Hospital-to-Home-Health Transition Quality (H3TQ) Index: Further Evidence on its Validity and Recommendations for Implementation.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
medline:
5
7
2024
pubmed:
5
7
2024
entrez:
5
7
2024
Statut:
ppublish
Résumé
We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time. Assess the validity of H3TQ in a large sample across diverse communities. A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and New York, NY. There were five hundred eighty-seven participants (309 older adults, 141 informal caregivers, and 137 HH providers). Older adults, caregivers, and HH providers rated 747 unique transitions. Of these, 403 were rated by both the older adult/caregiver and their HH provider, whereas the remaining transitions were rated by either party. Construct, concurrent, and predictive validity were assessed via the overall H3TQ rating, correlation with the care transition measure (CTM), and the Medicare Outcome and Assessment Information Set (OASIS). Proportion of transitions with quality issues as identified by HH providers and older adults/caregivers, respectively; Baltimore 55%, 35%; NYC 43%, 32%. Older adults/caregivers across sites rated their transitions as higher quality than did providers (P<0.05). H3TQ summed scores showed construct validity with the CTM-3 and concurrent validity with OASIS measures. Summed H3TQ scores were not significantly correlated with 30-day ED visits or rehospitalization. The H3TQ identifies care transition quality issues in real-time and demonstrated construct and concurrent validity, but not predictive validity. Findings demonstrate value in collecting multiple perspectives to evaluate care transition quality. Implementing the H3TQ could help identify transition-quality intervention opportunities for HH patients.
Sections du résumé
BACKGROUND
BACKGROUND
We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time.
OBJECTIVE
OBJECTIVE
Assess the validity of H3TQ in a large sample across diverse communities.
RESEARCH DESIGN
METHODS
A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and New York, NY.
SUBJECTS
METHODS
There were five hundred eighty-seven participants (309 older adults, 141 informal caregivers, and 137 HH providers). Older adults, caregivers, and HH providers rated 747 unique transitions. Of these, 403 were rated by both the older adult/caregiver and their HH provider, whereas the remaining transitions were rated by either party.
MEASURES
METHODS
Construct, concurrent, and predictive validity were assessed via the overall H3TQ rating, correlation with the care transition measure (CTM), and the Medicare Outcome and Assessment Information Set (OASIS).
RESULTS
RESULTS
Proportion of transitions with quality issues as identified by HH providers and older adults/caregivers, respectively; Baltimore 55%, 35%; NYC 43%, 32%. Older adults/caregivers across sites rated their transitions as higher quality than did providers (P<0.05). H3TQ summed scores showed construct validity with the CTM-3 and concurrent validity with OASIS measures. Summed H3TQ scores were not significantly correlated with 30-day ED visits or rehospitalization.
CONCLUSIONS
CONCLUSIONS
The H3TQ identifies care transition quality issues in real-time and demonstrated construct and concurrent validity, but not predictive validity. Findings demonstrate value in collecting multiple perspectives to evaluate care transition quality. Implementing the H3TQ could help identify transition-quality intervention opportunities for HH patients.
Identifiants
pubmed: 38967994
doi: 10.1097/MLR.0000000000002015
pii: 00005650-202408000-00002
doi:
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
503-510Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Coleman EA, Boult C. American Geriatrics Society Health Care Systems C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51:556–557.
Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842–1847.
Sutton E, Dixon-Woods M, Tarrant C. Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people. BMJ Open. 2016;6:e010988.
Arbaje AI, Kansagara DL, Salanitro AH, et al. Regardless of age: incorporating principles from geriatric medicine to improve care transitions for patients with complex needs. J Gen Intern Med. 2014;29:932–939.
Sato M, Shaffer T, Arbaje AI, et al. Residential and health care transition patterns among older medicare beneficiaries over time. Gerontologist. 2011;51:170–178.
Krumholz HM. Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med. 2013;368:100–102.
Carayon P. Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. CRC Press; 2012.
Gandhi TK, Lee TH. Patient safety beyond the hospital. N Engl J Med. 2010;363:1001–1003.
Murtaugh CM, Litke A. Transitions through postacute and long-term care settings—patterns of use and outcomes for a national cohort of elders. Med Care. 2002;40:227–236.
