolescents. The intervention was developed using a community-based participatory research approach that involved the cooperation of a community health care system, a public high school, and a university. Our process demonstrates the benefits, strengths, and challenges of using community-based participatory research in creating and implementing health promotion interventions.
Gomez, Marta; Reddy, Amanda L; Dixon, Sherry L; Wilson, Jonathan; Jacobs, David E
Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for
Ifediora, Chris O
Minimizing the risks and distress arising from aggression in after-hours house call (AHHC) services will help improve service quality in the industry. Unfortunately, no national study has ever evaluated this in Australian AHHCs. Apart from reducing this gap, findings from this work will have global relevance given the rising popularity of the AHHC industry worldwide. A survey of all 300 doctors employed by the National Home Doctor Service, Australia's largest AHHC service provider. A validated electronic questionnaire was used to examine the doctors' experiences over a 12-month period. There were 168 valid responses (56% response rate). Aggression prevalence was 47.1%, and just over half (51.8%) of the cases came from the patients. "Verbal aggression" was the commonest (48.3%). Others are "threats" (26.6%), "vexatious complaints" (13.3%), "property damage" (4.2%), "physical violence" (4.2%), "sexual harassment" (2.8%), and "stalking" (0.7%). Majority of the respondents were concerned (90.2%) and apprehensive (75.2%) regarding the risks. Doctors who have experienced aggression were more likely to express apprehension (OR = 3.99; CI = 1.54-10.31; P = 0.004), while those that have attained Postgraduate Fellowships (Vocationally Registered) were less likely to report experiences of aggression (OR = 0.28; CI = 0.09-0.84; P = 0.02). Even though a higher proportion of females were concerned (92.3% vs 89.6%) and apprehensive (82.1% vs 73.6%) compared with males, these differences were not statistically significant (Fisher's Exact Tests: P = 1.000 and 0.469, respectively). Aggression in Australian AHHC affects nearly 1-in-2 practitioners, with high levels of concern and apprehension being expressed. Concerned companies should do more to ensure that their doctors attain PG fellowships, as this is linked to lower reports of aggression. Where possible, family and friends need to be involved in patient care, as nearly half of the reported aggressions come from
AWARD NUMBER: W81XWH-15-1-0374 TITLE: Strength at Home Couples Program to Prevent Military Partner Violence PRINCIPAL INVESTIGATOR: Casey T...SUBTITLE 5a. CONTRACT NUMBER Strength at Home Couples Program to Prevent Military Partner Violence 5b. GRANT NUMBER W81XWH-15-1-0374 5c. PROGRAM...7 9. Appendices…………………………………………………………………………………..7 1 Annual Report for Period: Sep 30, 2016 to Sept 29, 2017 Strength at Home
Full Text Available Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith’s Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251 and content (n = 261 occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.
Blanter, R; Page, P M
Providing quality home care services to immigrants requires an integrated, holistic approach that genuinely addresses language and cultural differences. One home care agency in Massachusetts developed a team-oriented, culturally sensitive outreach program that ensures non-English-speaking patients the same level of service that the general population receives.
Full Text Available Jesús Favela,1 Luis A Castro,2 Francisco Franco-Marina,3 Sergio Sánchez-García,4 Teresa Juárez-Cedillo,4 Claudia Espinel Bermudez,4 Julia Mora-Altamirano,4 Marcela D Rodriguez,5 Carmen García-Peña41Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico; 2Sonora Institute of Technology, Ciudad Obregon, Mexico; 3National Institute of Respiratory Diseases, Mexican Ministry of Health, Mexico City, Mexico; 4Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico; 5School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, MexicoObjective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB is effective in reducing frailty compared to nurse home visits alone (NV-only and usual care (control group for older adults.Design: Unblinded, randomized, controlled trial.Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.Participants: Patients were aged over 60 years with a frailty index score higher than 0.14.Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients, they had died (107, they were ill (50, or they were not currently living in the city (28. A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete
Pitt, Catherine; Tawiah, Theresa; Soremekun, Seyi; ten Asbroek, Augustinus H. A.; Manu, Alexander; Tawiah-Agyemang, Charlotte; Hill, Zelee; Owusu-Agyei, Seth; Kirkwood, Betty R.; Hanson, Kara
Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5-18). We aimed to estimate the costs and
The after-hours house call (AHHC) service in Australia is growing, but studies have never explored the doctor variables associated with burnout and stress within the service. This study fills this knowledge gap. To determine the doctor variables associated with burnout and stress among doctors involved in AHHC. A quantitative, questionnaire-based survey of all 300 doctors engaged in AHHC through the National Home Doctor Service (NHDS), Australia's largest home visiting doctor-service provider. The Maslach Burnout Inventory (MBI) was used to assess burnout over a 12-month period from October 2013 to September 2014. Ordinal logistics regression was used to identify significant associations. There were 168 valid responses received, giving a 56 per cent response rate. The most significant factor associated with reduced stress and burnout is the adoption of self-protection measures while on the job. Such measures include the use of chaperones, the use of panic alarms or buttons, adopting de-escalation techniques, and reliance on relevant surgery policies. Other associations with reduced stress include the attainment of postgraduate fellowships (vocational registration), working less than 24 hours per week, being in legally recognised partnerships, and being male. Conversely, having general practice as a career, being under 40 years of age, and obtaining primary medical degrees from Australia (as opposed to overseas) are all associated with increased burnout for doctors involved in AHHC. A number of doctor variables have been found to significantly reduce burnout in AHHC Among these, the adoption of self-protective measures and the attainment postgraduate fellowships, where possible, should be encouraged among practitioners involved in the service.
Walus, Ashley N; Woloschuk, Donna M M
Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research
Doernberg, Nanette; And Others
To develop a meaningful intervention for waiting list families and their preschool emotionally disturbed children, a home training program for the parent and child was initiated. The focus of the program was on productive cooperation between parents and professionals. During a period of 2 years, 45 families completed the program. The program…
Atwal, Anita; Money, Arthur; Harvey, Michele
A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment in order to enable patients to function independently after hospital discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement, and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualize changes prior to implementing them. Customized VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration, if developed effectively and integrated into the PHV process. The intent of the study was to explore the perceptions of OTs with regard to using VRIDAs as an assistive tool within the PHV process. Task-oriented interactive usability sessions, utilizing the think-aloud protocol and subsequent semi-structured interviews were carried out with seven OTs who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centering around the parameters that impact upon the acceptance, adoption, and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). OTs' perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich
Background A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment in order to enable patients to function independently after hospital discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement, and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualize changes prior to implementing them. Customized VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration, if developed effectively and integrated into the PHV process. Objective The intent of the study was to explore the perceptions of OTs with regard to using VRIDAs as an assistive tool within the PHV process. Methods Task-oriented interactive usability sessions, utilizing the think-aloud protocol and subsequent semi-structured interviews were carried out with seven OTs who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centering around the parameters that impact upon the acceptance, adoption, and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential
'right@home': a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning environment at 2 years.
Goldfeld, Sharon; Price, Anna; Bryson, Hannah; Bruce, Tracey; Mensah, Fiona; Orsini, Francesca; Gold, Lisa; Hiscock, Harriet; Smith, Charlene; Bishop, Lara; Jackson, Dianne; Kemp, Lynn
By the time children start school, inequities in learning, development and health outcomes are already evident. Sustained nurse home visiting (SNHV) offers a potential platform for families experiencing adversity, who often have limited access to services. While SNHV programmes have been growing in popularity in Australia and internationally, it is not known whether they can improve children's learning and development when offered via the Australian service system. The right@home trial aims to investigate the effectiveness of an SNHV programme, offered to women from pregnancy to child age 2 years, in improving parent care of and responsivity to the child, and the home learning environment. Pregnant Australian women (n=722) are identified after completing a screening survey of 10 factors known to predict children's learning and development (eg, young pregnancy, poor mental or physical health, lack of support). Consenting women-surveyed while attending clinics at 10 hospitals in Victoria and Tasmania-are enrolled if they report having 2 or more risk factors. The intervention comprises 25 home visits from pregnancy to 2 years, focusing on parent care of the child, responsivity to the child and providing a good quality home learning environment. The standard, universal, Australian child and family health service provides the comparator (control). Primary outcome measures include a combination of parent-reported and objective assessments of children's sleep, safety, nutrition, parenting styles and the home learning environment, including the Home Observation of the Environment Inventory and items adapted from the Longitudinal Study of Australian Children. This study is approved by the Royal Children's Hospital Human Research Ethics Committees (HREC 32296) and site-specific HRECs. The investigators and sponsor will communicate the trial results to stakeholders, participants, healthcare professionals, the public and other relevant groups via presentations and
This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.
Brownell, Marni D; Nickel, Nathan C; Enns, Jennifer E; Chartier, Mariette; Campbell, Rhonda; Phillips-Beck, Wanda; Chateau, Dan; Burland, Elaine; Santos, Rob; Katz, Alan
First Nations people are descendants of Canada's original inhabitants. In consequence of historical and ongoing structural injustices, many First Nations families struggle with challenging living conditions, including high rates of poverty, poor housing conditions, mental illness and social isolation. These risk factors impede caregivers' abilities to meet their children's basic physical and psychosocial needs. Home visiting programmes were developed to support child developmental health in families facing parenting challenges. However, whether home visiting is an effective intervention for First Nations families has not been examined. We are evaluating two home visiting programmes in Manitoba, Canada, to determine whether they promote nurturing family environments for First Nations children. This research builds on new and established relationships among academic researchers, government decision-makers and First Nations stakeholders. We will link health, education and social services data from the Manitoba Population Research Data Repository to data from two home visiting programmes in Manitoba. Logistic regression modelling will be used to assess whether programme participation is associated with improved child developmental health, better connections between families and social services, reduced instances of child maltreatment and being taken into out-of-home care by child welfare and reduced inequities for First Nations families. Non-participating individuals with similar sociodemographic characteristics will serve as comparators. We will use an interrupted time series approach to test for differences in outcomes before and after programme implementation and a propensity score analysis to compare differences between participants and non-participants. Approvals were granted by the Health Information Research Governance Committee of the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba Health Research Ethics Board. Our
Des Moines Public Schools, IA. Teaching and Learning Div.
