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Project Information

COMPARATIVE EFFECTIVENESS OF HOME CARE ENVIRONMENTS FOR DIVERSE ELDERS' OUTCOMES

Agency:
AHRQ

HHS/Agency for Healthcare Research and Quality

Project Number:
1K99HS022406-01
Contact PI / Project Leader:
JARRIN, OLGA
Awardee Organization:
UNIVERSITY OF PENNSYLVANIA

Description

Abstract Text:
Project Summary The candidate is a community/public health nurse and gerontological health services researcher committed to comparative effectiveness research on home health delivery systems. Her short-term training objectives are (1) to develop comparative effectiveness research methods expertise and (2) data management and analytic methods specific to home health care datasets and research design issues. Long term research goals are to improve the design and deliver of home health nursing care outcomes for a rapidly aging and increasingly diverse population. In addition to focused research, career development plans include interaction with colleagues on her mentoring/research team, formal course work will be taken in comparative effectiveness research methods. The University of Pennsylvania will provide an outstanding environment for her career development. Resources include access to eminent interdisciplinary faculty who collaborate through focused Research Centers in Health Services Research, Aging and Comparative Effectiveness Research, across the Schools of Nursing, Medicine, Sociology, Statistics, and Business. Guided by excellent mentors, in a superb training environment, with access to rich datasets and strong preliminary data, this proposal addresses three specific aims: 1) Compare the effectiveness of nursing delivery system strategies (more nurses educated at the baccalaureate level, "front-loading" of nursing visits, and supportive agency work environments) to improve home health patient outcomes~ 2) Determine if and under what conditions the impact of nursing on home health outcomes is contingent upon informal caregiver assistance~ and 3) Determine the extent of racial/ethnic disparities in home health outcomes, and determine which nursing system delivery strategies are most likely to be associated with improved outcomes for racial/ethnic minority patients and clinically complex older adults. The proposed training and research will utilize the latest advances in comparative effectiveness research methods to detect racial/ethnic disparities in home health outcomes, understand the contributing factors (individual, family, community and health systems), and evaluate the comparative effectiveness of nursing delivery system strategies on improving outcomes for home health patients under different individual and socio-environmental circumstances. This innovative project will capitalize on a unique data set, comprised of nurse surveys providing detailed information about nursing care and work environment within home health agencies in nearly 250 home health agencies that serve older adults living in diverse communities. The nurse survey results combined with independent home health care patient assessment and outcomes data provides a window into each patient's unique circumstances, including the complexity and severity of their health status and care needs, as well as information about their living environment and informal caregivers. Linkages with additional administrative and public datasets will provide additional key variables regarding home health agency service patterns and community measures of crime, segregation, socio-economic status and health care provider availability/shortages. The proposed research is significant because it will highlight the value of different home health nursing delivery strategies for improving patient outcomes among vulnerable populations may be achieved. The challenge being addressed--how to best provide safe, effective, and affordable home health nursing care to diverse patients--affects patient outcomes across the continuum of care from home to medical home and hospital. Limited evidence is available to guide home health care systems administrators in making decisions about the pros and cons of home health nursing delivery system strategies. The best combination of home health nursing care delivery strategies may be categorically different depending on the presence of informal family caregivers and community supports. Professional home health nursing care and informal (lay) or community care may interact synergistically to increase the effectiveness of systems level intervention, for example, by reducing the intensity of services needed. The comparative effectiveness study proposed will form a critical body of evidence needed to translate effective nursing delivery system strategies into evidence-based practice recommendations that providers, payers, purchasers, policy makers, other principle investigators, and the public can trust.
Project Terms:
Address; Administrator; Affect; Aging; Businesses; care delivery; Care given by nurses; career development; Caregivers; Caring; Commit; Communities; Community Health Systems; comparative effectiveness; compare effectiveness; Complex; Continuity of Patient Care; Crime; Data; data management; Data Set; Decision Making; design; Development Plans; Discipline of Nursing; Effectiveness; effectiveness research; Elderly; Environment; Evidence based practice; Faculty; Family; Family Caregiver; Goals; Health; Health Personnel; Health Services; Health Services Research; Health Status; Healthcare Systems; Home Care Services; Home environment; Home Health Agency; Hospitals; improved; Individual; innovation; Intervention; Life; Measures; Medical; Medical Sociology; Mentors; Methods; Minority Groups; Nurses; Outcome; patient home care; Patient Outcomes Assessments; Patients; Pattern; Pennsylvania; Policy Maker; Population Heterogeneity; Provider; Public Health Nurses; Public Health Nursing; racial and ethnic disparities; Recommendation; Research; Research Design; Research Methodology; Research Personnel; Research Training; Resources; School Nursing; segregation; Services; Severities; Socioeconomic Status; statistics; Surveys; System; Training; Translating; Trust; Universities; Visiting Nurse; Vulnerable Populations; Work; Workplace

Details

Contact PI / Project Leader Information:
Name:  JARRIN, OLGA
Other PI Information:
Not Applicable
Awardee Organization:
Name:  UNIVERSITY OF PENNSYLVANIA
City:  PHILADELPHIA    
Country:  UNITED STATES
Congressional District:
State Code:  PA
District:  02
Other Information:
Fiscal Year: 2013
Award Notice Date: 19-Jul-2013
DUNS Number: 042250712
Project Start Date: 01-Aug-2013
Budget Start Date: 01-Aug-2013
CFDA Code: 226
Project End Date: 31-Jul-2015
Budget End Date: 31-Jul-2014
Agency: ?

Agency: The entity responsible for the administering of a research grant, project, or contract. This may represent a federal department, agency, or sub-agency (institute or center). Details on agencies in Federal RePORTER can be found in the FAQ page.

HHS/Agency for Healthcare Research and Quality
Project Funding Information for 2013:
Year Agency

Agency: The entity responsible for the administering of a research grant, project, or contract. This may represent a federal department, agency, or sub-agency (institute or center). Details on agencies in Federal RePORTER can be found in the FAQ page.

FY Total Cost
2013 AHRQ

HHS/Agency for Healthcare Research and Quality

$148,846

Results

i

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