Harvard Pilot Proves Value of In-Home Care Checklist

A quick intervention tool that aims to reduce hospital readmissions among home care patients has found some initial success in a recent pilot study approved by Harvard Medical School.

Hospital readmissions are one of the costliest expenses across the health care system, and home care can play a big role in reducing avoidable readmissions. The study, which was conducted over six months in early 2016, found that caregivers who utilize a short checklist about their patients’ conditions were able to report a number of changes that could result in more serious care interventions if left untreated.

The study looked at 22 offices with Right at Home (RAH), a home care company with more than 310 offices in 45 states. The company operates on a franchise model, and offers three levels of care, including companion, personal care, and skilled care.

Caregivers were required to clock-in and clock-out of a web-based software platform by ClearCare that operates for visit scheduling, integrated telephony for point-of-care reporting, two-way caregiver messaging and other managerial functions. The check-in moments, which were designated at the beginning and end of a shift for payroll purposes also included a checklist about their patients.

Check-in, Check-out 

The checklist was administered when caregivers clocked out telephonically, which required them to answer a number of questions devised by the study authors, ClearCare and RAH in 2014. The checklist asked a number of questions, such as, ”Does the client seem different than usual? Has there been a change in mobility, eating or drinking, toileting, skin condition or increase in swelling?”

If a caregiver notes any changes in condition, they receive additional questions before receiving a task on the system dashboard of the office’s care manager. The care manager can use that task, along with more information from the caregiver, to determine potential actions for the patient.

“Most interviewees suggested that changes in condition would not have been reported without the in-home checklist,” the study reads. “They also reported relatively few ‘false positives’ in that they felt that most of the tasks warranted attention.”

During the course of the study, caregivers throughout the 22 RAH offices that participated reported condition changes after 2% of all shifts, representing an average 1.9 changes per care recipient. There were 402 hospitalizations over the study period, or 18 hospitalizations per office on average.

Caregivers noted that the changes likely wouldn’t have been tracked if the checklist weren’t in place. However, care managers had varying views on the system.

“Certain care managers expressed concern that they already had systems in place to track changes in condition and hospitalizations and questioned the need for the In-Home intervention,” the study reads. “One care manager explained that, before the In-Home pilot, caregivers would call the office to report a change in an individual’s condition. thus, she felt that the In-Home program was somewhat redundant.”

Other issues with the tracking were related to care recipients with chronic conditions that flared up occasionally. Right at Home staff reportedly said the checklist was not the right mechanism for chronic conditions, because many of these changes were caused by predictable flare-ups.

Fortunately, caregivers reported that the checklist had a largely positive effect and felt “enthusiastic about the intervention,” according to the study. They even noted that the checklist did not add much time to the clock-out process overall, and enjoyed feeling they had a larger role in the overall care of the care recipient.

Written by Amy Baxter