Resource utilization in home health care: results of a prospective study
Department of Family Medicine and Community Health
Boston; Community Health Nursing; Data Collection; Diagnosis-Related Groups; Focus Groups; Health Resources; Home Care Services; House Calls; Nurses; Prospective Studies; Regression Analysis; Time and Motion Studies
Community Health | Other Medical Specialties | Preventive Medicine
Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length--and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio-economic status; patient's clinical status; patient's support services; and visit-specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail.
Home Health Care Serv Q. 1994;15(1):19-41.
Home health care services quarterly
Trisolini MG, Thomas C, Cashman SB, Payne SM. (1994). Resource utilization in home health care: results of a prospective study. Family Medicine and Community Health Publications. Retrieved from https://escholarship.umassmed.edu/fmch_articles/145