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Background Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 ( n  = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively). Conclusion This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

Objective This constructivist‐grounded‐theory study explored how foster and kinship carers conceptualize and experience their role. Background Internationally, amid growing emphasis on home‐based care for children and young people living outside parental care, issues such as carer shortages, dissatisfied carers, and placement instability present significant challenges. Method Sixteen carers (seven foster carers and nine kinship carers) from a regional area in Victoria, Australia, participated in in‐depth interviews following constructivist‐grounded‐theory protocols. Results Six categories reveal the central ways carers go about caring for children and young people and the main challenges they face in doing so. The core category of “being a parent, but not” demonstrates tensions that carers experience in trying to establish a sense of belonging and connectedness with a child, within the limits of the Victorian home‐based care system. Conclusion Home‐based carers view their role through a parental lens, but with various limitations that restrict their sense of being a parent. Implications The current research acknowledges the role tensions inherent within the Victorian home‐based care system and emphasizes the importance of raising the status of foster and kinship carers to provide more recognition of the expertise they hold in the care of children and young people within this complex context.

INTRODUCTION Persons living with dementia (PLWDs) have complex needs and high expenses, and primary care (PC) plays a key role in their care. However, few American PLWDs receive adequate care, and many have unmet but potentially modifiable dementia‐related care needs. Embedding effective evidence‐based care strategies into PC settings is an opportunity to reduce excess burden but remains rare. This study evaluated the feasibility and potential impact of adapting and implementing the MIND at Home Dementia Care Navigation Program (MIND at Home) into PC at two large unique health systems in the United States. METHODS A pilot pragmatic clinical trial evaluated the feasibility and potential impact of integrating MIND at Home into primary care. Process measures included identifying and addressing a comprehensive set of dementia‐related needs for PLWDs and care partners, conducting home visits, and capturing clinic‐based outcomes such as hospital transfers and medications. Data were collected on intervention patients, with additional data obtained for a validation group within the health systems based on eligibility criteria. RESULTS A total of 105 PLWD–care partners (dyads) were enrolled for a 3‐month intervention period. All dyads received a comprehensive needs assessment, a personalized care plan, and care navigation. Seventy‐four percent of identified needs were addressed. Health care utilization measures were feasible to collect from both sites, based on validation data. Medication data were collected but were difficult to interpret. DISCUSSION MIND at Home was successfully implemented into the PC setting and key outcomes were ascertained using electronic health record data. A comprehensive evidence‐based approach that combines the benefits of clinic‐based health care and home‐based supportive services for PLWDs, their families, and their care partners has the potential to reduce unmet care needs and reduce hospitalizations. Observed trends in hospital transfers suggest a potential association that warrants further investigation, especially among PLWDs with more advanced dementia. Highlights Persons with dementia and their care partners receive fragmented, suboptimal care and support. The MIND at Home Dementia Care Navigation Program (MIND at Home) provides a solution by adding home‐based assessments and primary care (PC) integration. MIND at Home was embedded successfully into PC with fidelity into two health systems. Patient and care partner needs were identified and addressed via a care plan. Key utilization outcomes were ascertained using electronic health record data.

Background and Aim Telerehabilitation has emerged as a promising solution to address accessibility, cost‐effectiveness, and continuity of care for patients requiring long‐term rehabilitation, like cerebral palsy (CP) patients. This study aimed to qualitatively explore the perceptions of clinical specialists, and CP patients regarding the feasibility, barriers, and facilitators of home‐based telerehabilitation. Methods This qualitative study conducted a thematic analysis approach. Participants include two groups: 17 medical informatics and rehabilitation professionals and 13 CP patients and/or their caregivers. Participants were selected via expert and snowball sampling. Interviews were semi‐structured, transcribed, and analyzed using the Braun‐Clarke thematic analysis technique and MAXQDA software. Results Thematic analysis revealed four dominant themes including feasibility, barriers, facilitators, and advantages. Feasibility was affected by technological infrastructure (internet connectivity, data security), human resources (availability of multidisciplinary specialists), legal aspects (patient data privacy), and financial sustainability. Key barriers included low digital literacy, limited access to specialized rehabilitation technologies, cultural resistance, legal regulations, and financial constraints. The findings also highlighted several advantages of home‐based telerehabilitation, including cost savings, improved accessibility to rehabilitation, and enhanced patient engagement in therapy. Conclusion The current study suggested that home‐based telerehabilitation can be a feasible alternative for CP patients in Iran, but a variety of technological, financial, legal, and cultural barriers must first be addressed for its successful development. Overcoming such barriers requires targeted investments, supportive policies, and cultural education for successful implementation.

