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In this study, the association between Medicare regulations and the provision of public home health care is examined. Medicare clients were compared with non-Medicare groups of those 65 years of age or over and those under 65. Results suggested that both age- and payer-related factors contribute to utilization of services. Older patients showed greater need for chronic illness care relative to younger patients; however, Medicare patients used fewer resources and had poorer outcomes relative to older non-Medicare patients.

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Although home health care traditionally is conceptualized as nursing care, in today's environment care at home may be delivered by a myriad of professional and nonprofessional practitioners. In fact, many patients who receive home care do not receive billed nursing visits. We studied a group of patients (n = 200) who received no billed nursing care, but rather received billed care from therapists, social workers and home health aides. This cohort of patients differed from patients who received billed nursing care in several ways: they were more frequently referred to home care from the community, their prognoses on admission to home care were significantly better, and their outcomes from home care services were considerably more favorable. Clearly patients not receiving billed nursing care have service and resource needs different from those of the population receiving billed nursing care. Therefore, new perspectives must be used when considering how to assess, deliver and perhaps pay for the requirements of these patients.

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The unprecedented growth in the home care industry over the past decade has produced a highly competitive environment for care delivery. To survive, most agencies are implementing strategies to maximize reimbursable care. This focus, while likely to improve an agency's financial situation, is fraught with potential problems. Reimbursed care represents only a small portion of the care that is required and delivered. Still, aside from anecdotes, little reporting has been done to document such additional service, much less to consider the consequences of reducing or deleting it. We selected a sample of 350 public health home care episodes throughout Virginia, and reviewed billing records to determine the number of billed home visits attached to them. We then reviewed home health records for the matching episodes and recorded all visits and other care-related activities (e.g., telephone calls, conferences, laboratory trips). Total home visits increased, with an average of 1.5 unbilled home visits per episode. In addition, 10 additional care-related activities take place per patient, none of which is billed. These findings represent one of the first attempts to quantify the amounts and types of nonbilled care delivered by nurses. This care consumes significant nursing resources and, as a result, may be destined to be reduced or totally eliminated.

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This study examined the feasibility of using routinely collected information on patients enrolled in home health care to predict their subsequent use of services. Data were gathered from 1,984 episodes of care randomly sampled from home health care agencies of the Virginia Health Department. Age, sex, Medicare and Medicaid enrollment, referral source, medical diagnosis, and prognosis were used to predict the total number of visits, the duration of enrollment, and the intensity of service. Since the data were originally gathered to study the effects of the implementation of diagnosis-related groups (DRGs) on home health services, half of the patients were enrolled before and half after the implementation of DRGs. Using multiple linear regression analysis, significant amounts of variance in each measure of home health care utilization were explained by the predictor variables (R2 = 0.04 to 0.10). For example, after controlling for other predictor variables, age 75 years or older predicted longer durations of enrollment and lower intensities of service as compared with other age groups (P less than 0.05), and four of 14 diagnosis categories predicted at least one measure of utilization (P less than 0.05). Medicaid enrollment predicted longer durations of enrollment and lower intensities of service in home health care (P less than 0.05) in the post-DRG but not the pre-DRG period. These results demonstrate the value of routinely collected information in predicting the use of home health services. To develop more accurate estimates of needs for home health services for particular groups of patients, additional information on chronic functional impairments, informal caregiving, and the chronicity of needs may be useful.

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It is no secret to any nurse in community health care that the DRG system has caused major shifts in the nature of the patient load, types of patients served, and level of care technology required. Phillips et al. detail the mechanism by which the care demands of the community have changed.

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Collaboration is an underutilized strategy for combining the strengths and perspective of home health care professionals in service and academic settings. This paper explores the importance of collaborative research strategies, focusing on the role of the unique talents, resources, and perspectives offered by each health professional to the research process. Finally, personal, professional and organizational barriers to collaboration are examined in order to alert would-be researcher collaborators to obstacles they are likely to encounter. When both the strengths of and obstacles to collaborative research are anticipated, collaboration can encourage research that is relevant to the needs and experiences of both home health service providers and academicians.

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Referrals to two home health agencies, one public and one private, were examined over a one-year period (n = 290). Clients in the public agency required greater frequency of visits, more nursing services, and care for a longer period of time than did those in the private agency. The public agency served a larger proportion of indigent and Medicaid clients. Increased service delivery with a decreased financial base may forebode an unhealthy future for traditional public home health agencies.

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Optimal antimicrobial therapy for viridans streptococcal endocarditis remains controversial. Rifampin was bactericidal at less than 0.2 micrograms/ml for ten strains of viridans streptococci isolated from patients with endocarditis. Administration of rifampin to one endocarditis patient already receiving penicillin and gentamicin increased the serum bactericidal activity fourfold. Rifampin has been effective in combination therapy for serious staphylococcal and enterococcal infections. The combination of penicillin and rifampin may be an effective, less toxic alternative to penicillin and streptomycin for the treatment of viridans streptococcal endocarditis.

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