Home economics programs are offered to students in grades 6-12 in the Des Moines INdependent Community School District (Iowa). Programs at the middle school level are exploratory, leading to occupational training in family and consumer science, child care, food service, and textile and fashion arts at the high school level. Health education…
van den Berg Neeltje
Full Text Available Abstract Background The AGnES-concept (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention was developed to support general practitioners (GPs in undersupplied regions. The project aims to delegate GP-home visits to qualified AGnES-practice assistants, to increase the number of patients for whom medical care can be provided. This paper focuses on the effect of delegating GP-home visits on the total number of patients treated. First, the theoretical number of additional patients treated by delegating home visits to AGnES-practice assistants was calculated. Second, actual changes in the number of patients in participating GP-practices were analyzed. Methods The calculation of the theoretical increase in the number of patients was based on project data, data which were provided by the Association of Statutory Health Insurance Physicians, or which came from the literature. Setting of the project was an ambulatory healthcare centre in the rural county Oberspreewald-Lausitz in the Federal State of Brandenburg, which employed six GPs, four of which participated in the AGnES project. The analysis of changes in the number of patients in the participating GP-practices was based on the practices’ reimbursement data. Results The calculated mean capacity of AGnES-practice assistants was 1376.5 home visits/year. GPs perform on average 1200 home visits/year. Since home visits with an urgent medical reason cannot be delegated, we included only half the capacity of the AGnES-practice assistants in the analysis (corresponding to a 20 hour-work week. Considering all parameters in the calculation model, 360.1 GP-working hours/year can be saved. These GP-hours could be used to treat 170 additional patients/quarter year. In the four participating GP-practices the number of patients increased on average by 133 patients/quarter year during the project period, which corresponds to 78% of the theoretically possible number of patients
Background The AGnES-concept (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention) was developed to support general practitioners (GPs) in undersupplied regions. The project aims to delegate GP-home visits to qualified AGnES-practice assistants, to increase the number of patients for whom medical care can be provided. This paper focuses on the effect of delegating GP-home visits on the total number of patients treated. First, the theoretical number of additional patients treated by delegating home visits to AGnES-practice assistants was calculated. Second, actual changes in the number of patients in participating GP-practices were analyzed. Methods The calculation of the theoretical increase in the number of patients was based on project data, data which were provided by the Association of Statutory Health Insurance Physicians, or which came from the literature. Setting of the project was an ambulatory healthcare centre in the rural county Oberspreewald-Lausitz in the Federal State of Brandenburg, which employed six GPs, four of which participated in the AGnES project. The analysis of changes in the number of patients in the participating GP-practices was based on the practices’ reimbursement data. Results The calculated mean capacity of AGnES-practice assistants was 1376.5 home visits/year. GPs perform on average 1200 home visits/year. Since home visits with an urgent medical reason cannot be delegated, we included only half the capacity of the AGnES-practice assistants in the analysis (corresponding to a 20 hour-work week). Considering all parameters in the calculation model, 360.1 GP-working hours/year can be saved. These GP-hours could be used to treat 170 additional patients/quarter year. In the four participating GP-practices the number of patients increased on average by 133 patients/quarter year during the project period, which corresponds to 78% of the theoretically possible number of patients. Conclusions The empirical
Mathus-Vliegen, Elisabeth M H
Bariatric surgery results in sustained weight loss in the majority of patients. The controlled setting of a trial, however, does not necessarily reflect the everyday routine practice. Therefore, to investigate the results of bariatric surgery in a more natural setting, patients were visited at home, outside a study and hospital environment. Patients who underwent a vertical banded gastroplasty or a gastric bypass between 1980 and 1997 were eligible. Body weight and height were measured. Patients filled out general and health status questionnaires (Nottingham Health Profile (NHP)). Responses were obtained from 236/313 subjects (75%) with a mean +/- SD age of 42.9 +/- 10.2 years and a mean current body weight of 100.3 +/- 20.7 kg. A maximum weight loss of 48.2 +/- 18.4 kg or 70.8 +/- 22.4% excess weight loss was obtained after 17 +/- 15 months, of which 32.1 +/- 22.6 kg or 45.2 +/- 29.3%, respectively, was maintained at 8.2 +/- 4.5 years after the intervention. Males and females did not differ in weight loss. The type of operation had no influence. Age >50 years and a BMI >50 kg/m(2) were not related to a poor outcome, but a time lapse of >5 years since the operation resulted in a less well sustained weight loss. The subjective health status improved considerably, but less so with a smaller weight loss and longer lapse of time since the operation. Especially in females, the NHP still deviated substantially from Dutch norm values. Surgically obtained weight loss is satisfactory in patients outside a strictly controlled study setting. Health benefits are substantial, but are adversely affected by weight gain and time elapsed since the operation.
Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko
To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.
Coates, Ralph J.; Pérez, Alejandro; Baer, Atar; Zhou, Hong; English, Roseanne; Coletta, Michael; Dey, Achintya
Objective We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP). Methods We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting 15 data with all ED visits in all 50 states and Washington, DC. Results Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented. Conclusions NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. PMID:26883318
The National Defense Authorization Act for Fiscal Year 1999 (FY 99) directed a 5-year pilot program to treat graduates of home schools and graduates of the National Guard Youth ChalleNGe Program holding General Education Development (GED...
Van 't Riet, Jonathan; Crutzen, Rik; De Vries, Hein
Online health communication has the potential to reach large audiences, with the additional advantages that it can be operational at all times and that the costs per visitor are low. Furthermore, research shows that Internet-delivered interventions can be effective in changing health behaviors. However, exposure to Internet-delivered health-communication programs is generally low. Research investigating predictors of exposure is needed to be able to effectively disseminate online interventions. In the present study, the authors used a longitudinal design with the aim of identifying demographic, psychological, and behavioral predictors of visiting, using, and revisiting an online program promoting physical activity in the general population. A webpage was created providing the public with information about health and healthy behavior. The website included a "physical activity check," which consisted of a physical activity computer-tailoring expert system where visitors could check whether their physical activity levels were in line with recommendations. Visitors who consented to participate in the present study (n = 489) filled in a questionnaire that assessed demographics, mode of recruitment, current physical activity levels, and health motivation. Immediately after, participants received tailored feedback concerning their current physical activity levels and completed a questionnaire assessing affective and cognitive user experience, attitude toward being sufficiently physically active, and intention to be sufficiently physically active. Three months later, participants received an email inviting them once more to check whether their physical activity level had changed. Analyses of visiting showed that more women (67.5%) than men (32.5%) visited the program. With regard to continued use, native Dutch participants (odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.16-6.81, P = .02) and participants with a strong motivation to be healthy (OR = 1.46, CI = 1
Taherh Hadian; Mojgan Mirghafourvand; Sakineh Mohammad-Alizadeh Charandabi; Solmaz Ghanbari; Jila Nahaeii; Shahla Meedya
Background: Adolescence pregnancy is high risk both for mother and child. This systematic review aimed to determine the effect of home visiting on maternal and neonatal outcomes in adolescent mothers.Materials and Methods: This systematic review was performed by searching English databases including Cochran library, PubMed, Google scholar, Scopus, web of science, Embase, Ovid and Persian databases including SID, Magiran, and Barakat Knowledge Network System without time limitation. The search...
Seaman, D.E.; Griffith, B.; Powell, R.A.
Kernel methods are state of the art for estimating animal home-range area and utilization distribution (UD). The KERNELHR program was developed to provide researchers and managers a tool to implement this extremely flexible set of methods with many variants. KERNELHR runs interactively or from the command line on any personal computer (PC) running DOS. KERNELHR provides output of fixed and adaptive kernel home-range estimates, as well as density values in a format suitable for in-depth statistical and spatial analyses. An additional package of programs creates contour files for plotting in geographic information systems (GIS) and estimates core areas of ranges.
Abbott, Laurie S; Elliott, Lynn T
The purpose of this systematic literature review was to synthesize the results of transdisciplinary interventions designed with a home visit component in experimental and quasi-experimental studies having representative samples of racial and ethnic minorities. The design of this systematic review was adapted to include both experimental and quasi-experimental quantitative studies. The predetermined inclusion criteria were studies (a) having an experimental or quasi-experimental quantitative design, (b) having a home visit as a research component, (c) including a prevention research intervention strategy targeting health and/or safety issues, (d) conducted in the United States, (e) having representation (at least 30% in the total sample size) of one or more racial/ethnic minority, (f) available in full text, and (g) published in a peer-reviewed journal between January, 2005 and December, 2015. Thirty-nine articles were included in the review. There were 20 primary prevention, 5 secondary prevention, and 14 tertiary prevention intervention studies. Community and home visitation interventions by nurses can provide an effective means for mitigating social determinants of health by empowering people at risk for health disparities to avoid injury, maintain health, and prevent and manage existing disease. © 2016 Wiley Periodicals, Inc.
Melnick, Alan L; Rdesinski, Rebecca E; Creach, E Dawn; Choi, Dongseok; Harvey, S Marie
To identify the influence of a community health nurse (CHN) home visit on perceived barriers to contraceptive access and contraceptive use self-efficacy. We enrolled 103 women into two groups in a randomized trial evaluating the influence of contraceptive dispensing and family planning counseling during home visits on perceived barriers to accessing contraceptives and contraceptive use self-efficacy. Both groups received counseling by a CHN about sexually transmitted disease and pregnancy prevention, and a resource card listing phone numbers of family planning clinics. After randomization, the CHN dispensed three months of hormonal contraception to the intensive intervention group and advised the minimal intervention group to schedule an appointment at a family planning clinic. Data collection at baseline and 12 months included demographic, reproductive and other health-related information as well as quantitative assessments of information on perceived barriers to contraceptive access and contraceptive use self-efficacy. The mean age of participants was 24.7 years. Three-fourths had household incomes under $25,000. We found significant reductions in three perceived barriers to contraceptive access for both groups, as well as significant increases in two measures of contraceptive use self-efficacy at twelve months compared to baseline. Nurse home visits involving family planning counseling might be effective in reducing perceived barriers to contraceptive access and increasing contraceptive use self-efficacy.
Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients with Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact. Objective The objective of this analysis was to compare hospital-at-home care with inpatient hospital care for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) who present to the emergency department (ED). Clinical Need: Condition and Target Population Acute Exacerbations of Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease is a disease
Szilagyi, Peter G; Humiston, Sharon G; Gallivan, Sarah; Albertin, Christina; Sandler, Martha; Blumkin, Aaron
To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents. Randomized clinical trial allocating adolescents (aged 11-15 years) to intervention vs standard of care control. Eight primary care practices. Population-based sample of adolescents (N = 7546). Immunization navigators at each practice implemented a tiered protocol: immunization tracking, telephone or mail reminder/recall, and home visits if participants remained unimmunized or behind on preventive care visits. Immunization rates at study end. Secondary outcomes were preventive care visit rates during the previous 12 months and costs. The intervention and control groups were similar at baseline for demographics (mean age, 13.5 years; 63% black, 14% white, and 23% Hispanic adolescents; and 74% receiving Medicaid), immunization rates, and preventive care visit rates. Immunization rates at the end of the study were 44.7% for the intervention group and 32.4% for the control group (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.5); preventive care visit rates were 68.0% for the intervention group and 55.2% for the control group (1.2; 1.2-1.3). Findings were similar across practices, sexes, ages, and insurance providers. The number needed to treat for immunizations and preventive care visits was 9. The intervention cost was $3.81 per adolescent per month; the cost per additional adolescent fully vaccinated was $465, and the cost per additional adolescent receiving a preventive care visit was $417. A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents. clinicaltrials.gov Identifier: NCT00581347.
Peek, Lucia E.; Roxas, Maria L.
Content analysis of 62 accounting programs' websites indicated the following: 53% include mission statements; 62.9% list accreditation; many faculty biographies and personal pages used inconsistent formats; provision of information on financial aid, student organizations, career services, and certified public accountant requirements varied. Many…
Prieto Rodríguez, M Angeles; Gil García, Eugenia; Heierle Valero, Cristina; Frías Osuna, Antonio
A hot debate exists in our country as to the models of home care which must be developed. This study is aimed at ascertaining how the family caregivers of terminal cancer patients, of the elderly suffering from dementia and of individuals having undergone major operations in outpatient surgery programs rate the quality of the home care provided. A phenomenological type qualitative study based on discussion groups (9), triangular groups (5) and in-depth interviews (22). This study was conducted in Andalusia throughout the 1999-2000 period. The subjects of the study were the main caregivers of patients provided with home care through the healthcare centers. The information must be analyzed by means of a Nudist-4 software-aided content analysis. The analysis variables were those of the Servqual model. For the caregivers of cancer patients, the most important aspects of the quality of the home care provided were the Response Capacity and Accessibility. This analysis revealed that the patients suffered pain but the pain was not controlled. Negative aspects hindering accessibility were the lack of home care coverage outside of regular working hours, the difficulty of getting in touch by phone, the length of time it takes for someone to come and the visits solely on request. The caregivers of patients having undergone major outpatient surgery want Security and Reliability. They complain of the short length of time within which the patients are released from the hospital and of the home care provided by the health care center. The caregivers of the elderly with dementia place top priority on being provided with the materials they need to take care of these patients. Caregivers' and patients' expectations differ, depending on health problems, therefore, the type of home care provided should vary, according to the health problems involved. It is necessary to develop a flexible model, capable of adapting to different patient needs and the diverse circumstances that affect
AF Branding & Trademark Licensing Join the Air Force Home About Us The Air Force Symbol Display Resources Document Library TM Connect Search AF Branding and Trademark Licensing Program: important links Legal Documents 10 U.S.C. Â§ 2260 15 U.S.C. Â§ 167;167; 1114-1125 DODI 5535.12, DoD Branding and
Pitt, Catherine; Tawiah, Theresa; Soremekun, Seyi; ten Asbroek, Augustinus H A; Manu, Alexander; Tawiah-Agyemang, Charlotte; Hill, Zelee; Owusu-Agyei, Seth; Kirkwood, Betty R; Hanson, Kara
Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5-18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting. We prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI -12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20-60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates. In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to -7674) per newborn life saved, or $352 (95% CI 104 to -268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER
Conclusion: The eagerness of patients wanting the teams to reach their residence may be judged by the given figures. The total number of patients visited by the homecare teams of Cansupport in the year 2008-2009 was 1025. Out of them, there were about 104 patients who were discharged. The term discharge means that the patients were not interested in our visit or were not available in our subsequent visit. It has to be mentioned here that the service is a definite demand by society provided that the cost may be catered too.