Background Cameroon’s palliative care system employs both hospital-based and traditional home-based methods, each influenced by cultural, structural, and practical considerations. This study investigated nurses’ and family caregivers’ perceptions of the differences between the two care settings, focusing on quality of care, cultural adaptation, and patient dignity. Methods This qualitative study used semi-structured interviews to explore palliative care experiences in hospital and home-based settings in Cameroon. Participants were selected using a purposeful sampling strategy to gather a diverse range of experiences. Thematic analysis was used to identify key insights and recurring patterns related to the research questions. Results Our findings highlight substantial differences between the provision of palliative care in hospitals and at home. While hospitals offer sophisticated medical interventions and standardized protocols, they face challenges due to resource limitations and conflicting cultural values with patient preferences. Home-based care, conversely, emphasizes personalized and culturally appropriate practices; however, it is often hindered by a lack of professional monitoring and adequate resources. Navigating these settings presents logistical and emotional difficulties for nurses, while family caregivers stress the significance of cultural factors in their caregiving decisions. Conclusion A blended approach to palliative care, integrating the advantages of both hospital and home settings while mitigating their drawbacks, is crucial. In Cameroon, effective palliative care depends on policymakers and healthcare providers implementing culturally sensitive strategies and optimizing resource utilization.

Background Pediatric palliative care focuses on optimizing the quality of life for children with life-limiting or life-threatening conditions and their families. Home-based pediatric palliative care is often recommended as the preferred model of care. To ensure effective home-based care, it is essential to deepen our understanding of the specific needs of families in this context. This study aimed to explore family care and communication needs in home-based pediatric palliative care from the perspective of the parents. Methods This qualitative exploratory study was conducted with five focus groups with a total of 18 parents of children with life-threatening or life-limiting conditions. Data were analyzed using narrative thematic analysis. Results Four main themes were developed: (1) The healthcare system lacks a comprehensive understanding of family needs; (2) A dedicated coordinator can alleviate the caregiving burden on parents; (3) A hotline to healthcare professionals familiar with the child is essential; and (4) A shared health record system can enhance information sharing and provide parents with a sense of control and oversight. Conclusion Parents of children with life-limiting or life-threatening conditions face complex caregiving responsibilities while simultaneously navigating the healthcare system, seeking information, and coordinating care. These findings highlight the importance of a dedicated care coordinator in communicating with the various healthcare services involved. Also, parents emphasized the need for streamlined information sharing and easier access to critical health information regarding their child’s condition.

We report the case of an 82‐year‐old male with a history of multiple cerebral infarctions who developed bullous pemphigoid while receiving home‐based care. Anti‐BP180‐NC16a antibody was initially negative, but later became positive as the disease severity worsened. The patient was successfully managed at home through a collaborative effort between a home‐visiting physician (general practitioner), dermatologist, nursing staff, and pharmacists. This case highlights the value of reevaluating anti‐BP180‐NC16a antibody levels and the feasibility of home‐based care for severe bullous pemphigoid in bedridden patients. We present the case of an elderly male with bullous pemphigoid, initially negative for the anti‐BP180‐NC16a antibody, which later became positive as disease activity progressed. The patient was successfully managed at home through multidisciplinary collaboration, including a general practitioner, dermatologist, nurses, and pharmacists.