Wolff JL, Meadow A, Weiss CO, et al. Medicare home health patients’ transitions through acute and post-acute care settings. Med Care. 2008;46:1188–1193.
Rosati RJ, Huang L. Development and testing of an analytic model to identify home healthcare patients at risk for a hospitalization within the first 60 days of care. Home Health Care Ser Quarterly. 2007;26:21–36.
Sears NA, Blais R, Spinks M, et al. Associations between patient factors and adverse events in the home care setting: a secondary data analysis of two Canadian adverse event studies. journal article. Bmc Health Serv Res. 2017;17:400.
Sengupta M, Lendon J, Caffrey C, et al. Post-acute and long-term care providers and services users in the United States, 2017–2018. Vital Health Stat 3. 2022:1–93. PMID: 35604771.
Centers for Medicare & Medicaid Services. Updated September 14, 2004 www.cms.hhs.gov
Jones CD, Wald HL, Boxer RS, et al. Characteristics Associated with Home Health Care Referrals at Hospital Discharge: Results from the 2012 National Inpatient Sample. Health Serv Res. 2017;52:879–894.
Report to the Congress: Medicare Payment Policy. 2016. http://www.medpac.gov/docs/default-source/reports/mar17_entirereport224610adfa9c665e80adff00009edf9c.pdf?sfvrsn=0
AHHQI Home Health Chartbook 2020. 2020. September.
The Future of Home Health Care project. 2014. May. http://www.ahhqi.org/images/pdf/future-whitepaper.pdf
Patient Safety in the Home. 2017.
Coleman EA, Parry C, Chalmers S, et al. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822–1828.
Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613–620.
Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150:178–187.
Arbaje AI, Maron DD, Yu Q, et al. The geriatric floating interdisciplinary transition team. J Am Geriatr Soc. 2010;58:364–370.
Boult C, Reider L, Leff B, et al. The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. Arch Intern Med. 2011;171:460–466.
Innovation AfHHQa. Improving Care Transitions Between Hospital and Home Health http://www.ahhqi.org/images/uploads/AHHQI_Care_Transitions_Tools_Kit_r011314.pdf
Boling PA. Understanding quality of care in Medicare home health agency care. J Am Geriatr Soc. 2017;65:2557–2558.
Arbaje AI, Hsu Y-J, Keita M, et al. Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: a novel measure to engage patients and home health providers in evaluating hospital-to-home care transition quality. Qual Manag Health Care. 2023. doi:10.1097/QMH.0000000000000419
doi: 10.1097/QMH.0000000000000419
Gunawan J, Marzilli C, Aungsuroch Y. Establishing appropriate sample size for developing and validating a questionnaire in nursing research. Belitung Nursing Journal. 2021;7:356–360.
Clark LA, Watson D. Constructing validity: basic issues in objective scale development. Methodological issues and strategies in clinical research, 4th. American Psychological Association; 2016:187–203.
Parry C, Mahoney E, Chalmers SA, et al. Assessing the quality of transitional care: further applications of the care transitions measure. Med Care. 2008;46:317–322.
Forum TNQ. Specifications for the Three-Item Care Transition Measure - CTM-3https://mhdo.maine.gov/_pdf/NQF_CTM_3_%20Specs_FINAL.pdf
ATLAS.ti: The Knowledge Workbench. Version 8.2. 2018 www.atlasti.com
Pollack AH, Mishra SR, Apodaca C, et al. Different roles with different goals: designing to support shared situational awareness between patients and clinicians in the hospital. J Am Med Inform Assoc. 2021;28:222–231.
O’Hara JK, Aase K, Waring J. Scaffolding our systems? Patients and families ‘reaching in’ as a source of healthcare resilience. BMJ Quality & Safety. 2019;28:3–6.
Lee JH, Kim SJ, Lam J, et al. The effects of shared situational awareness on functional and hospital outcomes of hospitalized older adults with heart failure. J Multidiscip Healthc. 2014;7:259–265.
Leff B, Boyd CM, Norton JD, et al. Skilled home healthcare clinicians’ experiences in communicating with physicians: a national survey. J Am Geriatr Soc. 2022;70:560–567.
Norton JD, Nkodo A, Nangunuri B, et al. Skilled home healthcare clinician and staff perspectives on communication with physicians: a multisite qualitative study. Home Healthc Now. 2021;39:145–153.