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，通过培训他们作为疾病管理教练（DMC）的基础上，社区卫生工作者（CHW）计划的模式为慢性病患者。HHA DMC将接受培训，以通过专门修改的CHW课程实施充血性心力衰竭（CHF）和糖尿病疾病管理方案，以加强方案实施。将检验两个主要假设。首先，与被分配到传统HHA或没有HHA的患者相比，被分配到HHA DMC的CHF或糖尿病初步诊断的家庭医疗保健（HHC）患者将具有更少的住院和ER访视，更便宜的HHC发作，以及更高的护理满意度。其次，HHA DMC将比传统HHA有更高的工作满意度 将在MedStar，Health VNA的华盛顿、贝塞斯达和巴尔的摩MD研究中心实施一项为期48个月的随机HHA DMC干预试验，包括2组、36个月的患者招募期、自HHC指数入院之日起60天的随访以及随机分配28名HHA中的14名作为HHA DMC接受培训。在第1组中，所有通常会接受HHA的CHF（N = 300）和糖尿病（N = 210）患者将被随机平均分配到传统HHA或HHA DMC组。在第2组中，随机选择的通常未分配HHA的Medicare患者子集（600名CHF，600名糖尿病患者）将被随机平均分配到HHA DMC组或无HHA组。患者基线/结局数据将通过OASIS获得，OASIS是一个标准化的HHC临床/人口统计学数据集，定期收集HHC患者的数据，其他机构的临床、管理和索赔数据，以及一项电话调查，用于收集满意度和自我报告的医院/ER使用数据。HHA工作满意度和培训/绩效评估数据将由待创建的工具捕获 这项研究将有助于努力控制HHC成本，提高护理质量，减少HHC辅助人员短缺。首先，它将测试一种新的HHC交付模式。如果HHA DIVICS改善了患者的预后，降低了护理成本，并且对他们的工作更满意，那么如果未来的研究支持普遍性，该模型就有希望。第二，将编制一个独特的课程，用于培训作为DMC的HHA，其中首次纳入了用于培训CHW的课程。对HHA DMC的培训和绩效进行评估，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.