Mangwi Ayiasi, Richard; Atuyambe, Lynn Muhimbuura; Kiguli, Juliet; Garimoi Orach, Christopher; Kolsteren, Patrick; Criel, Bart
Home visits by Community Health Workers [In Uganda Community Health Workers are given the collective term of Village Health Teams (VHTs). Hereafter referred to as VHTs] is recommended to improve maternal and newborn care. We investigated perceived maternal and newborn benefits of home visits made by VHTs, combined with mobile phone consultations with professional health workers for advice. A qualitative study was conducted in Masindi and Kiryandongo districts, Uganda, in December-2013 to March-2014. Study participants were drawn from the intervention arm of a randomised community-intervention trial. In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs; 5 group discussions and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers. Data were analysed using latent content analysis techniques. Majority women and VHTs contend that the intervention improved access to maternal and newborn information; reduced costs of accessing care and facilitated referral. Women, VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practices. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community. A minority of VHTs perceived the implementation of recommended maternal and newborn care practices as difficult. Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs. For a range of reasons, a number of professional health workers were not always available on phone or at the health centre to address VHT concerns. Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted. Our study highlights potential benefits of
Beck, Anne Marie; Kjær, Stine; Hansen, Birthe Stenbæk
Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.Design:Twelv......Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.......Design:Twelve-week single-blind randomized controlled study.Setting and subjects:Geriatric medical patients (65+ years) at nutritional risk.Interventions:Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented......, rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality.Results:One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks...
Ana Railka de Souza Oliveira
Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.
Ana Railka de Souza Oliveira
Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.
Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry
Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; phome care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993
Thodberg, Karen; Sørensen, Lisbeth U; Videbech, Poul B
, and gender were collected. We found that the immediate responses to, and interaction with, the visiting animal depended on the type of animal that was brought along. The dog and the interactive robot seal triggered the most interaction, in the form of physical contact (F(2,103) = 7.50, p eye......Previous studies suggest that contact with dogs can positively affect the wellbeing of elderly people in nursing homes, but there is a lack of research investigating the causal pathways of these effects. One such path- way may relate to the behavioral responses of the elderly when interacting...... contact (F(4,151) = 6.26, p
Mortensen, Kjeld Høyer; Schougaard, Kari Rye; Schultz, Ulrik Pagh
, even in a worst-case scenario where an unauthorized user gains remote control of the facilities. We address this safety issue at the programming language level by restricting the operations that can be performed on devices according to the physical location of the user initiating the request......-based restrictions on operations. This model has been implemented in a middleware for home AV devices written in Java, using infrared communication and a FireWire network to implement location awareness....
Mortensen, Kjeld Høyer; Schougaard, Kari Sofie Fogh; Schultz, Ulrik Pagh
, even in a worst-case scenario where an unauthorized user gains remote control of the facilities. We address this safety issue at the programming language level by restricting the operations that can be performed on devices according to the physical location of the user initiating the request......-based restrictions on operations. This model has been implemented in a middleware for home AV devices written in Java, using infrared communication and a FireWire network to implement location awareness....
Umusya'adah, L.; Juwaedah, A.; Jubaedah, Y.; Ratnasusanti, H.; Puspita, R. H.
PKH (Program Keluarga Harapan) is a program of Indonesia’s Government through the ministry of social directorate to accelerate the poverty reduction and the achievement of Millennium Development Goals (MDGs) target as well as the policies development in social protection and social welfare domain or commonly referred to as Indonesian Conditional Cash Transfer (CCT) Program. This research is motivated that existing participants of the family expectation program (PKH) that already exist in Sumedang, Indoensia, especially in the South Sumedang on the social welfare components is only limited to the health checking, while for assisting the elderly based Home Care program there has been no structured and systematic, where as the elderly still need assistance, especially from the family and community environment. This study uses a method of Research and Development with Model Addie which include analysis, design, development, implementation and evaluation. Participants in this study using purposive sampling, where selected families of PKH who provide active assistance to the elderly with 82 participants. The program is designed consists of program components: objectives, goals, forms of assistance, organizing institutions and implementing the program, besides, program modules include assisting the elderly. Form of assistance the elderly cover physical, social, mental and spiritual. Recommended for families and companions PKH, the program can be implemented to meet the various needs of the elderly. For the elderly should introspect, especially in the health and follow the advice recommended by related parties
Whyte, Kristin Lyn; Karabon, Anne
Education has embraced the idea of an "asset approach" to working with families and children, creating a focus on developing collaborative relationships with families by building on what they bring to the table. In this paper we explore what happened when early childhood teachers entered homes to learn from families and identify their…
Buss, Arne; Wolf-Ostermann, Karin; Dassen, Theo; Lahmann, Nils; Strupeit, Steve
Facilitating and maintaining functional status (FS) and quality of life (QoL) and avoiding care dependency (CD) are and will increasingly become major tasks of nursing. Educational nursing home visits may have positive effects on FS and QoL in older adults. The aim of this study was to determine the effectiveness of educational home visits on FS, QoL and CD in older adults with mobility impairments. We performed a randomized controlled trial. The study was conducted in the living environments of 123 participants with functional impairments living in Hamburg, Germany. The intervention group received an additional nursing education intervention on mobility and QoL; the control group received care as usual. Data were collected from August 2011 to December 2012 at baseline, 6 months and 12 months of follow-up. The main outcomes were FS (Barthel Index), QoL (WHOQOL-BREF) and CD (Care Dependency Scale). Data were analyzed using descriptive statistics and generalized linear models. In total, 113 participants (57 in the intervention and 56 in the control group) were included in the study. The intervention had no statistical significant effect on FS, QoL and CD. The intervention did not show the benefits that we assumed. Further studies on the effects of educational nursing interventions should be performed using different concepts and rigorous research methods. © 2015 John Wiley & Sons, Ltd.
... Administration (FHA): PowerSaver Home Energy Retrofit Loan Pilot Program: Extension of Pilot Program AGENCY...: On March 31, 2011, HUD published a notice that announced HUD's FHA Home Energy Retrofit Loan Pilot Program (Retrofit Pilot Program) known as FHA PowerSaver, which is a pilot program conducted for loans...
Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: a theory-based process evaluation.
Stijnen, Mandy M N; Jansen, Maria W J; Duimel-Peeters, Inge G P; Vrijhoef, Hubertus J M
Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ≥75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery. Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team. Fidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care. The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received
Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.
This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.
...-emotional, and physical development; parenting skills; school readiness; reductions in crime or domestic... be controlled. Reassignment (see Table 1, Note 1 Analysis must be based No requirement......... below... our criteria for the high rating, the analysis must be performed on the sample as originally assigned...
Full Text Available OBJETIVOS: conocer la repercusión de la visita domiciliaria de los profesionales en enfermería a personas de 65 años o más, pluripatológicas, en morbimortalidad.MÉTODO: estudio retrospectivo caso-control por auditoria de historias clínicas. Muestreo aleatorio. Variables principales morbilidad, mortalidad; descriptivas: visitas de la enfermera, filiación, datos clínicos y socio sanitarios. Análisis por medidas de tendencia central, dispersión, posición, tabulación, frecuencias relativas, absolutas; no paramétricas, contrastes χ2; Wilcoxon-Mann-Whitney.RESULTADOS: se estudiaron a 1743 pacientes, de ellos 199 recibieron visita domiciliaria; la edad media de quien recibe visita es de 81,99 años; estos presentan mayor número de patologías de media 3,76; habitan en domicilio particular, si bien en conjunto presentan más institucionalización que los controles; el 50% no tiene identificado el Cuidador Principal; es mayor el número de visitas de las enfermeras a los pacientes que viven en residencias (p < 0,001. El 50% de casos no tiene plan de cuidados, con relación significativa (p < 0,001. No existen diferencias significativas en tiempo de vida entre los casos y los controles.CONCLUSIÓN: la visita domiciliaria del profesional en enfermería no repercute en la morbimortalidad; visita a los pacientes cuando ya ha aparecido el problema de salud, no hay datos de prevención.
Dios-Guerra, Caridad; Carmona-Torres, Juan Manuel; Ruíz-Gándara, África; Muñoz-Alonso, Adoración; Rodríguez-Borrego, María-Aurora
OBJETIVOS: conocer la repercusión de la visita domiciliaria de los profesionales en enfermería a personas de 65 años o más, pluripatológicas, en morbimortalidad. MÉTODO: estudio retrospectivo caso-control por auditoria de historias clínicas. Muestreo aleatorio. Variables principales morbilidad, mortalidad; descriptivas: visitas de la enfermera, filiación, datos clínicos y socio sanitarios. Análisis por medidas de tendencia central, dispersión, posición, tabulación, frecuencias relativas, absolutas; no paramétricas, contrastes χ2; Wilcoxon-Mann-Whitney. RESULTADOS: se estudiaron a 1743 pacientes, de ellos 199 recibieron visita domiciliaria; la edad media de quien recibe visita es de 81,99 años; estos presentan mayor número de patologías de media 3,76; habitan en domicilio particular, si bien en conjunto presentan más institucionalización que los controles; el 50% no tiene identificado el Cuidador Principal; es mayor el número de visitas de las enfermeras a los pacientes que viven en residencias (p < 0,001). El 50% de casos no tiene plan de cuidados, con relación significativa (p < 0,001). No existen diferencias significativas en tiempo de vida entre los casos y los controles. CONCLUSIÓN: la visita domiciliaria del profesional en enfermería no repercute en la morbimortalidad; visita a los pacientes cuando ya ha aparecido el problema de salud, no hay datos de prevención. PMID:26312638
... Noncompetitive Supplements to Nursing Assistant and Home Health Aide Program Grantees AGENCY: Health Resources... expansion supplements of $100,000 to 10 Nursing Assistant and Home Health Aide (NAHHA) Program grantees to... Management; Care Coordination and Follow Up; and Behavioral Health and Social Support for Home Health Aides...
... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in... Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home...
Lukachko, A.; Grin, A.; Bergey, D.
The Wyandotte NSP2 project aims to build 20 new houses and retrofit 20 existing houses in Wyandotte, MI. This report will detail the retrofit of 2 existing houses in the program. Wyandotte is part of a Michigan State Housing Development Authority-led consortium that is funded by HUD under the NSP2 program. The City of Wyandotte has also been awarded DOE EE&CBG funds that are being used to develop a district GSHP system to service the project. This draft report examines the energy efficiency recommendations for retrofit construction at these homes. The report will be of interest to anyone planning an affordable, high performance retrofit of an existing home in a Cold Climate zone. Information from this report will also be useful to retrofit or weatherization program staff as some of the proposed retrofit solutions will apply to a wide range of projects. Preliminary results from the first complete house suggest that the technology package employed (which includes spray foam insulation and insulating sheathing) does meet the specific whole house water, air, and thermal control requirements, as well as, the project's affordability goals. Monitoring of the GSHP system has been recommended and analysis of this information is not yet available.
Lukachko, A. [Building Science Corporation (BSC), Somerville, MA (United States); Grin, A. [Building Science Corporation (BSC), Somerville, MA (United States); Bergey, D. [Building Science Corporation (BSC), Somerville, MA (United States)
The Wyandotte NSP2 project aims to build 20 new houses and retrofit 20 existing houses in Wyandotte, MI. Wyandotte is part of a Michigan State Housing Development Authority-led consortium that is funded by HUD under the NSP2 program. The City of Wyandotte has also been awarded DOE EE&CBG funds that are being used to develop a district ground source heat pump (GSHP) system to service the project. This report details the retrofit of two existing houses in the program, and examines the energy efficiency recommendations for the homes. The report will be of interest to anyone planning an affordable, high performance retrofit of an existing home in a cold climate zone. Information from this report will also be useful to retrofit or weatherization program staff as some of the proposed retrofit solutions will apply to a wide range of projects. Preliminary results from the first complete house suggest that the technology package employed (which includes spray foam insulation and insulating sheathing) does meet the specific whole house water, air, and thermal control requirements, as well as, the project’s affordability goals. Monitoring of the GSHP system has been recommended and analysis of this information is not yet available.
