Penny Hollander Feldman, Ph.D., Principal Investigator
Lori Burno, M.P.H., Research Analyst
Amy Clark, Research Analyst
David Hoffner, Grants Manager
Laurie Reische, B.S., Associate Director

Background: The proposed program addresses a series of interrelated problems that have led to suboptimal geriatric care for many home healthcare patients and takes advantage of a changing environment that has created stronger incentives for home healthcare agencies to put quality of care for this patient population at the top of their strategic goals and priorities.The Problem: 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.

The Opportunities: 1) Changing financial and regulatory incentives, combined with national data on home health patient outcomes, have elevated quality improvement as a key issue for HHAs; 2) Medicare, the primary purchaser of home health services, has charged its Quality Improvement Organizations (QIOs) with strengthening QI in the home health industry, and many QIOs are increasing their outreach efforts to HHAs; 3) Management training with an emphasis on managing for quality is emerging as a federal priority for retaining health care workers and meeting quality goals; 4) HHAs have begun their own efforts to identify management training and QI resources to advance their quality agendas; and 5) Web-based resources, teleconferencing and E-learning are emerging as more widely used vehicles to facilitate knowledge and skills development in HHAs.

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 nurse 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 implementation of the training program, which will be conducted twice 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 within the VNAA, the reach of the program should be far greater.

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 content modules 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 and teaching for improvement;
3. Design, test and refine a multimode training model for the home healthcare managers combining, Face-to-face workshops; Group coaching calls; E-learning modules combining instruction in geriatric content with problem solving tools and exercises to be applied by managers with frontline nurses under their supervision; and An "E-measurement" system designed so that program participants can enter the data from simple record reviews into the program’s web-based database and obtain repeat measurements of their progress toward reaching practice improvement goals;
4. Conduct two iterations of training during the project period;
5. Evaluate the model to a) provide "formative" 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
6. Establish a firm structure for spread and sustainability under the sponsorship of the VNAA.

Conclusions:

Publications:

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