Improving Quality and Outcomes in Home Health Care

“The impact of AHRQ funding on health services research cannot be overstated! Support from AHRQ has been essential in promoting high quality care for home health care patients.”

Improving home health care quality is a passion and top priority for Penny Hollander Feldman, Ph.D., Emerita Director and Senior Research Scientist of the Center for Home Care Policy and Research at the Visiting Nurse Service of New York. Many aging adults prefer to receive care in their own homes for as long as they can to preserve some independence, and Dr. Feldman’s research focuses on improving the quality, outcomes, and cost-effectiveness of home-based care. With AHRQ funding, she has developed information, tools, and materials to help translate evidence-based research into daily practice and support informed policymaking.

In 2001, Dr. Feldman began her AHRQ-funded work with a grant to test the effectiveness of just-in-time email “reminders” to deliver best practice information to home health nurses caring for patients with heart failure. That project, which received a national award for innovation, demonstrated that just-in-time patient-specific emails can increase nurses’ adherence to best practices and, more important, improve their patients’ outcomes, including relief from shortness of breath associated with heart failure.

Dr. Feldman was also the first researcher to examine how in-home health care team structure can influence patient outcomes and adverse events. According to the Centers for Medicare & Medicaid Services (CMS), a decline in activities of daily life (ADL) such as eating, bathing, and grooming is considered an adverse event if a home health patient experiences a substantial decrease in the ability to perform these activities while receiving care at home. Dr. Feldman and her colleagues developed a predictive model to determine the most appropriate ADL index for defining adverse events related to functional decline in home care. They found that when nursing teams visit patients more frequently and provide more weekend visits, adverse event rates are significantly lower.

The efficiency of home health care processes can impact a wide range of patients. With additional AHRQ funding, Dr. Feldman has focused on ways that processes of care affect patients with chronic conditions such as heart failure and diabetes. She found that, with more efficient communication to nurses and more systematic collection and feedback of data to nursing teams, fewer patients were hospitalized.

Building on this research, Dr. Feldman and her team used AHRQ funding to develop the Reducing Acute Care Hospitalization (ReACH) National Demonstration Collaborative. ReACH was a virtual learning model that aimed to reduce hospitalization rates for home health patients nationwide. Nearly 200 home health agencies implemented the targeted improvement strategies, including risk assessment tools and targeted interventions for high-risk patients. Using such measures, ReACH participants effectively reduced hospitalization rates among their patients. AHRQ funding also helped Dr. Feldman and the ReACH collaborative to disseminate effective strategies through a national conference, which included 90 U.S. home care leaders and featured a panel of four agencies that shared ReACH experiences in quality improvement.

Dr. Feldman continues to use AHRQ funding to find ways to make care safer for home health patients, most recently by focusing on how technology can be used to improve care for patients with complex medication regimens (e.g., specific instructions about time of day or taking medicine with food). Automating the process of identifying complex regimens and using a clinical decision support system to notify nurses and patients could reduce medication errors such as mixed or wrong doses. This, in turn, could decrease emergency department visits and hospital admissions.

In addition to her positions with the Visiting Nurse Service of New York, Dr. Feldman is an associate professor of public health at Weill Cornell Medical College in New York City and a member of the New York Academy of Medicine. She is also a member of AcademyHealth and the Gerontological Society of America.

Principal Investigator: Penny Feldman, Ph.D.
Institution: Visiting Nurse Service of New York
Grantee Since: 2001
Type of Grant: Various

Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.

To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.