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Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot.

The aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home.

Informal Home Care for Elderly in Belgium: A Study on the Features and Challenges of Informal Care at Local Level.

In Belgium, and in other OECD countries, there is a growing awareness about the importance of informal home care for the elderly's well-being. Informal care is considered as an intrinsically valuable social phenomenon. Public authorities in Belgium have been advocating an active policy of support for informal carers. In 2007, an extensive survey was carried out in the Belgian municipality of Kruibeke in order to establish a better picture of the various needs of the elderly in their home situation, but also...

The practicalities of cross boundary working in respect of acp for care home with nursing residents.

Within a care home with nursing reviewing the use of ACP to prevent inappropriate hospital admissions at end of life and the use of ACP to prevent delayed discharge from a General Hospital back to the care home. Review of admission data from a care home to general hospital and on the number of admissions resulting in hospital deaths compared to care home deaths during the last 2 years.

Gender and career paths of female primary care physicians in Andalusia, Spain, at the beginning of 21st century.

The purpose of this article was to study, from a feminist perspective, the diversity and homogeneity in the career paths of female primary care physicians from Andalusia, Spain in the early 21st century, by analyzing the meanings they give to their careers and the influence of personal, family and professional factors. We conducted a qualitative study with six discussion groups. Thirty-two female primary care physicians working in urban health centers of the public health system of Andalusia participated in...

Breakdown in informational continuity of care during hospitalization of older home-living patients: a case study.

The successful transfer of an older patient between health care organizations requires open communication between them that details relevant and necessary information about the patient's health status and individual needs. The objective of this study was to identify and describe the process and content of the patient information exchange between nurses in home care and hospital during hospitalization of older home-living patients.

Helping patients to die at home: carers' views on home care with the midhurst macmillan specialist palliative care service.

The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team providing care in the home, community hospitals and care homes. Care includes specialist interventions. Case data review shows that over two thirds of patients referred to the service die at home.

Pain in care home residents with dementia: an exploration of frequency, prescribing and relatives' perspectives.

This study aims to determine pain frequency amongst care home residents with dementia, to investigate variables associated with pain, to explore analgesic use among residents and to seek residents' relatives' views on provision of care and management of pain by the care home.

Patient-Centered Care or Cultural Competence: Negotiating Palliative Care at Home for Chinese Canadian Immigrants.

The literature about Chinese attitudes toward death and dying contains frequent references to strong taboos against open discussion about death; consequently, there is an assumption that dying at home is not the preferred option. This focused ethnographic study examined the palliative home care experiences of 4 Chinese immigrants with terminal cancer, their family caregivers, and home care nurses and key informant interviews with 11 health care providers. Three main themes emerged: (1) the many facets of ta...

Family carers' delivery of medications for the person dying at home: preliminary findings from the 'unpacking the home' study.

Current UK health policy aims to increase the numbers of people dying at home, but it relies on family members being available to take responsibility for caring. The 'Unpacking the home' study elicited the views and experiences of family carers who have cared for a dying family member at home.

Hospice at home: optimising care and enabling home death.

The Cambridgeshire Hospice at Home (H@H) service provides specialist community care for people approaching the end of their lives, enabling them to be cared for and to die at home if that is their wish. An independent evaluation is underway that is both shaping the evolving service and providing commissioners with detailed information needed to ensure continuing NHS funding.

Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs.

Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families.METHODS: Secondary data analysis of participants i...

Empowering care home staff to deliver quality end of life care: the impact of the six steps to success programme on end of life care in care homes in north west England.

Inappropriate admissions to hospital from care homes at the end-of-life (EoL), identified within the UK Department of Health's End-of-Life Care (EoLC) Strategy resulted in the call for improved education surrounding EoLC for care home staff. In response, the Six Steps to Success , an organisational change programme, was developed for use with care home staff. The aim of the programme is to ensure all residents receive high quality EoLC provided by a care home that encompasses the philosophy of palliative ca...

Transferring critically ill patients home to die: development of a guideline for clinical practice.

Transfer home to die from critical care is rare despite health policy supporting patient choice concerning preferred place of care at end of life. A clinical guideline to inform decision making about the rapid transfer of critically ill patients home was developed based on data from a two year mixed methods study.

