Background: Very little is known about the factors that affect home health care quality, and there are many: Patients often have multiple and complex health conditions. Many actors are involved in their care, and medical, social, and housing issues are all important to home care patients. Care is highly decentralized, with as many sites of care as there are patients.

To maximize patient health and safety, a greater understanding is needed of how the home care work environment and characteristics of the home care nursing workforce affect quality of care and patient outcomes.

Purpose: To gain an understanding of the relationships that exist among characteristics of the home care work environment, the home care workforce, and patient care errors and preventable adverse events in the home care setting.

Study Design: The study had samples of 86 service-delivery teams and over 50,000 patient home care episodes. An index of 13 CMS-defined adverse events was created. This index - risk-adjusted using a comprehensive set of patient health, economic and environmental variables - was used to construct two quality scores for each team (the organizational unit of interest). The first used an econometric fixed effects approach and the second a more traditional z-score ranking. Resulting quality scores (i.e. "team attributable" adverse event rates) then were regressed on eighteen organizational and work force measures using both bivariate and multivariate ordinary least squares.

Findings: Analysis in Progress

Conclusions: This study is one of relatively few studies that has examined the relationships between patient outcomes and organizational processes such as leadership, coordination or communication. It is the first study in the home care setting to employ rigorous quantitative methods to identify organizational factors associated with potential adverse events. In addition, it is unusual in its two-stage approach, which first created case mix adjusted "team-attributable" quality scores and then examined their association with a variety of work environment and work force factors.

Publications: In Progress

Sponsor: Agency for Healthcare Research and Quality (AHRQ)