Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, New York, NY, 10021, United States.
Cornell Tech, New York, NY, USA.
J Gen Intern Med. 2020 Jun;35(6):1721-1729. doi: 10.1007/s11606-020-05675-8.
Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal.
We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist.
In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018.
Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image.
Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step.
Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.
心力衰竭（HF）患者在住院后需要家庭保健（HHC），其再入院率较高。尽管需要 HHC 的 HF 患者通常比不需要的患者病情更严重，但 HHC 的提供本身也可能不理想。
我们旨在描述 HF 患者出院后接受 HHC 的工作流程，包括各利益相关者的角色，并确定在这些工作流程中存在挑战和改进机会的地方。
在这项定性研究中，我们使用有目的的抽样方法，接触并招募了各种利益相关者，包括家庭保健助理、护士、HF 患者、家庭护理人员、医生、社会工作者、家庭护理机构领导人和政策专家。该研究于 2018 年 3 月至 10 月在纽约进行。
我们使用半结构化主题指南，通过一对一访谈和焦点小组的结合，从 HF 患者的 HHC 中引出参与者的经验。数据进行了记录、转录和主题分析。我们还要求选定的参与者用一幅画来描绘他们对 HF 患者住院后 HHC 工作流程的理解。我们将这些图画综合成最终图像。
研究参与者（N=80）描述了 HF 患者的 HHC 分 6 个步骤进行，家庭保健助理发挥主要作用：（1）从医院过渡到家庭；（2）识别临床变化；（3）做出决策；（4）管理症状；（5）寻求帮助；（6）拨打 911。参与者确定了每个步骤的挑战和改进机会。
我们的研究结果表明，HF 患者的 HHC 发生在不同的阶段，每个阶段都有不同的挑战。在出院后期间，为 HF 患者提供 HHC 需要各种干预措施，而不是一刀切的方法。