Evaluation of interprofessional training in home care.

The increasing number of patients in home care and the importance of teamwork make it important to provide successful ways of interprofessional learning for students. The aim of this study was to evaluate a group of undergraduate students' experiences of a one-day interprofessional home care training in a realistic setting. A study group comprised of 88 students and a control group with 182 students answered the questionnaire. In the study group the students practised interprofessional learning for a fictit...

A randomized controlled comparison of flushing protocols in home care patients with peripherally inserted central catheters.

Research has failed to demonstrate an optimal flushing solution or frequency for central catheters. In a 2002 study of 50 000 home care patients, catheter dysfunction with loss of patency was the most common complication and occurred in 29% of the peripherally inserted central catheters (PICCs) tracked. With the advent of the Affordable Care Act and the promise of expanded home care services, this study offers evidence as to a preferred flushing protocol to prevent catheter patency complications for home in...

Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

Purpose of the Study: To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients.

The community care pathways at the end of life (cape) study- early findings.

Current NHS End of Life Care policy favours raising the proportion of deaths that occur at home. Currently this only occurs in 21.8% of the total. Although most people would like to die at home, research has shown that people's preferences are influenced by the progression of their illness, how much support is available and their social circumstances.

Evaluating a specialist palliative care initiative for nursing and residential homes.

The End of Life Care report from the National Audit Office identified that 50% of care home residents who died in hospital, could have died in their care home. The support needed by care homes to enable residents to remain in their preferred place for death is complex; education alone does not change practice. We report interim data from a two year pilot of a hospice care home support team.

Pressure Ulcers In Palliative
home Care Patients: Prevalence And Characteristics.

Persons in palliative care develop pressure ulcers (PU) as death approaches, but the extent of the problem is still unknown. The objectives were to identify the prevalence of pressure ulcers in people with cancer in palliative home care, compare the socio-demographic and clinical profile of patients with and without pressure ulcers, and analyze the characteristics of the ulcers. This descriptive, cross-sectional study included 64 people with advanced cancer in palliative home care. Twelve of them (18.8%) ha...

Comparison of Effects of Home Visits and Routine Postpartum Care on the Healthy Behaviors of Iranian Low-Risk Mothers.

Postpartum care at home is a post delivery care method that can be provided by public health nurses, trained health workers, or midwifery nurses. A study conducted to compare effect of two midwife visits at home to usual postpartum care on the healthy behaviors of low-risk Iranian mothers.

The Early-Career Psychiatrist: Getting Started in a Career in Integrated Care.

Costs of formal and informal home care and quality of life for patients with multiple sclerosis in sweden.

Disease progression in multiple sclerosis leads to dramatic changes in a person's ability to perform daily activities and increases reliance on external help. This study aims to describe and to estimate costs of formal/informal home care and quality of life related to multiple sclerosis. A mailed survey to a random sample of MS sufferers (n = 1500) collected data on the number of hours of home care received, type of help, productivity losses, quality of life, and disease characteristics. Costs for home care...

Urban and rural differences in risk of admission to a care home: A census-based follow-up study.

Research on admissions to care homes for older people has paid more attention to individual and social characteristics than to geographical factors. This paper considers rural-urban differences in household composition and admission rates. Cohort: 51,619 people aged 65 years or older at the time of the 2001 Census and not living in a care home, drawn from a data linkage study based on c.28% of the Northern Ireland population. Living alone was less common in rural areas; 25% of older people in rural areas li...

Hospital Utilization After a Telemonitoring Program: A Pilot Study.

The long term effects of remote monitoring on hospital utilization and health care costs are understudied in home health care. The researchers performed a retrospective study, in a hospital based home health care agency, to consider the effects of remote monitoring in 326 patients with heart failure 90 days after discharge from services. While statistical significance was not noted, clinical significance suggests that there was a decreased hospital utilization rate and decreased average cost per hospitaliza...

Predictors of hospital stay and home care services use: A population-based, retrospective cohort study in stage IV gastric cancer.

Home care services use has been proposed as a means of reducing costs in palliative care by decreasing hospital stay without impacting quality of clinical care; however, little is known about utilization of these services in the time following a terminal cancer diagnosis.

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