Continuity of Nursing Care Improves Patient Outcomes-ScienceDaily

Home care (mainly nurses visiting patients’ homes to provide care) has become a major source of home and community-based services for people with dementia. These individuals often suffer from multiple chronic illnesses, are taking several medications, and need assistance in activities of daily living. In 2018, more than 5 million Medicare recipients received home care, including 1.2 million people with Alzheimer’s disease and related dementia.

“Nurses play a vital role in providing home care,” said Chenjuan Ma, PhD, and MSN, an assistant professor at NYU Myers and lead author of the study. “As the population ages and older people choose to“ age in place ”as much as possible, the demand for home care for people with dementia is expected to grow rapidly. “

For most patients, home care often begins after discharge. Given that readmission to the hospital is an important quality, safety, and financial issue in medical care, Ma and her colleagues have continued care, or the same nurse visits each home. I wanted to understand if coming to would help prevent the patient from being readmitted.

Using multi-year data from a large non-profit home care institution, the researchers surveyed 23,886 elderly people with dementia who received home care after admission. They measure care continuity based on the number of nurses and visits during home care, and higher scores indicate higher care continuity.

In this study, about 1 in 4 (24%) elderly people with dementia were readmitted from home care. Infections, respiratory problems, and heart disease were the three most common reasons for re-admission to the hospital.

Researchers have found that there is a great deal of variability in the continuity of nursing in home visits for people with dementia. Eight percent had no continuity of care and were visited by different nurses each time, and 26% received all visits from one nurse. They also found that the higher the intensity of the visit, or the longer the time of care provided each week, the lower the continuity of care.

“This may suggest that it is difficult to achieve continuity of care when the patient needs more care, but the higher the continuity of care, the more efficient it is. We cannot rule out the possibility of providing care and thus reducing care time, “Ma explained.

In particular, improved home care continuity reduced the risk of readmissions, even after researchers managed other clinical risk factors and the intensity of home care (average treatment time per week). People with low or moderate dementia were 30 to 33 percent more likely to be readmitted than those with high continuity of care.

“Continuity of long-term care is valuable for home care because it is a decentralized and intermittent care model,” says Ma. “Continuing long-term care may benefit all home care patients, but it may be especially important for people with dementia. Having the same person provide long-term care increases friendliness and trust. Can be planted to reduce confusion for patients and their families. “

To improve the continuity of nursing care, researchers recommend addressing the shortage of home care nurses, improving care coordination, and adopting telemedicine for home care.

“Multiple structural factors pose challenges to the continuity of care for home nurses and other staff, which depend on long commuting times, few full-time or part-time staff, and primarily regimen staff. There are institutions that do, and organizational cultures that do not promote retention. For home health staff. ” Dr. Allison Squires, Associate Professor of RN, FAAN, NYU Myers and Lead Author of Research. “A law proposed by Congress aimed at increasing salaries for front-line nursing and home care staff can improve the continuity of care for government agencies and thus reduce penalties associated with readmissions. You will pay for it. “

A hybrid care model of face-to-face and telemedicine visits may also help improve care continuity, researchers say. They encourage policy makers to consider expanding the scope of telemedicine visits in home care.