Home Care Outcomes of Expanded Home Health Aide Roles

描述(由申请人提供)：本研究建议扩展家庭健康助理(HHA)的传统角色，以慢性病患者社区卫生工作者(CHW)计划的模式为基础，培训他们担任疾病管理教练(DMC)。HHA DMC将通过CHW课程进行培训，以实施充血性心力衰竭(CHF)和糖尿病疾病管理方案，以加强方案的实施。我们将检验两个主要假设。首先，与分配到传统家庭保健中心或没有家庭保健中心的患者相比，被分配到HHA DMCs的初级诊断为CHF或糖尿病的家庭卫生保健(HHC)患者将有更少的住院和急诊室就诊，更便宜的HHC发作，以及更高的护理满意度。其次，卫生与健康管理中心的工作满意度将高于传统的卫生保健服务。 一项为期48个月的随机HHA DMC干预试验将在MedStar，Health VNA的华盛顿特区、贝塞斯达和巴尔的摩MD站点实施，包括2个ARM，36个月的患者累计期，从HHC指数纳入之日起60天的随访，并随机分配28小时中的14小时作为HHA DMC进行培训。在组1中，所有入院的CHF(N=300)和糖尿病(N=210)患者将被随机分配到传统的HHA或HHA DMC。在组2中，随机选择的通常未分配HHA的Medicare患者(600名CHF，600名糖尿病)子集将被随机分配到HHA DMC或未分配HHA的DMC。患者基线/结果数据将通过OASIS获得，OASIS是为HHC患者常规收集的标准化HHC临床/人口数据集，其他机构的临床、行政和索赔数据，以及将精心制作的电话调查，以收集满意度和自我报告医院/急诊室使用数据。HHA工作满意度和培训/绩效评估数据将由要创建的工具捕获 这项研究将有助于控制HHC成本，提高护理质量，减少HHC准专业人员短缺。首先，它将测试一种新的HHC交付模式。如果HHA DIVIC改善了患者的预后，降低了护理成本，并对他们的工作更满意，如果未来的研究支持推广，该模型就有希望。第二，将编制一套独特的培训卫生福利院作为母婴健康中心的课程，首次纳入用于培训卫生福利院的课程。对HHA DMCs的培训和绩效的评估将有助于深入了解如何交叉培训辅助专业人员，以实现有效和令人满意的强化实践角色。

DESCRIPTION (provided by applicant): This study proposes to expand the traditional role of the home health aide (HHA) by training them to function as disease management coaches (DMCs) based on the model of community health worker (CHW) programs for the chronically ill. HHA DMCs will be trained to implement congestive heart failure (CHF) and diabetes disease management protocols via CHW curricula specially modified to reinforce protocol implementation. Two major hypotheses will be tested. First, home health care (HHC) patients with primary diagnoses of CHF or diabetes who are assigned to HHA DMCs will have fewer hospitalizations and ER visits, cheaper HHC episodes, and greater satisfaction with care than patients assigned to traditional HHAs or to no HHA. Second, HHA DMCs will have greater job satisfaction than traditional HHAs A 48-month randomized HHA DMC intervention trial with 2 arms, a 36-month patient accrual period, 60 day follow-up from the date of the HHC index admission, and random assignment of 14 of 28 HHAs to be trained as HHA DMCs, will be implemented in the Washington, DC, Bethesda and Baltimore MD sites of MedStar , Health VNA. In arm 1, all CHF (N=300) and diabetes (N=210) patients admitted who normally would get an HHA will be randomized equally to a traditional HHA or an HHA DMC.In arm 2, a randomly selected subset of Medicare patients (600 CHF, 600 diabetes) ordinarily not assigned HHAs will be randomized equally to an HHA DMC or no HHA. Patient baseline/outcome data will be obtained via OASIS, a standardized HHC clinical/demographic data set collected routinely for HHC patients, other agency clinical, administrative, and claims data, and a telephone survey to be crafted to collect satisfaction and self report hospital/ ER use data. HHA job satisfaction, and training/performance evaluation data will be captured by tools to be created This study will contribute to efforts to contain HHC costs, improve care quality and reduce HHC paraprofessional shortages. First, it will test a new HHC delivery model. If HHA DIVICS improve patient outcomes, decrease care costs, and are more satisfied with their jobs, the model holds promise if future studies support generalizability. Second, a unique curriculum for training HHAs as DMCs will be produced which incorporates for the first time curricula used to train CHWs. Evaluation of training and performance of the HHA DMCs will provide insight into how to cross-train paraprofessionals for effective and satisfying enhanced practice roles.