Ajjarapu, Aparna Sai; Broderick, Ann
An estimated 1.5 billion people across the globe live with chronic pain, and an estimated 61 million people worldwide experience unrelieved serious health-related suffering. One-sixth of the global population lives in India, where approximately 10 million people endure unrelieved serious health-related suffering. The state of Kerala is home to Pallium India, one of the most sophisticated palliative care programs in the country. This private organization in Trivandrum provides palliative and hospice care to underresourced populations and emphasizes holistic pain treatment. The current project features the pain stories of six patients who received treatment from Pallium India. Basic patient demographic information was collected, and a Pallium India staff member who was fluent in Malayalam and English asked questions about each patient's pain experience. Pain narratives illustrate the substantial impact of Pallium India's home visit program and the role of total pain assessment in delivering high-quality palliative care.
Nair, Nirmala; Tripathy, Prasanta; Sachdev, Harshpal S; Bhattacharyya, Sanghita; Gope, Rajkumar; Gagrai, Sumitra; Rath, Shibanand; Rath, Suchitra; Sinha, Rajesh; Roy, Swati Sarbani; Shewale, Suhas; Singh, Vijay; Srivastava, Aradhana; Pradhan, Hemanta; Costello, Anthony; Copas, Andrew; Skordis-Worrall, Jolene; Haghparast-Bidgoli, Hassan; Saville, Naomi; Prost, Audrey
Child stunting (low height-for-age) is a marker of chronic undernutrition and predicts children's subsequent physical and cognitive development. Around one third of the world's stunted children live in India. Our study aims to assess the impact, cost-effectiveness, and scalability of a community intervention with a government-proposed community-based worker to improve growth in children under two in rural India. The study is a cluster randomised controlled trial in two rural districts of Jharkhand and Odisha (eastern India). The intervention tested involves a community-based worker carrying out two activities: (a) one home visit to all pregnant women in the third trimester, followed by subsequent monthly home visits to all infants aged 0-24 months to support appropriate feeding, infection control, and care-giving; (b) a monthly women's group meeting using participatory learning and action to catalyse individual and community action for maternal and child health and nutrition. Both intervention and control clusters also receive an intervention to strengthen Village Health Sanitation and Nutrition Committees. The unit of randomisation is a purposively selected cluster of approximately 1000 population. A total of 120 geographical clusters covering an estimated population of 121,531 were randomised to two trial arms: 60 clusters in the intervention arm receive home visits, group meetings, and support to Village Health Sanitation and Nutrition Committees; 60 clusters in the control arm receive support to Committees only. The study participants are pregnant women identified in the third trimester of pregnancy and their children (n = 2520). Mothers and their children are followed up at seven time points: during pregnancy, within 72 hours of delivery, and at 3, 6, 9, 12 and 18 months after birth. The trial's primary outcome is children's mean length-for-age Z scores at 18 months. Secondary outcomes include wasting and underweight at all time points, birth weight, growth
Mangwi Ayiasi, Richard; Kolsteren, Patrick; Batwala, Vincent; Criel, Bart; Orach, Christopher Garimoi
Introduction The World Health Organisation recommends home visits conducted by Community Health Workers (in Uganda known as Village Health Teams—VHTs) in order to improve maternal and newborn health. This study measured the effect of home visits combined with mobile phone consultations on maternal and newborn care practices. Method In a community intervention trial design 16 health centres in Masindi and Kiryandongo districts, Uganda were randomly and equally allocated to one of two arms: control and intervention arms. Eight control health centres received the usual maternal and newborn educational messages offered by professional health workers and eight intervention health centres that received an intervention package for maternal care and essential newborn care practices. In the intervention arm VHTs made two prenatal and one postnatal home visit to households. VHTs were provided with mobile phones to enable them make regular telephone consultations with health workers at the health centre serving the catchment area. The primary outcome was health facility delivery. Other outcomes included antenatal attendances, birth preparedness, cord and thermal care and breastfeeding practices. Analysis was by intention-to-treat. Results A total of 1385 pregnant women were analysed: 758 and 627 in the control and intervention arms respectively. Significant post-intervention differences were: delivery place [adjusted Odds Ratio aOR: 17.94(95%CI: 6.26–51.37); pcare [aOR: 3.05(95%CI: 1.81–5.12); pcare [aOR: 7.58(95%CI: 2.52–22.82); pcare-seeking for newborn illness [aOR: 4.93(95%CI: 1.59–15.31); p = 0.006]. Conclusion VHTs can have an effect in promoting proper cord and thermal care for the newborn and improve timely care-seeking for health facility delivery and newborn illness, because they could answer questions and refer patients correctly. However, VHTs should be supported by professional health workers through the use of mobile phones. Trial Registration Clinical
Richard Mangwi Ayiasi
Full Text Available The World Health Organisation recommends home visits conducted by Community Health Workers (in Uganda known as Village Health Teams--VHTs in order to improve maternal and newborn health. This study measured the effect of home visits combined with mobile phone consultations on maternal and newborn care practices.In a community intervention trial design 16 health centres in Masindi and Kiryandongo districts, Uganda were randomly and equally allocated to one of two arms: control and intervention arms. Eight control health centres received the usual maternal and newborn educational messages offered by professional health workers and eight intervention health centres that received an intervention package for maternal care and essential newborn care practices. In the intervention arm VHTs made two prenatal and one postnatal home visit to households. VHTs were provided with mobile phones to enable them make regular telephone consultations with health workers at the health centre serving the catchment area. The primary outcome was health facility delivery. Other outcomes included antenatal attendances, birth preparedness, cord and thermal care and breastfeeding practices. Analysis was by intention-to-treat.A total of 1385 pregnant women were analysed: 758 and 627 in the control and intervention arms respectively. Significant post-intervention differences were: delivery place [adjusted Odds Ratio aOR: 17.94(95%CI: 6.26-51.37; p<0.001], cord care [aOR: 3.05(95%CI: 1.81-5.12; p<0.001] thermal care [aOR: 7.58(95%CI: 2.52-22.82; p<0.001], and timely care-seeking for newborn illness [aOR: 4.93(95%CI: 1.59-15.31; p = 0.006].VHTs can have an effect in promoting proper cord and thermal care for the newborn and improve timely care-seeking for health facility delivery and newborn illness, because they could answer questions and refer patients correctly. However, VHTs should be supported by professional health workers through the use of mobile phones
Described is a home reading program for educationally disadvantaged elementary school children who need motivation to read at home. Principles of behavior change and parent role are the major motivation factors used in developing the children's reading ability. (CB)
Belzer, D.; Mosey, G.; Plympton, P.; Dagher, L.
Home Performance with ENERGY STAR (HPwES) is a jointly managed program of the U.S. Department of Energy (DOE) and the U.S. Environmental Protection Agency (EPA). This program focuses on improving energy efficiency in existing homes via a whole-house approach to assessing and improving a home's energy performance, and helping to protect the environment. As one of HPwES's local sponsors, Austin Energy's HPwES program offers a complete home energy analysis and a list of recommendations for efficiency improvements, along with cost estimates. To determine the benefits of this program, the National Renewable Energy Laboratory (NREL) collaborated with the Pacific Northwest National Laboratory (PNNL) to conduct a statistical analysis using energy consumption data of HPwES homes provided by Austin Energy. This report provides preliminary estimates of average savings per home from the HPwES Loan Program for the period 1998 through 2006. The results from this preliminary analysis suggest that the HPwES program sponsored by Austin Energy had a very significant impact on reducing average cooling electricity for participating households. Overall, average savings were in the range of 25%-35%, and appear to be robust under various criteria for the number of households included in the analysis.
White, Lesley; Klinner, Christiane; Carter, Stephen
The Australian Home Medicines Review (HMR) is a free consumer service to assist individuals living at home to maximize the benefits of their medicine regimen and prevent medication-related problems. It consists of a pharmacist reviewing a person's medicines and collaborating with the general practitioner to optimize the individual's medicine management. The uptake of this service has remained below the projected use, although the program has shown to successfully identify medication-related problems and improve drug knowledge and adherence of the patient. This study investigates the perceived benefits and barriers of the patients regarding the HMR service who have used the service and who are eligible for it but have never used it. Consumer perceptions were drawn from 14 semistructured focus groups, with patients and carers belonging to the general HMR target population and consumer segments that have been postulated to be underrepresented with regard to this service. The major benefits reported were acquisition of medicine information, reassurance, feeling valued and cared for, and willingness to advocate medication changes to the general practitioner. Perceived barriers were concerns regarding upsetting the general practitioner, pride and independence, confidence issues with an unknown pharmacist, privacy and safety concerns regarding the home visit, and lack of information about the program. Participants agreed that the potential benefits of the service outweighed its potential barriers. It is expected that direct-to-consumer promotion of HMRs would increase the uptake of this valuable service. It would be necessary to ensure that the process and benefits of the service are communicated clearly and sensitively to eligible patients and their carers to obviate common consumer misconceptions and/or barriers regarding the HMR service. Furthermore, any direct-to-consumer promotion of the service must enable patient/carer self-identification of eligibility. Copyright
Glintborg, Bente; Hillestrøm, Peter René; Olsen, Lenette Holm
were compared to the patients' self-reported medication history. Information on prescribed drugs dispensed from any Danish pharmacy was collected from nationwide real-time pharmacy records. The authors performed home visits in a subgroup of 115 patients 4 weeks after their discharge. Stored drugs were......The medication history among hospitalized patients often relies on patients' self-reports due to insufficient communication between health care professionals. The aim of the present study was to estimate the reliability of patients' self-reported medication use. Five hundred patients admitted...... to an acute medical department at a Danish university hospital were interviewed on the day of admission about their recent medication use. Blood samples drawn immediately after admission were screened for contents of 5 drugs (digoxin, bendroflumethiazide, amlodipine, simvastatin, glimepiride), and the results...
Full Text Available Primary care providers are critical in providing and optimizing health care to an aging population. This paper describes the volunteer component of a program (Health TAPESTRY which aims to encourage the delivery of effective primary health care in novel and proactive ways. As part of the program, volunteers visited older adults in their homes and entered information regarding health risks, needs, and goals into an electronic application on a tablet computer. A total of 657 home visits were conducted by 98 volunteers, with 22.45% of volunteers completing at least 20 home visits over the course of the program. Information was summarized in a report and electronically sent to the health care team via clients’ electronic medical records. The report was reviewed by the interprofessional team who then plan ongoing care. Volunteer recruitment, screening, training, retention, and roles are described. This paper highlights the potential role of a volunteer in a unique connection between primary care providers and older adult patients in their homes.
Birckmayer, Jennifer; And Others
Group leaders of 10- to 13-year-olds may use this program guide to help the preteens interact with young children through six discussion meetings and five visits with a preschool child at home. Discussion topics concern (1) the family environment of young children, (2) children's play; (3) children's play areas at home, (4) safety at home, (5)…
... INSURANCE BENEFITS Home Health Services Under Hospital Insurance § 409.48 Visits. (a) Number of allowable... home health visits. All Medicare home health services are covered under hospital insurance unless there... 42 Public Health 2 2010-10-01 2010-10-01 false Visits. 409.48 Section 409.48 Public Health CENTERS...
Linton, Julie M; Stockton, Maria Paz; Andrade, Berta; Daniel, Stephanie
Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.
