FOR INFORMATION CONTACT:Pam Surges(708) 202-2716[email protected]
Embargoed by the Journal of the American Medical AssociationFor Release on Tuesday, December 12, 2000 at 3:00 PM, CT
CHICAGO -- New research appearing in the December 13 issue of the Journal of the American Medical Association, finds that an innovative model for home health care used at U.S. Department Veterans Affairs (VA) medical centers yields more satisfaction for patients and family caregivers, than private-sector home care. VA's home care model features a greater hands-on role for doctors and close cooperation among nurses, social workers and other team members.
The study is among the first large-scale evaluations of home care to consider the burden on family members and their emotional well-being. "This is the first home-care effectiveness study, to our knowledge, to assess the impact on caregiver health-related quality of life, caregiver satisfaction with the patient's care, and caregiver burden," write the authors. "Consistent benefits [for the VA home-care group] were observed in these outcomes."
Researchers from VA, the University of Illinois at Chicago, and Northwestern University tested VA's "Team-Managed Home-Based Primary Care" model against non-VA home-care at 16 sites. Nearly 2,000 home-care patients, most of them severely disabled or terminally ill participated in the study.
While death rate and physical functioning did not differ between the two groups of patients, VA patients and their caregivers overall expressed more satisfaction with their care. Terminally ill patients in the VA sample gave higher marks to their care in six of eight quality-of-life measures, including emotional functioning, bodily pain and mental health. Caregivers in the VA group reported less "burden," translating into reduced caregiver stress and burnout.
The VA model allows for greater physician involvement in patient care, even to the point where physicians make home visits when needed, according to VA researcher and co-author Frances Weaver, Ph.D. In the study, about 15 percent of VA patients were visited by a doctor at home, compared to none with the Medicare group.
"Since VA home-care physicians have a defined amount of time allocated to home care, they are not constrained by administrative and billing issues," notes, Dr. Weaver, who is with the Midwest Center for Health Services and Policy Research at the Hines VA Medical Center, in Hines, Ill., and the Institute for Health Services and Policy Research at Northwestern University.
"The physician is free to work with the patient directly or with the team on the patient's behalf. This flexible arrangement can be viewed as adding value and benefit to the patient."
The authors conclude that the VA hospital-based model of home care promotes better communication between the physician and other team members--nurses, physician assistants, therapists, dietitians, social workers.
Lead author Susan L. Hughes, D.S.W., believes that in the private sector, where it is up to individual home-care agencies to maintain contact with the primary-care physician, "the quality and quantity of communication can be quite variable."
"Our interpretation is that when the primary-care physician is working closely with the home-care team, per the VA model, then continuity of care is enhanced, improving patient and caregiver satisfaction with care," says Hughes.
Informal home-based family care costs in the U.S. are nearly $200 billion per year, compared to around $30 billion for formal home health care, according to a 1999 study.
This four-year study was funded by VA's Health Services Research and Development Service and Cooperative Studies Program. Collaborating with Dr. Weaver were lead author Susan L. Hughes, D.S.W., with the University of Illinois at Chicago and formerly with VA; Anita Giobbie-Hurder, M.S., of VA; Larry Manheim, Ph.D., of VA and Northwestern University; William Henderson, Ph.D., Joseph D. Kubal, M.A., and Joan Cummings, M.D., all with VA; and Alec Ulasevich, Ph.D., formerly with VA.
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NOTE FOR EDITORS OR PRODUCERS : For interviews with Dr. Frances Weaver, co-author of this study, please contact Pam Surges, Public Affairs Officer, Hines VA Medical Center at (708) 202-2716, or [email protected]. For additional assistance, please contact Jim Blue at (212) 807-3429 or [email protected].
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