EVIDENCE-BASED 'REMINDERS' IN HOME HEALTH CARE

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This project will test the relative effectiveness and cost-effectiveness of two alternative information-based strategies designed to improve provider performance and promote adherence to evidence-based practice guidelines among home health care nurses. Two interventions will be tested - a "basic" and an augmented intervention - on two tracer conditions: congestive heart failure and cancer pain. Both basic and augmented interventions will provide an e-mail reminder highlighting four to six condition-specific practices that nurses should follow to achieve optimal patient outcomes. The two interventions will differ, however, with respect to the extent of information provided and the availability of an "expert peer." The basic intervention will provide the nurse with a one-time reminder of applicable clinical guidelines shortly after her assessment of a new CHF or cancer pain patient. This intervention falls within the class of computerized reminder strategies that were found to be consistently effective in promoting change in behavior among other health professionals. The augmented intervention will substantially expand the information and resources available to the nurse. In addition to the just-in-time e-mail reminder, this multifaceted intervention will include the distribution of a comprehensive clinical guideline (HOME Plan), patient education materials, and follow-up e-mail contact and outreach by a Clinical Nurse Specialist (CNS), who will serve as an "expert peer". The study will employ a randomized design that assigns nurses to either one of the treatment groups or to a control group (usual care). The analysis will estimate the impact of the interventions on nursing practices and processes of care, on patient outcomes, and on costs. Measures of these dependent variables will be derived from a combination of primary and secondary data, including patient records, patient assessment (OASIS) instruments, patient interviews, and administrative files. Estimates of regression-adjusted treatment-control group differences (for both interventions) will determine the extent to which differences in provider practice, patient outcomes and costs are attributable to the alternative information-based strategies. The project will conclude with a discussion of the implications of our cost-effectiveness findings for home care policy and program initiatives.