Hafskjold, Linda; Eide, Tom; Holmström, Inger K; Sundling, Vibeke; van Dulmen, Sandra; Eide, Hilde
Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons' worries and (2) the content of these expressions. An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. The two-step approach provides an in-depth knowledge of older persons' worries, causes of worries, and their related emotions. The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Hüning, B M; Reimann, M; Sahlmen, S; Leibold, S; Nabring, J C; Felderhoff-Müser, U
Marked progress in neonatology changed care of very preterm infants (VLBW) over the last decades - but also the attitude towards family-centred care (FCC). With the directive of the German Federal Joined Committee (G-BA), politicians recognize the necessity of neonatal FCC. To evaluate time and personnel costs necessary at a centre of established FCC. Elternberatung "Frühstart" is a FCC programme for VLBW and seriously ill neonates from preganancy at risk to follow-up home-visits delivered by one interdisciplinary team. Analysis (2011-2014): 1.) Number of cases /participation in programme, 2.) resources of time, 3) and personnel, 4.) funding, 5) economic impact. 1.1.2011-31.12.2014: 441 cases (total cases: 2 212) participated in the programme. Participation of VLBW: mean 92% (86.4-97,2%). Costs of time are highest in neonates with congenital malformations: median 13.8 h, VLBW: median 11,2 h. Transition to home is most time intensive: median 7,3 (0-42.5) h. In average of 3.1 full-time nurses (part-time workers) are able to counsel 48 families/quarter. In severe cases funding is partly provided by health care insurances for social medical aftercare: positive applications: mean 92.7% (79.6-97.7%). Participation in the FCC programme in neonatology is high and costs of time are manageable. © Georg Thieme Verlag KG Stuttgart · New York.
Shah, Nikhil; Reintjes, Frances; Courtney, Mark; Klarenbach, Scott W; Ye, Feng; Schick-Makaroff, Kara; Jindal, Kailash; Pauly, Robert P
Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P =0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P <0.01). In the 6 months before exit, the negative disposition group had significantly more in-center respite dialysis sessions, had more and longer hospitalizations, and required more on-call care team support in terms of phone calls and drop-in visits (each P <0.05). The most common reason for modality conversion was medical instability in 15 of 23 (65%) followed by caregiver or care partner burnout in three of 23 (13%) each. The 90-day mortality among patients undergoing modality conversion was 26%. Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization ( e.g. , hospitalization, respite treatments, nursing time, etc. ). Copyright © 2017 by the American Society of Nephrology.
Murphy, Mary; Smith, Lucia; Palma, Anton; Lounsbury, David; Bijur, Polly; Chambers, Paul; Gallagher, E John
Injuries from motor vehicle crashes are a significant public health problem. The emergency department (ED) provides a setting that may be used to screen for behaviors that increase risk for motor vehicle crashes and provide brief interventions to people who might otherwise not have access to screening and intervention. The purpose of the present study was to (1) assess the feasibility of using a computer-assisted screening program to educate ED patients about risky driving behaviors, (2) evaluate patient acceptance of the computer-based traffic safety educational intervention during an ED visit, and (3) assess postintervention changes in risky driving behaviors. Pre/posteducational intervention involving medically stable adult ED patients in a large urban academic ED serving over 100,000 patients annually. Patients completed a self-administered, computer-based program that queried patients on risky driving behaviors (texting, talking, and other forms of distracted driving) and alcohol use. The computer provided patients with educational information on the dangers of these behaviors and data were collected on patient satisfaction with the program. Staff called patients 1 month post-ED visit for a repeat query. One hundred forty-nine patients participated, and 111 completed 1-month follow up (75%); the mean age was 39 (range: 21-70), 59 percent were Hispanic, and 52 percent were male. Ninety-seven percent of patients reported that the program was easy to use and that they were comfortable receiving this education via computer during their ED visit. All driving behaviors significantly decreased in comparison to baseline with the following reductions reported: talking on the phone, 30 percent; aggressive driving, 30 percent; texting while driving, 19 percent; drowsy driving, 16 percent; driving while multitasking, 12 percent; and drinking and driving, 9 percent. Overall, patients were very satisfied receiving educational information about these behaviors via computer
The Technical Report of the Research Reactor Institute, Kyoto University, is published as occasion demands, summarizing as prompt reports the date required for research and experiment, such as the results of the functional test on various experimental facilities, the results of the test on the things manufactured for trial, the state of radiation control and waste treatment, the reports of study meetings and so on, or the remarkable results and new methods obtained on the way of research, and the discussion on other papers and reports. In this report, 78 visiting research projects using the KUR and 10 visiting research projects using the KUCA in the second half of 1990 are summarized. Also 2 projects in the first half of 1990 are added. The adoption No., the kind of project, title, the names of researchers and their posts, and the gist of research are reported in each project. (K.I.)
Kitamura, Tatsuru; Shiota, Shigehito; Jinkawa, Shigetoshi; Kitamura, Maki; Hino, Shoryoku
During hospitalization for behavioural and psychological symptoms of dementia (BPSD), it is imperative to build a support system for each patient in the community for after they obtain symptom remission. To this end, patients lacking adequate family support are less likely to be discharged to their own homes and need stronger support systems to be established. This study therefore investigated the effects of home-visit nursing before admission on time to home discharge among patients with limited familial care who were hospitalized for treatment of BPSD. A single-centre chart review study was conducted on consecutive patients admitted from home between April 2013 and September 2015 for treatment of BPSD and who had lived alone or with a working family member. Time to home discharge was compared between patients who had home-visit nursing before their admission and those who did not. In total, 58 patients were enrolled in the study, of whom 12 had preceding home-visit nursing (PHN group) and 46 did not (non-PHN group). Patients in the PHN group were younger (77.7 ± 4.9 vs. 84.1 ± 6.1 years, P = 0.0011) and had higher Mini-Mental State Examination scores (16.8 ± 7.2 vs 11.8 ± 7.3, P = 0.0287). A multivariate Cox proportional hazard regression analysis adjusted for age and Mini-Mental State Examination scores showed a higher likelihood of discharge to home in the PHN group (hazard ratio: 3.85; 95% confidence interval: 1.27-11.6;, P = 0.017) than in the non-PHN group. Home-visit nursing before admission of BPSD patients for treatment could improve the rate of discharge to home among patients with limited familial care after subsequent hospitalization. Home-visit nursing could also enhance collaborative relationships between social and hospital-based care systems, and early implementation could improve the likelihood of vulnerable patient types remaining in their own homes for as long as possible. © 2018 Japanese Psychogeriatric
... reduce your overall relocation costs. You must not make a home marketing incentive payment that exceeds... our home marketing incentive payment program? 302-14.100 Section 302-14.100 Public Contracts and... 14-HOME MARKETING INCENTIVE PAYMENTS Agency Responsibilities § 302-14.100 How should we administer...
Quarles, Stephen, L.; Sindelar, Melissa
The primary goal of the Wildfire ignition resistant home design(WIRHD) program was to develop a home evaluation tool that could assess the ignition potential of a structure subjected to wildfire exposures. This report describes the tests that were conducted, summarizes the results, and discusses the implications of these results with regard to the vulnerabilities to homes and buildings.
Pigg, Scott [Energy Center of Wisconsin, Madison, WI (United States); Cautley, Dan [Energy Center of Wisconsin, Madison, WI (United States); Francisco, Paul [Univ. of Illinois, Urbana-Champaign, IL (United States); Hawkins, Beth A [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Brennan, Terry M [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)
This report summarizes findings from a national field study of indoor air quality parameters in homes treated under the Weatherization Assistance Program (WAP). The study involved testing and monitoring in 514 single-family homes (including mobile homes) located in 35 states and served by 88 local weatherization agencies.
Moor, C C; Wapenaar, M; Miedema, J R; Geelhoed, J J M; Chandoesing, P P; Wijsenbeek, M S
In idiopathic pulmonary fibrosis (IPF), home monitoring experiences are limited, not yet real-time available nor implemented in daily care. We evaluated feasibility and potential barriers of a new home monitoring program with real-time wireless home spirometry in IPF. Ten patients with IPF were asked to test this home monitoring program, including daily home spirometry, for four weeks. Measurements of home and hospital spirometry showed good agreement. All patients considered real-time wireless spirometry useful and highly feasible. Both patients and researchers suggested relatively easy solutions for the identified potential barriers regarding real-time home monitoring in IPF.
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Elliott, Rohan A; Lee, Cik Yin; Beanland, Christine; Goeman, Dianne P; Petrie, Neil; Petrie, Barbara; Vise, Felicity; Gray, June
To develop a collaborative, person-centred model of clinical pharmacy support for community nurses and their medication management clients. Co-creation and participatory action research, based on reflection, data collection, interaction and feedback from participants and other stakeholders. A large, non-profit home nursing service in Melbourne, Australia. Older people referred to the home nursing service for medication management, their carers, community nurses, general practitioners (GPs) and pharmacists, a multidisciplinary stakeholder reference group (including consumer representation) and the project team. Feedback and reflections from minutes, notes and transcripts from: project team meetings, clinical pharmacists' reflective diaries and interviews, meetings with community nurses, reference group meetings and interviews and focus groups with 27 older people, 18 carers, 53 nurses, 15 GPs and seven community pharmacists. The model was based on best practice medication management standards and designed to address key medication management issues raised by stakeholders. Pharmacist roles included direct client care and indirect care. Direct care included home visits, medication reconciliation, medication review, medication regimen simplification, preparation of medication lists for clients and nurses, liaison and information sharing with prescribers and pharmacies and patient/carer education. Indirect care included providing medicines information and education for nurses and assisting with review and implementation of organisational medication policies and procedures. The model allowed nurses to refer directly to the pharmacist, enabling timely resolution of medication issues. Direct care was provided to 84 older people over a 15-month implementation period. Ongoing feedback and consultation, in line with participatory action research principles, informed the development and refinement of the model and identification of enablers and challenges. A collaborative
Nakaishi, Lindsay; Moss, Helen; Weinstein, Marc; Perrin, Nancy; Rose, Linda; Anger, W Kent; Hanson, Ginger C; Christian, Mervyn; Glass, Nancy
Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed. Copyright 2013, SLACK Incorporated.
Poff, Renee McCoy; Browning, Sarah Via
Creating a meaningful infection control program in the home care setting proved to be challenging for agency leaders of one hospital-based home healthcare agency. Challenges arose when agency leaders provided infection control (IC) data to the hospital's IC Committee. The IC Section Chief asked for national benchmark comparisons to align home healthcare reporting to that of the hospital level. At that point, it was evident that the home healthcare IC program lacked definition and structure. The purpose of this article is to share how one agency built a meaningful IC program.
Sier, M. F.; Oostenbroek, R. J.; Dijkgraaf, M. G. W.; Veldink, G. J.; Bemelman, W. A.; Pronk, A.; Spillenaar-Bilgen, E. J.; Kelder, W.; Hoff, C.; Ubbink, D. T.; Havenga, K.; Veltkamp, S. C.; T Dekker, J. W.; Boerma, D.; Eijsbouts, Q. A. J.; Lamme, B.; Vuylsteke, R. J. C. L. M.; Tobon Morales, R. E.; van Tets, W. F.
Aim Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable
... [CMS-1510-CN] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification... effective as if they had been included in the Medicare Program; Home Health Prospective Payment System Rate...
Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.
This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.
Berry, Alessandra; Borgi, Marta; Terranova, Livia; Chiarotti, Flavia; Alleva, Enrico; Cirulli, Francesca
An ever increasing interest in the therapeutic aspects of the human-animal bond has led to a proliferation of animal-assisted interventions (AAI) involving dogs. However, most of these programs lack a solid methodological structure, and basic evaluative research is needed. The purpose of this study was to test the value of dog-assisted interventions as an innovative tool to increase quality of life in the geriatric population. Nineteen patients (men and women) with a mean age of 85 years participated in the study. Interactions between patients and visiting dogs occurred either in a social situation (socialization sessions) or in a therapeutic context (physical therapy sessions). We derived and characterized a specific ethogram of elderly-dog interactions aimed at evaluating the effectiveness of visiting dogs in improving mood, catalyzing social interactions and reducing their everyday apathetic state. Cortisol levels were also measured in the saliva, and depressive state was evaluated. Overall, results show a time-dependent increase in social behaviour and spontaneous interactions with the dogs. Dog-mediated interactions affected the daily increase in cortisol levels, thus having an 'activational effect', in contrast to the apathetic state of institutionalized elderly. Dog-mediated intervention programs appear to be promising tools to improve the social skills and enrich the daily activities of the institutionalized elderly. © 2012 The Authors. Psychogeriatrics © 2012 Japanese Psychogeriatric Society.
