Project Title: Collaboration for Homecare Advances in Management and Practice (CHAMP)
Project Start Date: October 1, 2004
Key Project Staff:

Penny Hollander Feldman, Ph.D., Principal Investigator
Laurie Reische, B.S., Associate Director, CHAMP
Thomas E. Bow, M.A., Research Analyst
Amy McGuire, B.A. Research Analyst
Dhara Naik, MPH Research Analyst
Reed Smidebush, Community Manager
David Hoffner, Grants Manager

Background: This program addresses a series of interrelated problems that have led to suboptimal geriatric care for many home healthcare, namely: 1) Home care nurses are inadequately prepared in geriatric care; 2) Continuing education for home health nurses is variable and outmoded; 3) Home healthcare managers lack the management and teaching skills necessary to help them supervise and support nurses in achieving improved outcomes for geriatric patients; and 4) Inadequate training and staff development opportunities for home healthcare managers and nurses detract from job satisfaction and quality of care for older persons.

Purpose: The purpose of this initiative is to improve care for older patients served by home health agencies and to embed in those agencies the capacity for continuous practice improvement. The specific aim is to develop and test a sustainable training model for frontline managers in home healthcare agencies. In turn, the nurses they manage will be equipped to employ "best geriatric practices" in the care of their older patients. Successful development and implementation of the training program, to be conducted over a four-year project period, should reach approximately 300 frontline managers, 3000 nurses under their supervision, and 150,000 to 200,000 older patients in the short run. Established on a permanent basis, the reach of the program should be far greater.  More information on the CHAMP Program can be found at www.champ-program.org

Study Design: The foundation for this initiative is an enhanced "train the trainer" model. The emphasis of the model will be on 1) implementation of geriatric best practices, 2) use of quality improvement (QI) and measurement tools and skills to track progress in implementation, and 3) techniques for integrating best practices into frontline care. 

Specifically the project will:

  1. Develop two geriatric best practice courses focused on significant clinical or functional problems of older home healthcare patients - e.g., medication management, pain, pressure ulcers, confusion, or difficulty in walking or transferring - and identify a list of additional modules for future development;
  2. Develop a curriculum for frontline managers in HHAs focused on managing for quality improvement and teambuilding;
  3. Design, test and refine a multimode training model for frontline home healthcare managers combining Face-to-face workshops, Group coaching calls, an “E-measurement” system, and E-learning modules.  The resulting program will contain instruction in geriatric content and problem solving tools, with exercises to be applied by managers with nurses under their supervision.  An E-measurement system will allow participants to monitor their teams’ progress, over time, toward reaching practice improvement goals.  This system will also allow participants to compare their own team’s results to those of other CHAMP teams in the participant’s own agency and in the CHAMP course as a whole;
  4. Evaluate the model to a) provide information for refining its individual components and overall design, and b) assess its impact on the participating organizations and the geriatric practices selected for improvement; and
  5. Establish a firm structure for spread and sustainability.

Results

Program Reach
CHAMP has developed and successfully implemented two courses in topics critical to geriatric home care; Medication Management and Pain Management.  Approximately 175 frontline managers in 50 agencies from across the country have completed the first two offerings of Medication Management.  In addition, fifty-five participants from 16 agencies have graduated from the inaugural Geriatric Pain Management course. The three CHAMP course offerings combined have reached approximately 1,930 field nurses and approximately 125,750 patients.

Program Results
Patient care is significantly better after participation CHAMP.

For agencies who participated in the Medication Management course:

  • Patients were more likely to have a comprehensive medication assessment at the start of their homecare.
  • Nurses and therapists correctly identified signs/symptoms of potential medication-related complications, and notified the patient's physician.
  • Physicians were consulted about potential drug / drug interactions, and about the use of medications potentially inappropriate for older persons.
  • Patients had a reduction in polypharmacy between start and end of care.
For agencies who participated in the Pain Management course, significant improvements were made in:
  • Improvement in pain interfering with activity
  • Identifying the patient's pain goal
  • Communicating with physician about sever pain and pain-related complications
  • Improving the frequency of pain assessment
Frontline manager job satisfaction also, with over half of the frontline manager graduates reporting that their job satisfaction improved as a result of participating in CHAMP. 90% would recommend CHAMP to a colleague.

Publications: 
McDonald, M.V., & Peterson, L. 2008.  Finding success in medication management.  Home Health Care Management & Practice. 20(2): 135-140.

Sponsors: The Atlantic Philanthropies with the Visiting Nurses Association of America

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