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While home health agencies (HHAs) can seek accreditation to recognize their quality of service, it is unknown whether agencies with accreditation perform better in providing care than those without accreditation. Using 5-year data from national data sources, the aims of this study were: 1) to depict characteristics of HHAs with and without accreditation; and 2) to examine the relationship between accreditation status and HHA performance on quality-of-care metrics. This study analyzed 7,697 agencies in the US and found that 1) agencies that were for-profit, urban, not-hospital-affiliated, single-branch, Medicare enrolled only, and without hospice program were more likely to have accreditation; and 2) overall, accredited agencies performed better on the three commonly used quality indicators, timely initiation of care, hospitalization, and emergency department visit, though not all the observed differences were substantial in absolute value. Our results provide unique empirical information to agencies considering seeking accreditation. [ABSTRACT FROM AUTHOR]

Purpose: Home health care is one of the fastest growing health care sectors in the United States. However, little is known of differences in trends in quality performance between rural and urban home health agencies over time. This study aimed to examine disparities in quality performance between rural and urban home health agencies between 2014 and 2018. Methods: This is a cohort study using 2014‐2018 national Home Health Compare data and Providers of Service Profile data, including 7,908 home health agencies, of which 1,537 were rural agencies. Quality performance measures included timely initiation of care, hospitalization, and emergency department (ED) visits. Two‐level hierarchical regression models were used to identify rural‐urban differences in these quality indicators over time when controlling organizational characteristics. Findings: Rural agencies were less likely to be for‐profit and accredited, and more likely to be hospital‐based, serve both Medicare and Medicaid beneficiaries, and have hospice programs. Rural agencies consistently outperformed on timely initiation of care over time, and urban agencies consistently outperformed on hospitalization and ED visits over time. These gaps between rural and urban agencies were steady over time except the gap in hospitalization, which slightly narrowed over time (Coef. = 0.11, P =.001 for urban and year interaction term). Conclusions: Significant differences exist in quality of care between rural and urban home health agencies and such differences have not been significantly narrowed over time. To reduce rural‐urban disparities, policy makers should take into account unique challenges faced by urban and rural agencies when making policy decisions. [ABSTRACT FROM AUTHOR]

Introduction: With the increasing need for home care in Shanghai, China, it is crucial to ensure its quality. This study aimed to explore quality-related issues of home care in Shanghai, China, and identify strategies for improvement. Method: This is a descriptive qualitative study. Semistructured interviews were conducted among 27 individuals, including home care managers (n = 8), nurses (n = 10), and patients and/or their caregivers (n = 9). Colaizzi's seven-step analysis method was used to guide data analysis. Results: Three themes emerged regarding the quality of home care in China: unsatisfactory structure quality, unsatisfactory process quality, and imperfect outcome quality evaluation system. Recommended strategies for quality improvement included issuing standards for home care evaluation, refining structure quality and process quality, and establishing an outcome quality evaluation system. Conclusions: Concerns about the quality of home care in China were identified by providers and patients. More research especially studies quantifying the care quality and its influencing factors are needed. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the quality of home care in China using the Home Care Quality Assessment Tool (HCQuAT). Method: We recruited 38 home health agencies in Shanghai, China, which included 18 in urban areas, 11 in suburban areas, and nine in rural areas. Data on quality of home care from each agency were collected by trained staff using the HCQuAT. Results: On average, these home health agencies scored 74.28/100.00 (SD = 6.80) on the HCQuAT, with an excellence rate of 39.5% and a failing rate of 23.7%. The mean scores on the structure quality module, process quality module, and outcome quality module were 71.2 ± 21.8, 86.6 ± 9.2, and 44.1 ± 37.5, respectively. Significant differences existed across geographic locations (p =.018). Discussion: Significant variations were identified in the quality of home care across quality modules and geographic locations. Outcome quality and quality in rural areas were lower than those for their counterparts. [ABSTRACT FROM AUTHOR]

Purpose: To examine which characteristics of the practice environment were associated with missed nursing care in U.S. acute care hospital units. Design: A descriptive, correlational study used secondary analysis of the 2015 National Database of Nursing Quality Indicators® Registered Nurse (RN) Survey data. Subscales of the Practice Environment Scale of the Nursing Work Index were used to measure practice environment characteristics. The sample included 1,583 units in 371 hospitals, containing survey responses from 31,650 RNs. Methods: Multilevel logistic regression was performed to estimate the effects of the practice environment characteristics on missed care, controlling for hospital and unit characteristics. Results: About 84.1% of unit RNs reported missing at least one of the 15 necessary care activities. Good environment units had 63.3% significantly lower odds of having RNs miss care activities than poor environment units. Units had 81.5% lower odds of having RNs miss any necessary activities with 1 point increase of the staffing and resource adequacy score; 21.9% lower odds for 1 point increase in the nurse–physician relations score; and approximately 2.1 times higher odds with 1 point increase in the nurse participation in hospital affairs score. Conclusions: Good environments were significantly associated with lower levels of missed care. The impact on missed care differed by the characteristics of the practice environment. Clinical Relevance: Hospital and nursing administrators should maintain good practice environments for nurses to reduce missed care activities and thus potentially improve patient outcomes. Specifically, their efforts should be targeted on improving staffing and resource adequacy and nurse–physician relations and on reducing workloads on hospital affairs. [ABSTRACT FROM AUTHOR]

Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. To explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care. A qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data. A large urban home health care agency located on the East Coast of the United States. Thirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist]. A total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety. Home health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient's language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models. [ABSTRACT FROM AUTHOR]