Experiment areas, offices, workshops: it is possible to have co-workers or friends visit these places. You already know about the official visits service, the VIP office, and professional visits. But do you know about the safety instruction GSI-OHS1, “Visits on the CERN site”? This is a mandatory General Safety Instruction that was created to assist you in ensuring safety for all your visits, whatever their nature—especially those that are non-official. Questions? The HSE Unit will be happy to answer them. Write to email@example.com. The HSE Unit
From left to right: Frank Schmidt (AB), Jukka Klem (Helsinki Institute of Physics), Andreas Wagner (IT), Eric McIntosh (IT) and Ben Segal (IT). The program of LHC@home, which aims to use the computing power of PCs when the screen saver is activated, is being relauched as part of the World Year of Physics.
Nair, Nirmala; Tripathy, Prasanta; Sachdev, H S; Pradhan, Hemanta; Bhattacharyya, Sanghita; Gope, Rajkumar; Gagrai, Sumitra; Rath, Shibanand; Rath, Suchitra; Sinha, Rajesh; Roy, Swati Sarbani; Shewale, Suhas; Singh, Vijay; Srivastava, Aradhana; Costello, Anthony; Copas, Andrew; Skordis-Worrall, Jolene; Haghparast-Bidgoli, Hassan; Saville, Naomi; Prost, Audrey
Around 30% of the world's stunted children live in India. The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts. We aimed to find out the effect of such a worker carrying out home visits and participatory group meetings on children's linear growth. We did a cluster-randomised controlled trial in two adjoining districts of Jharkhand and Odisha, India. 120 clusters (around 1000 people each) were randomly allocated to intervention or control using a lottery. Randomisation took place in July, 2013, and was stratified by district and number of hamlets per cluster (0, 1-2, or ≥3), resulting in six strata. In each intervention cluster, a worker carried out one home visit in the third trimester of pregnancy, monthly visits to children younger than 2 years to support feeding, hygiene, care, and stimulation, as well as monthly women's group meetings to promote individual and community action for nutrition. Participants were pregnant women identified and recruited in the study clusters and their children. We excluded stillbirths and neonatal deaths, infants whose mothers died, those with congenital abnormalities, multiple births, and mother and infant pairs who migrated out of the study area permanently during the trial period. Data collectors visited each woman in pregnancy, within 72 h of her baby's birth, and at 3, 6, 9, 12, and 18 months after birth. The primary outcome was children's length-for-age Z score at 18 months of age. Analyses were by intention to treat. Due to the nature of the intervention, participants and the intervention team were not masked to allocation. Data collectors and the data manager were masked to allocation. The trial is registered as ISCRTN (51505201) and with the Clinical Trials Registry of India (number 2014/06/004664). Between Oct 1, 2013, and Dec 31, 2015, we recruited 5781 pregnant women. 3001 infants were born to pregnant women recruited between Oct 1, 2013, and Feb 10, 2015
Baddeley, Gwen; Evans, Laura; Lajeunesse, Marilyn; Legari, Stephen
"Sharing the Douglas/Sharing the Museum," a collaboration program of the Montreal Museum of Fine Arts (MMFA), the Douglas Mental Health Institute and the Department of Creative Arts Therapies at Concordia University, serves patients from the Eating Disorder Unit of the Douglas. Participants eat lunch at the museum and look at, talk…
Lankshear, Sara; Huckstep, Sherri; Lefebre, Nancy; Leiterman, Janis; Simon, Deborah
Home healthcare nurses often work in isolation and rarely have the opportunity to meet or congregate in one location. As a result, nurse leaders must possess unique leadership skills to supervise and manage a dispersed employee base from a distance. The nature of this dispersed workforce creates an additional challenge in the ability to identify future leaders, facilitate leadership capacity, and enhance skill development to prepare them for future leadership positions. The ALIVE (Actively Leading In Virtual Environments) web-based program was developed to meet the needs of leaders working in virtual environments such as the home healthcare sector. The program, developed through a partnership of three home healthcare agencies, used nursing leaders as content experts to guide program development and as participants in the pilot. Evaluation findings include the identification of key competencies for nursing leaders in the home healthcare sector, development of program learning objectives and participant feedback regarding program content and delivery.
Smego, Raymond A; Khan, Mohammad Aslam; Khowaja, Khurshid; Rafique, Rozina; Datoo, Farida
This article describes a university-sponsored home health nursing program in a large urban center in Pakistan and details the essential elements needed in implementing such a program in a developing country. Compared to in-hospital treatment, home healthcare reduced hospital stay from 12.8 days to 3.9 days, and resulted in a net savings of Pakistani rupees (PRs) 5,374,135 (USD 89,569). A cost-effective home treatment program in a resource-limited country can be successfully implemented by using the hospital pharmacy as the central point for the preparation and distribution of medications and specialty nursing services.
CERN Internal Communication is organising a visit to ISOLDE – an opportunity for you to see the CERN set-up that can produce over 1000 different isotopes! If you wish to participate, you can sign up for a visit by sending us an e-mail. Note that the visits will take place between 18 and 22 February, and will be open only to CERN access-card holders. The visit will include an introduction by experts and a tour of the ISOLDE set-up. NB: For security reason, pregnant women and kids under the age of 16 can not take the tour.
... (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request AGENCY.... DeBakey Home Care Program. DATES: Written comments and recommendations on the proposed collection of...: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number...
... (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request AGENCY... Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number: 2900-0775. Type... home care program staff. An agency may not conduct or sponsor, and a person is not required to respond...
Donoso Brown, Elena V; Fichter, Renae
Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented. The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used. An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors. A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients' goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program. Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders' perspectives on home programs and determine effective strategies for ensuring adherence is needed.
The technical reports of KURRI are published at any time summarizing in the form of interim report the data required for research and experiment, such as the results of various functional tests of experimental devices, the test results of the things made for trial, the state of radiation control and waste treatment and the reports of study meetings, or the remarkable results obtained during research, new techniques, the discussion on other papers and reports and so on. In this report, the summaries of 90 researches carried out under the visiting research program in the first half of 1984 are collected. The subject number, title, reporters and the gist of each research are reported. (Kako, I.)
Wang, Limin; Bandyopadhyay, Sushenjit; Cosgrove-Davies, Mac; Samad, Hussain
Scaling-up adoption of renewable energy technology, such as solar home systems, to expand electricity access in developing countries can accelerate the transition to low-carbon economic development. Using a purposely collected national household survey, this study quantifies the carbon and distributional benefits of solar home system programs in Bangladesh. Three key findings are generated...
Sood, Divya; Szymanski, Monika; Schranz, Caren
This study discusses the impact of the Enriched Home Environment Program (EHEP) on participation in home activities among two children with ASD using case study methodology. EHEP involves occupational therapists to collaborate with families of children with ASD to educate them about the impact of factors that influence child's participation within…
Cheung, Chau-kiu; Ngan, Raymond Man-hung
Objective: Despite past findings about the contribution of home care services to older users' functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care program. Method: The study gathered 116 observations during 2 years…
Gfellner, Barbara M.; McLaren, Lorraine; Metcalfe, Arron
This article is a 20-year evaluation of the Parent-Child Home Program (PCHP) of Child and Family Services in Western Manitoba. Following Levenstein's (1979, 1988) approach, home visitors model parent-child interchanges using books and toys to enhance children's cognitive development through appropriate parenting behaviors. The evaluation provides…
... Prospective Payment System Rate Update for Calendar Year 2012; Final Rule #0;#0;Federal Register / Vol. 76, No... 0938-AQ30 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012... sets forth updates to the home health prospective payment system (HH PPS) rates, including: the...
... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The... the Medicare prospective payment system for HHAs. This correcting amendment corrects a technical error...
Boongird, Chitima; Keesukphan, Prasit; Phiphadthakusolkul, Soontraporn; Rattanasiri, Sasivimol; Thakkinstian, Ammarin
To investigate the effects of a simple home-based exercise program on falls, physical functioning, fear of falling and quality of life in a primary care setting. Participants (n = 439), aged ≥65 years with mild-to-moderate balance dysfunction were randomly assigned to an exercise (n = 219) or control (n = 220) group. The program consisted of five combined exercises, which progressed in difficulty, and a walking plan. Controls received fall prevention education. Physical functioning and other outcomes were measured at 3- and 6-month follow-up visits. Falls were monitored with fall diaries and phone interviews at 3, 6, 9, and 12 months respectively. The 12 months of the home-based exercise program showed the incidence of falls was 0.30 falls per person year in the exercise group, compared with 0.40 in the control group. The estimated incidence rate ratio was 0.75 (95% CI 0.55-1.04), which was not statistically significant. The fear of falling (measured by the Thai fall efficacy scale) was significantly lower in the exercise than control group (24.7 vs 27.0, P = 0.003). Also, the trend of program adherence increased in the exercise group. (29.6% to 56.8%). This simple home-based exercise program showed a reduction in fear of falling and a positive trend towards exercise adherence. Further studies should focus on factors associated with exercise adherence, the benefits of increased home visits and should follow participants longer in order to evaluate the effects of the program. Geriatr Gerontol Int 2017; 17: 2157-2163. © 2017 Japan Geriatrics Society.
Gunnarsdottir, Johanna; Bjornsdottir, Thorbjörg Edda; Halldorsson, Thorhallur Ingi; Halldorsdottir, Gudrun; Geirsson, Reynir Tomas
To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay. A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 - 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index. Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤ 25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge. Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.
Key words: Intensive home based program, health services, admission, outpatient, inpatient, aged care. Received: ... vate agencies were sometimes also used and funded by APS or more .... result of other structural changes in the system.
...) are the co-Principal Investigators for the Partnership for Asthma Trigger-Free Homes. The PATH study's goal is reducing the asthma disease burden on low-income housing residents by means of a peer-based education program...
Polak, Rani; Pober, David M; Budd, Maggi A; Silver, Julie K; Phillips, Edward M; Abrahamson, Martin J
This case series describes and examines the outcomes of a remote culinary coaching program aimed at improving nutrition through home cooking. Participants (n = 4) improved attitudes about the perceived ease of home cooking (p culinary skills (p = 0.02); and also improved in confidence to continue online learning of culinary skills and consume healthier food. We believe this program might be a viable response to the need for effective and scalable health-related culinary interventions.
Helewa, M; Heaman, M; Robinson, M A; Thompson, L
OBJECTIVE: To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia. DESIGN: A descriptive study of outcomes between Apr. 1, 1985, and Dec. 31, 1989. SETTING: St. Boniface General Hospital, Winnipeg. PATIENTS: Urban Winnipeg residents between 27 and 40 weeks' gestation with mild pre-eclampsia who demonstrated acceptance and compliance with home-care management; 321 patients of 1330 were enrolled in the program. INTERVENTION...
Andrew B Ross
Full Text Available BACKGROUND: In June of 2010, an antenatal ultrasound program to perform basic screening for high-risk pregnancies was introduced at a community health care center in rural Uganda. Whether the addition of ultrasound scanning to antenatal visits at the health center would encourage or discourage potential patients was unknown. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics. METHODS AND FINDINGS: Records at Nawanyago clinic were reviewed to obtain the number of antenatal visits and deliveries for the 42 months preceding the introduction of ultrasound and the 23 months following. The monthly mean deliveries and antenatal visits by category (first visit through fourth return visit were compared pre- and post- ultrasound using a Kruskal-Wallis one-way ANOVA. Following the introduction of ultrasound, significant increases were seen in the number of mean monthly deliveries and antenatal visits. The mean number of monthly deliveries at the clinic increased by 17.0 (13.3-20.6, 95% CI from a pre-ultrasound average of 28.4 to a post-ultrasound monthly average of 45.4. The number of deliveries at a comparison clinic remained flat over this same time period. The monthly mean number of antenatal visits increased by 97.4 (83.3-111.5, 95% CI from a baseline monthly average of 133.5 to a post-ultrasound monthly mean of 231.0, with increases seen in all categories of antenatal visits. CONCLUSIONS: The availability of a low-cost antenatal ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods.