Presentation A 77-year-old man began receiving home care services at the request of his wife, reporting that the patient had been experiencing a persistent cough and wheezing for 2 weeks yet resolutely refused to seek medical care outside the home. Per his wife and daughter, he suffered from visual impairment, and his refusal to seek medical care was driven by a desire to conceal this condition from others. Vital signs were recorded as follows: body temperature, 36.9°C; blood pressure, 144/60 mmHg; heart rate, 90 bpm; respiratory rate, 24 per minute; and oxygen saturation, 97% on ambient air. Laboratory results indicated a white blood cell count of 18,560/μL (reference range: 3590–9640), a platelet count of 32.0 × 104/μL (reference range: 14.8–33.9), and a C-reactive protein (CRP) level of 5.30 mg/dL (reference range: 0.00–0.14).

Background Successful implementation and sustainability of person-centred care (PCC) require continuous evaluations and valid measurements. While several instruments measure patients’ experience with PCC, to our knowledge, no validated instrument exists in Swedish for use in home-based primary care (HBPC). This study aimed to adapt and further develop an instrument for measuring patients’ experiences of person-centred care in HBPC for use in the Swedish municipal health care system, with a 12-item version of the Person-Centred Community Care Inventory (PERCCI) used as a starting point. Furthermore, its content and measurement properties were evaluated via a mixed-methods approach involving item response theory and qualitative content analyses. Methods This study was conducted in two stages. First, the PERCCI 12 item version was translated into Swedish using a forward-backward approach. Content validity was evaluated through focus groups with 24 registered nurses and managers, resulting in revisions. Second, the revised version (PERCCI-S) was psychometrically evaluated via two rounds of postal questionnaires (2022; 2023) with patients 18 years or older receiving municipal HBPC in Sweden ( n  = 1,171; n  = 1,429). The psychometric evaluation involved factor analyses and item response theory analyses to assess dimensionality, item difficulty and discrimination, item and test information, test‒retest reliability, internal consistency reliability, as well correlational analyses of convergent and discriminant validity. Content validity was further assessed through a panel review with experts ( n  = 7) and cognitive interviews with patients ( n  = 20). Results Exploratory and confirmative factor analyses support an overall unidimensional structure. The item response theory analyses indicate acceptable item characteristic curves and overall test information. The internal consistency reliability was satisfactory ( r 2022 = 0.97 and r 2023 = 0.96). Test-retest reliability showed good temporal stability ( r  = 0.79, n  = 96). The content validity index was 1.0, indicating that all the items were relevant. However, the scale’s discriminant validity was unsatisfactory, with 18.0% of respondents having the highest score. Conclusions The psychometric evidence of the PERCCI-S provides support for its use in the Swedish municipal HBPC. Future studies should test different response formats in an effort to reduce ceiling effects.

Background In 2014, Mass General Brigham, formerly Partners HealthCare, launched a novel urgent home‐based medical care program to provide rapid medical evaluation and treatment to homebound patients and older adults with frailty or limited mobility named the partners mobile observation unit (PMOU) program. Methods We conducted a pragmatic, embedded evaluation assessing the impact of PMOU on postreferral utilization and total medical expenditure (TME). We used propensity weighting and logistic regression to estimate the 30‐day adjusted odds ratios (ORs) of emergency department (ED) utilization and inpatient medical hospitalization for patients enrolled in PMOU (891 episodes of care) relative to those who were referred but not enrolled in the program (57 episodes of care) during the period of April 2017 to June 2018. We additionally conducted a difference‐in‐differences analysis assessing program impact on TME, comparing claims data 30 days pre/post referral. Results Despite positive trends, there were no statistically significant differences between the two groups with regard to postreferral ED visits or hospitalizations, with an OR of 0.83 (p = 0.56) and OR of 0.64 (p = 0.21), respectively. There was no statistically significant difference in pre/post referral TME for intervention relative to control episodes (p = 0.64). In post hoc analysis of control episodes, 75% received care elsewhere within 14 days of referral. Conclusion Although the results suggested positive trends, this analysis of this relatively mature program was unable to identify statistically significant reductions in ED visits, hospitalizations, or TME associated with the PMOU program. Future efforts to build home‐based urgent care programs or related programs targeting older adults with frailty or limited mobility should aim to improve patient targeting and identify opportunities to improve program operations and generate meaningful reductions in healthcare utilization and spending.