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Home-care visits questioned in new study; advocates cry foul


By Sabriya Rice
Posted: March 12, 2014 - 5:30 pm ET
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No robust, consistent evidence exists to show that home care visits actually help the elderly to live longer or more independent lives, when compared with seniors who have not been visited, the authors of a new study conclude in a review of literature on home care visits in the U.S., Canada, the United Kingdom and several other countries. Advocates in the U.S. called the results misleading and baffling, warning that, without context, the study could derail future improvement efforts.

“Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits,” wrote the authors of a literature review published Wednesday in the journal PLOS One. “Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective,” they said.

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To evaluate the effect of home care visits on reducing death rates, preventing injuries, reducing rates of hospitalization and improving overall quality of life—investigators from Yale, Oxford and University College London examined the evidence of trials spanning the past 20 years in multiple countries, which included a total estimated population of more than 29,000 patients. Their review concluded that preventive home visits did not have “important effects” on mortality or on independent living overall, and that in the future, guidelines might recommend against the interventions altogether.

Currently in the U.S., Medicare provides a benefit for qualifying patients to obtain certain healthcare services at home. Skilled nurses can visit certain patients to administer shots, provide tube feedings, change dressings and give educational instruction. Patients also can receive services such as physical and occupational therapy, and speech-language pathology. In 2011, about 3.4 million Medicare beneficiaries received home care, and the program spent about $18.4 billion on home health services, according to a report from the Medicare Payment Advisory Commission (PDF), which advises congress on Medicare issues.

Groups advocating for home care in the United States issued harsh responses to the study findings, saying the nation's programs have been very effective in helping vulnerable patients.

“The study… presents a misleading view of the role of home health for elderly populations and its place in healthcare policy,” responded Tracey Moorhead, president and CEO of the Visiting Nurse Associations of America, a Washington-based not-for-profit that advocates for home health services. In a statement issued Wednesday by the VNAA, Moorhead said the conclusions are a “sweeping generalization based on vague definitions and without acknowledgement of the systemic differences in the healthcare policy and laws of the 13 countries included in its analysis.”

The researchers, she said, did not define what services would be considered part of a good home health program, and the methodology used “does not align with U.S. Medicare policy and law, which views home healthcare as a short-term post-acute benefit to prevent re-hospitalizations in vulnerable patients.”

“It's baffling to see the results of this literature review, said William Dombi, vice president for law of the National Association for Home Care. “The conclusion seems to be off-base from what we see as evidence in a number of programs in the U.S.” The researchers started with the premise that programs in each of the countries are essentially the same, he argued, something he doesn't believe to be true. “Home care has been around in the U.S. in an organized way for more than 100 years. There has been increased integration, improved data sources—the value of home care has been more than established, it's been established in the sense that it's axiomatic,” he said.

He did agree with the authors on one point, however, that there are still shortcomings in uniform reporting data and assessment tools for looking at quality care and clinical outcomes of home care visits. Although admitting the U.S. could get better at reporting on that aspect, he warned that the current study could end up derailing efforts to bring about future improvements.

“We're not going to sit lightly with a study like this,” Dombi said.

Follow Sabriya Rice on Twitter: @MHSrice


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