Araújo, Roque da Silva; Arcuri, Edna Apparecida Moura; Lopes, Victor Cauê
to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%). verificar causas de inatividade no Programa Remédio em Casa, referidas por usuários de Unidade Básica de Saúde de São Paulo, comparando-as às registradas pelo programa e analisando-as no modelo teórico Conceito de Acesso à Saúde. estudo transversal entrevistando 111 usuários inativos; e documental, nos registros do programa. metade dos usuários desconhecia a condição de inatividade. Constatadas discrepâncias nas informações usuário versus programa, observando-se diferentes níveis de concordância: Falta de médico e funcion
intersect as Attack Wing leaders change roles The 112th COS postured as cyber shield for Pa. infrastructure 111th Attack Wing 111th Attack Wing 21st Century Guard Airmen Home News Photos Art Video Resources - The Balance Search 111th Attack Wing: COMMUNITY/ENVIRO May 16, 2018; Pa. Department of Health update
California State Univ., Sacramento. Dept. of Civil Engineering.
This manual was prepared by experienced wastewater treatment plant operators to provide a home study course to develop new qualified workers and expand the abilities of existing workers. The objective of this manual is to provide the knowledge and skills necessary for certification. Participants learn the basic operational aspects of treatment…
The visit itinerary includes five area of halls 191 and 180:. End-Cap Toroid Integration Area . Barrel Toroid Integration Area . Cryogenic Test Facility for Toroid Magnets and Helium Pumps . Liquid Argon Cryostats Assembly Area . Central Solenoid Magnet Test Station
... Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request... determine patients' satisfaction with services provided by or through the Michael E. DeBakey Home Care...: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number...
... Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request... satisfaction with the quality of services/care provided by home care program staff. An agency may not conduct... Form 10-0476).'' SUPPLEMENTARY INFORMATION: Title: Patient Satisfaction Survey Michael E. DeBakey Home...
A pilot study to evaluate the efficacy of adding a structured home visiting intervention to improve outcomes for high-risk families attending the Incredible Years Parent Programme: study protocol for a randomised controlled trial.
Lees, Dianne G; Fergusson, David M; Frampton, Christopher M; Merry, Sally N
Antisocial behaviour and adult criminality often have their origins in childhood and are best addressed early in the child's life using evidence-based treatments such as the 'Incredible Years Parent Programme'. However, families with additional risk factors who are at highest risk for poor outcomes do not always make sufficient change while attending such programmes. Additional support to address barriers and improve implementation of positive parenting strategies while these families attend the Incredible Years Programme may improve overall outcomes.The study aims to evaluate the efficacy of adding a structured home visiting intervention (Home Parent Support) to improve outcomes in families most at risk of poor treatment response from the Incredible Years intervention. This study will inform the design of a larger prospective randomised controlled trial. A pilot single-blind, parallel, superiority, randomised controlled trial. Randomisation will be undertaken using a computer-generated sequence in a 1:1 ratio to the two treatments arranged in permuted blocks with stratification by age, sex, and ethnicity. One hundred and twenty six participants enrolled in the Incredible Years Parent Programme who meet the high-risk criteria will be randomly allocated to receive either Incredible Years Parent Programme and Home Parent Support, or the Incredible Years Parent Programme alone. The Home Parent Support is a 10-session structured home visiting intervention provided by a trained therapist, alongside the usual Incredible Years Parent Programme, to enhance the adoption of key parenting skills. The primary outcome is the change in child behaviour from baseline to post-intervention in parent reported Eyberg Child Behavior Inventory Problem Scale. This is the first formal evaluation of adding Home Parent Support alongside Incredible Years Parent Programme for families with risk factors who typically have poorer treatment outcomes. We anticipate that the intervention will help
nation. The model works at a granular level by constructing the mortality time series for 26 main disease groups, by gender and age groups. As we show...in the report, the granularity makes it possible to model events that selectively impact certain of the disease groups, gender or age groups. This...a Bell inequality by SU Parity Entangled Perelomov Coherent States of a bimodal quantum mechanical system. Second, I give a status update, including
Wood, Siri; Foster, Jennifer; Kols, Adrienne
In many settings in Africa, social marketing has proven more successful in generating brand recognition for chlorine water treatment products than in promoting their use. To promote household use of one such product in Malawi, WaterGuard, the Ministry of Health (MOH) and Population Services International (PSI) distributed free hygiene kits that included WaterGuard to pregnant women attending antenatal clinics in 2007. Follow-up surveys documented a sustained increase in WaterGuard use three years after the initial intervention. In 2010, PATH (www.path.org) conducted qualitative research on the factors motivating women to adopt, sustain, or discontinue use. To provide context, interviews were also conducted with their friends, relatives, and husbands. Interviews revealed that sustained use of WaterGuard does not necessarily imply consistent use. Most respondents reported switching back and forth between WaterGuard and stock chlorine distributed for free by the government, and many treated water seasonally rather than year-round. Qualitative findings suggest that two program strategies strongly influenced women's decisions to adopt, purchase, and continue using WaterGuard. First, positive, ongoing contacts with health care workers, especially during home visits, raised awareness of the need to treat water, encouraged trial use, and supported continuing use. Second, an extended free trial of the product overcame initial cost barriers and allowed women and their families to experience the health benefits of WaterGuard, appreciate its value and relevance to their lives, and get used to its taste. Social support-from like-minded relatives, friends, neighbors, health care workers, husbands, and children-was also a critical factor that promoted consistent, ongoing use of WaterGuard. The findings confirm the importance of interpersonal communication in prompting adoption of household water treatment and suggest that consumers assess the perceived value of a product, not
... Find physicians and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers). Find programs providing methadone for the treatment of opioid addiction (heroin or pain relievers). /locator/widget/220 SAMHSA ...
This presentation discusses the Building America Program. This presentation discusses the background and goals of the program. A few hot topic technologies are discussed. Outreach activities are discussed as well.
Maryam M. Almandil
Full Text Available Background: Compliance depends on the caregiver and the health care professional committing to the same objectives.Compliance with the prescribed physical therapy (PT home program is a significant contributor to treatment success. Methods: One hundred caregivers were invited to fill in a questionnaire after the explanation of the procedure, and signing the consent form. The questionnaire explored factors affecting compliance including nature of the exercise, physical and emotional stresses on the caregiver, and the role of PT in teaching and counseling the caregiver. Result: Ninety-one participants out of the 100 were committed to administering the exercises with their children. Despite this, there was a discrepancy in either the frequency of repeating the exercises per day or the content of the exercise program when compared with the exercise program prescribed by the therapist. Some of the primary reasons for these differences were the pain experienced by the child when exercising (71%, having other family commitments (57%, not having the time to administer the home program (37%, and lacking skills or equipment to administer the exercises (34%. Conclusion: Adherence to treatment is a complex act that requires an understanding of treatment approach, having the confidence in one’s skills to administer the unsupervised home program and the existence of a support system both in the hospital and at home that can provide aid when needed. It is the PT role to address all these issues when prescribing a home program to meet treatment objectives.
Lian Leng Low
Full Text Available Background: Organizing care into integrated practice units (IPUs around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU for a patient segment of functionally dependent patients with limited community ambulation. Methods: 1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge. Patients who rejected enrolment into THC-IPU received usual post-discharge care planned by their attending hospital physician, and formed the control group. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge. Results: We found a statistically significant reduction in 30-day readmissions and emergency department visits in patients on THC-IPU care compared to usual care, even after adjusting for confounders. Conclusion: Delivering transitional care to patients with functional dependence in the form of home visits and organized into an IPU reduced acute hospital utilization in this patient segment. Extending the program into the pre-hospital discharge phase to include discharge planning can have incremental effectiveness in reducing avoidable hospital readmissions.
In the Baltimore region, a successful housing mobility program is providing families living in very disadvantaged inner city communities with a new home and a chance for a new life. Minority voucher holders in the federal Housing Choice Voucher Program (formerly titled Section 8) have often been limited to living in "voucher submarkets"…
Mikitka, Kathleen Faith; Van Camp, Mary Lou
A study was done of higher education curricula with substantial enrollment by women (such as fashion merchandising and home economics) to examine the context and substance of the curricula, to identify infrastructures that have supported these programs, and to probe issues that face administrators, faculty and students engaged in such programs.…
Youssef, Enas Fawzy; Shanb, Alsayed Abd Elhameed
Aging is associated with a progressive decline in physical capabilities and a disturbance of both postural control and daily living activities. The aim of this study was to evaluate the effects of supervised versus home exercise programs on muscle strength, balance and functional activities in older participants. Forty older participants were equally assigned to a supervised exercise program (group-I) or a home exercise program (group-II). Each participant performed the exercise program for 35-45 minutes, two times per week for four months. Balance indices and isometric muscle strength were measured with the Biodex Balance System and Hand-Held Dynamometer. Functional activities were evaluated by the Berg Balance Scale (BBS) and the timed get-up-and-go test (TUG). The mean values of the Biodex balance indices and the BBS improved significantly after both the supervised and home exercise programs ( P training programs significantly increased balance performance. The supervised program was superior to the home program in restoring functional activities and isometric muscle strength in older participants.
THE PURPOSE OF THIS STUDY, WHICH IS A SUMMARY OF A DOCTORAL DISSERTATION, WAS TO DEVELOP A WORK ORIENTATION PROGRAM FOR HOME ECONOMICS-RELATED OCCUPATIONS IN CONNECTICUT. QUESTIONNAIRES WERE SENT TO 43 TEACHERS OF SUCH PROGRAMS IN THE UNITED STATES AND ALL RESPONDED, GIVING INFORMATION ABOUT THEIR OBJECTIVES, COURSES, TEACHERS' BACKGROUNDS,…
Komenda, Paul; Copland, Michael; Makwana, Jay; Djurdjev, Ogdjenka; Sood, Manish M; Levin, Adeera
Home extended hours hemodialysis improves some measurable biological and quality-of-life parameters over conventional renal replacement therapies in patients with end-stage renal disease. Published small studies evaluating costs have shown savings in terms of ongoing operating costs with this modality. However, all estimates need to include the total costs, including infrastructure, patient training, and maintenance; patient attrition by death, transplantation, technique failure; and the necessity of in-center dialysis. We describe a comprehensive funding model for a large centrally administered but locally delivered home hemodialysis program in British Columbia, Canada that covered 122 patients, of which 113 were still in the program at study end. The majority of patients performed home nocturnal hemodialysis in this 2-year retrospective study. All training periods, both in-center and in-home dialysis, medications, hospitalizations, and deaths were captured using our provincial renal database and vital statistics. Comparative data from the provincial database and pricing models were used for costing purposes. The total comprehensive costs per patient-incorporating startup, home, and in-center dialysis; medications; home remodeling; and consumables-was $59,179 for years 2004-2005 and $48,648 for 2005-2006. The home dialysis patients required multiple in-center dialysis runs, significantly contributing to the overall costs. Our study describes a valid, comprehensive funding model delineating reliable cost estimates of starting and maintaining a large home-based hemodialysis program. Consideration of hidden costs is important for administrators and planners to take into account when designing budgets for home hemodialysis.
On 11 December, President Stjepan Mesic of the Republic of Croatia visited CERN. He was welcomed by Director General, Robert Aymar, and the President of CERN Council, Maurice Bourquin. Afterwards he met, among others, the Directors of CERN and Croatian scientists working here. He finished his tour by visiting the underground cavern for the ATLAS experiment. The arrival at CERN of the President of the Republic of Croatia, Stjepan Mesic. In the first row, from left to right: Maurice Bourquin, President of CERN Council, Stjepan Mesic, President of the Republic of Croatia and Robert Aymar, Director General of CERN.
On 6 October, Professor Michal Kleiber, Polish Minister of Science and Chairman of the State Committee for Scientific Research, visited CERN and met both the current and designated Director General, Luciano Maiani and Robert Aymar. Professor Kleiber visited the CMS and ATLAS detector assembly halls, the underground cavern for ATLAS, and the LHC superconducting magnet string test hall. Michal Kleiber (left), Polish minister of science and Jan Krolikowski, scientist at Warsaw University and working for CMS, who shows the prototypes of the Muon Trigger board of CMS.
