Needs assessment for hospital-based home care services

Area of Science:

• Health Services Research
• Nursing
• Public Health

Background:

• Effective health care program planning requires robust needs assessment from a population perspective.
• Existing literature lacks comprehensive strategies for assessing home care needs.
• Hospital-based home care (HBHC) services are crucial for patient transitions and continuity of care.

Purpose of the Study:

• To estimate the need for hospital-based home care (HBHC) services.
• To evaluate the effectiveness of a nurse-screening method for identifying patients requiring HBHC.
• To assess the gap between patient need and service utilization for HBHC.

Main Methods:

• A nurse-screening of admissions was conducted in an acute care general hospital over a 5-month period.
• Inclusion/exclusion criteria for HBHC were defined, and a screening nurse received training.
• Inter-rater reliability was assessed between the screening nurse and HBHC staff (Kappa coefficient = +0.45).

Main Results:

• An estimated 64% of discharged patients appropriate for home care did not receive HBHC services.
• Significant under-referral rates were observed across most hospital services, with neurology being an exception (over-referral).
• The primary cost associated with this needs assessment method is the screening nurse's salary.

Conclusions:

• A nurse-led screening approach can reliably identify unmet needs for hospital-based home care.
• A substantial gap exists in the provision of HBHC services to eligible patients.
• This needs assessment strategy is most suitable for addressing significant, infrequent policy issues in home care program planning.