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Making health care safer for older adults receiving skilled home health care services after hospital discharge

Award Number: R01HS026599
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Care transitions are the movement of a person from one healthcare setting to another. Older adults who require skilled home health care (SHHC) services (e.g., home-based nursing) after hospital discharge are at high risk of experiencing early re-hospitalization. SHHC agencies need strategies to ensure safe transitions, yet there is relatively little research to guide improvement efforts. The goal of the current proposal is to develop tools to allow SHHC agencies to identify and act upon threats to older adults' safety in real time. Specific Aim 1: Analyze threats to older adult safety during hospital-to-SHHC transitions through a prospective cohort study. 1a: Describe the incidence of threats to older adults' safety (as measured by the Index of SHHC Transition Quality applied to the transitions of recently hospitalized older adults) and identify strategies for improvement from the perspectives of SHHC providers, older adults, and informal caregivers. 1b: Compare threats identified by SHHC providers versus older adults'/caregivers' Index responses. 1c: Identify which Index threats are drivers of suboptimal outcomes: (1) 30-day emergency department (ED) use or re- hospitalization; (2) older adult/caregiver/SHHC provider transition experience; (3) timely resolution of medication issues; and (4) mortality. Specific Aim 2: Refine a bundle of interventions through stakeholder engagement. Guided by a participatory ergonomics approach, we will form intervention refinement teams (IRTs) including older adults/caregivers, SHHC providers, and SHHC leadership at two large SHHC agencies. In preparation for pilot testing of the bundle of interventions, IRTs will meet to (1) present key drivers of suboptimal outcomes (from SA1) to prioritize areas for SHHC performance improvement, (2) identify system constraints and design requirements for the bundle, (3) present and select strategies for inclusion in the bundle, (4) evaluate workflow and assign roles for implementation of the bundle, and (5) anticipate barriers and brainstorm solutions. Specific Aim 3: Pilot test bundle implementation in a second prospective cohort study to test feasibility. We will use the Index to identify older adults experiencing high-risk hospital-to-SHHC transitions and deliver the bundle to these older adults. We will investigate 30-day ED use, re-hospitalization, and mortality for the intervention group and compare to concurrent and historical controls. IRTs will meet to assess the impact of the bundle as assessed through surveys and focus groups of older adults/caregivers and SHHC providers discussing (1) acceptability, (2) appropriateness, (3) identification of barriers to implementation, and (4) analysis of impact on workflow, including unanticipated consequences. Completion of these aims will result in tools to improve the quality of older adults' hospital-to-SHHC transitions. Study findings will build the foundation for future work, including a randomized-controlled-trial testing the bundle in a broader population of older adults receiving SHHC services after hospital discharge.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	6/23/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	4/4/2022	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $966,754 )
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	2/18/2021	SUPPLEMENT FOR EXPANSION	$0
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	002	3	4/15/2021	NON-COMPETING CONTINUATION	$481,581
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	1/21/2021	SUPPLEMENT FOR EXPANSION	$485,173
														Subtotal = $966,754

Issue Date FY: 2020 ( Subtotal = $488,664 )
2020	2020	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	4/22/2020	NON-COMPETING CONTINUATION	$488,664
														Subtotal = $488,664

Issue Date FY: 2019 ( Subtotal = $499,459 )
2019	2019	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	7/29/2019	NEW	$499,459
														Subtotal = $499,459

Grand Total All Awards = $1,954,877

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Making health care safer for older adults receiving skilled home health care services after hospital discharge

Award Number: R01HS026599

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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