The European Commissioner for Science and Research, Janez PotoÄnik, (on the right) visited the CMS assembly hall accompanied by Jim Virdee, Deputy Spokesman of CMS (on the left), and Robert Aymar, Director-General of CERN. The European Commissioner for Science and Research, Janez PotoÄnik, visited CERN on Tuesday 31 January. He was welcomed by the Director-General, Robert Aymar, who described the missions and current activities of CERN to him, in particular the realisation of the LHC with its three components: accelerator, detectors, storage and processing of data. The European Commissioner then visited the CMS assembly hall, then the hall for testing the LHC magnets and the ATLAS cavern. During this first visit since his appointment at the end of 2004, Janez PotoÄnik appeared very interested by the operation of CERN, an example of successful scientific co-operation on a European scale. The many projects (30 on average) that CERN and the European Commission carry out jointly for the benefit of res...
Ibach, M.T.; Gallagher, J.H. Jr.
A requirement was levied on a Maryland builder by the FHA to demonstrate acceptable radon levels in his homes before they would be approved for loans. This paper describes the use of products shown by appropriate tests to be effective radon barriers to meet this requirement. The sheet goods can be used in exterior and interior applications on foundation walls. The other is applied to the interior floors and/or walls of the basement area. Product installation procedures are straightforward and relatively simple. Problems encountered were routine and concerned primarily the complete sealing of floor and wall penetrations, window openings, sealing the top of the wall under the sill plate, and the location and mounting of permanent fixtures on walls and floors. Also discussed are methods of repairing ruptures of the seal, warranties to protect the homeowner, support systems and costs. Conclusions are that effective reductions in radon levels can be achieved by the application of sealants during the construction of new homes or as a retrofit to existing structures
In Maplewood Richmond Height, Missouri, the Teacher Home Visit Program has become a crucial component of the district's success. At the end of the first semester of the 2010-11 school year, discipline referrals were down 45 percent, and parent attendance at each school's first open house was up by almost 20 percent. Attendance is nudging up as…
Shakeel, Saad; Newhouse, Ian; Malik, Ali; Heckman, George
Background Structured exercise programs for frail institutionalized seniors have shown improvement in physical, functional, and psychological health of this population. However, the ?feasibility? of implementation of such programs in real settings is seldom discussed. The purpose of this systematic review was to gauge feasibility of exercise and falls prevention programs from the perspective of long-term care homes in Ontario, given the recent changes in funding for publically funded physioth...
ETT Division; Division ETT; Service des visites
The Visit Service noticed that for many years countries such as Great Britain, Germany, Spain, Portugal, the Netherlands and the Scandinavian countries visit CERN less than other member countries and that is due to the high price of the trip for the students. To improve the situation the Visit Service plans to create a network of 'Family-Accommodation' ('Famille-Accueil') in Geneva and in France nearbywith the aim to facilitate the trip to foreign students especially from the more distant member countries and to encourage them to visit our unique laboratory. We expect this exchange to be an interesting experience for both the students and the welcoming family ('famille d'accueil'). If you are interested in participating in this family network, please fill in the questionnaire below. The questionnaire is to be returned to the Visit Service, Mrs Christine Fromm, e-mail Christine.Fromm@cern.ch.Name: First name: CERN address: E-mail: Portable phone number: Home address...
Doll, Gayle A; Cornelison, Laci J; Rath, Heath; Syme, Maggie L
Nursing homes have been challenged in their attempts to achieve deep, organizational change (i.e., culture change) aimed at providing quality of care and quality of life for nursing home residents through person-centered care. To attain deep change, 2 well-defined components must be in place: a shared understanding of (a) the what, or content goals, and (b) the how, or process of change. However, there are few examples of this at a macro or micro level in long-term care. In an effort to enact true culture change in nursing homes statewide, the Kansas Department for Aging and Disability Services implemented the Promoting Excellent Alternatives in Kansas Nursing Homes program. This program is a Medicaid, pay-for-performance program that formalizes the content and process of achieving culture change through person-centered care principles. This article aims to detail the content (what) and process (how) of a model macro-level program of culture change throughout the State of Kansas. Applications to the micro level (individual homes) are presented, and implications for psychologists' roles in facilitating culture change are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Zomorodi, Meg; Odom, Trish; Askew, Naomi C; Leonard, Christina R; Sanders, Kimberly A; Thompson, Daniel
The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients' social determinants of health through home visits. This article describes this process, known as "hotspotting," and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.
On Saturday, 19 September, ESA astronaut Luca Parmitano and Amalia Ercoli Finzi, Principal Investigator of the SD2 experiment on board the ESA Rosetta spacecraft, visited the AMS Control Centre and other CERN installations. From left to right: Sergio Bertolucci (CERN Director of Research and Computing), Amalia Ercoli Finzi (Emeritus Professor in the Aerospace department of the Polytechnic University of Milan and Principal Investigator of the SD2 experiment on board the ESA Rosetta spacecraft), Maurice Bourquin (AMS-02 Senior Scientist and Honorary Professor in the Nuclear and Corpuscular Physics department of the University of Geneva) and Luca Parmitano (Major in the Italian Air Force and European Space Agency astronaut) in the AMS Payload and Operation Control Centre. They were welcomed in the early morning by Sergio Bertolucci and then headed to the Prévessin site to visit the CERN Control Centre and the Payload and Operation Control Centre (POCC) of the Alpha Magnetic Sp...
During his visit to CERN on 4 July 2003, Karen Chshmaritian, Armenian Minister for Trade and Economic Development, toured the ATLAS experimental cavern and assembly hall. From left to right: Aram Kotzinian, from the international organization JINR from Dubna, Marzio Nessi from ATLAS, Karen Chshmaritian, Armenian Minister for Trade and Economic Development, Zohrab Mnatsakanian, Ambassador at the Permanent Mission of the Republic of Armenia to the United Nations in Geneva, Alexandre Sissakian, Vice-Director of JINR and Peter Jenni, ATLAS spokesman.
Black, Maureen M; Bentley, Margaret E; Papas, Mia A; Oberlander, Sarah; Teti, Laureen O; McNary, Scot; Le, Katherine; O'Connell, Melissa
were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended > or = 8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6-8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.
Calvo-Espinos, Claudio; Ruiz de Gaona, Estefania; Gonzalez, Cristina; Ruiz de Galarreta, Lucia; Lopez, Cristina
Palliative sedation is a common treatment in palliative care. The home is a difficult environment for research, and there are few studies about sedation at home. Our aim was to analyze this practice in a home setting. We conducted a retrospective cross-sectional descriptive study in a home cohort during 2011. The inclusion criteria were as follows: 18 years or older and enrolled in the Palliative Home Care Program (PHCP) with advanced cancer. The variables employed were: sex, age, primary tumor location, and place of death. We also registered indication, type, drug and dose, awareness of diagnosis and prognosis, consent, survival, presence or absence of rales, painful mouth, and ulcers in patients sedated at home. We also collected the opinions of family members and professionals about the suffering of sedated patients. A total of 446 patients (56% at home) of the 617 admitted to the PHCP between January and December of 2011 passed away. The typical patient in our population was a 70-year-old man with a lung tumor. Some 35 (14%) home patients required sedation, compared to 93 (49%) at the hospital. The most frequent indication was delirium (70%), with midazolam the most common drug (mean dose, 40 mg). Survival was around three days. Rales were frequent (57%) as well as awareness of diagnosis and prognosis (77 and 71%, respectively). Perception of suffering after sedation was rare among relatives (17%) and professionals (8%). In most cases, the decision was made jointly by professionals and family members. Our study confirmed the role of palliative sedation as an appropriate therapeutic tool in the home environment.
Nugent, J. Kevin; Bartlett, Jessica Dym; Valim, Clarissa
Relationship-based interventions are an effective means for reducing postpartum depression (PPD), but few cost-effective tools that can be administered efficiently in medical and home settings are available or well-studied. This study examines the efficacy of the Newborn Behavioral Observations (NBO), an infant-centered relationship-based…
Hafskjold, L.; Eide, T.; Holmström, I.K.; Sundling, V.; Dulmen, S. van; Eide, H.
Objective: Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims
Sier, M F; Oostenbroek, R J; Dijkgraaf, M G W; Veldink, G J; Bemelman, W A; Pronk, A; Spillenaar-Bilgen, E J; Kelder, W; Hoff, C; Ubbink, D T
Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost. Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care. The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.
Ruppel, T; van den Berg, N; Hoffmann, W
Objective: Triggered by the AGnES model project of the University Medicine Greifswald, the Code of Social Law V was changed by the German Lower and Upper House of Parliament (Bundestag and Bundesrat) in 2008 so that the delegation of GP's activities to non-physician colleagues was allowed under highly restricted preconditions. Delegated home visits should become an integral part of the standard care in Germany. In this study, the implementation of § 87 para 2b clause 5 SGB V, established in Annex 8 of the Federal Collective Agreement, was checked for its legality in terms of qualification. Methods: The problem was checked with the legal methods of interpretation in pursuance of the norm and the methods of systematic, historic and teleologic interpretation. Results: Even though the Parliament clearly required orientation to the AGnES model project (in order to assure safety and effective care of delegated home visits), self-management in the implementation of the law remained far behind these guidelines. The main outcome of the legal analysis was that the implementation arrangements of the Code of Social Law V are predominantly illegal. Conclusions: The parties of the Federal Collective Agreement have to change the arrangements to meet the requirements of the Parliament and to avoid risks of liability for delegating GPs. © Georg Thieme Verlag KG Stuttgart · New York.
Itatani, Tomoya; Horiike, Ryo; Nakai, Hisao; Kyota, Kaoru; Tsukasaki, Keiko
There has been a noticeable population decline in the Noto area. The Ministry of Land, Infrastructure, Transport and Tourism has determined the population size necessary for the establishment of daily living-related service businesses and, if the population falls below this, there is a possibility of businesses withdrawing from the area. In this research, we examine the number of home visit and daycare businesses established in the Noto area in 2025, using the geographic information system (GIS). The number of sites of businesses established was calculated using data published by the National Institute of Population and Social Security Research, and the Ministry of Land, Infrastructure, Transport and Tourism. Next, I depicted a buffer with a radius of 15 km from the establishment and confirmed the blank area of the service. Under the condition that the placement of sites is 80%, almost all the municipalities have exceeded the number of home visit care facilities and the number of daycare facilities. In the buffer analysis, blank areas were found in the north. To maintain these services, efforts by groups other than profit-oriented organizations are necessary, especially in the north of Noto. Route analysis by GIS and the consideration of population distribution and location of business establishment will be needed.
Grevatt, Jim [Energy Futures Group (United States); Hoffman, Ian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hoffmeyer, Dale [US Department of Energy, Washington, DC (United States)
After more than 40 years of effort, energy efficiency program administrators and associated contractors still find it challenging to penetrate the home retrofit market, especially at levels commensurate with state and federal goals for energy savings and emissions reductions. Residential retrofit programs further have not coalesced around a reliably successful model. They still vary in design, implementation and performance, and they remain among the more difficult and costly options for acquiring savings in the residential sector. If programs are to contribute fully to meeting resource and policy objectives, administrators need to understand what program elements are key to acquiring residential savings as cost effectively as possible. To that end, the U.S. Department of Energy (DOE) sponsored a comprehensive review and analysis of home energy upgrade programs with proven track records, focusing on those with robustly verified savings and constituting good examples for replication. The study team reviewed evaluations for the period 2010 to 2014 for 134 programs that are funded by customers of investor-owned utilities. All are programs that promote multi-measure retrofits or major system upgrades. We paid particular attention to useful design and implementation features, costs, and savings for nearly 30 programs with rigorous evaluations of performance. This meta-analysis describes program models and implementation strategies for (1) direct install retrofits; (2) heating, ventilating and air-conditioning (HVAC) replacement and early retirement; and (3) comprehensive, whole-home retrofits. We analyze costs and impacts of these program models, in terms of both energy savings and emissions avoided. These program models can be useful guides as states consider expanding their strategies for acquiring energy savings as a resource and for emissions reductions. We also discuss the challenges of using evaluations to create program models that can be confidently applied in
Funk, M.; Chen, L.; Chen, Y.-K.; Yang, S.-W.
The Internet of Things (IoT) and connected products have become ubiquitous technological advances into personal and professional living spaces, such as the smart home. What connectivity and distributed computing have made possible, is still programmed only in more or less simplified rule systems (or