Since its founding 125 years ago, the Visiting Nurse Service of New York (VNSNY) has not only become the largest not-for-profit home- and community-based health care organization in the United States, it’s also launched dozens of groundbreaking research projects and created an infrastructure within the business dedicated to these efforts.
Over the past three decades, in particular, VNSNY and its Center for Home Care Policy & Research has spent roughly $65 million on dozens of groundbreaking research projects focused on the booming home health, home care and hospice fields. Most of that funding has come from 38 federal grants and contracts, with additional funds steadily flowing into VNSNY’s research coffers from the New York State Department of Health and from a long list of foundation-type backers.
Some of those backers include the John A. Hartford Foundation, the Robert Wood Johnson Foundation and The Fan Fox and Leslie R. Samuels Foundation, Kathryn H. Bowles, vice president and director of the VNSNY Center for Home Care Policy & Research, told Home Health Care News.
“We’re the only research center of this ilk in home care in the U.S., as far as we’re aware of,” said Bowles, who also works as a professor at the University of Pennsylvania School of Nursing and holds the title of van Ameringen Chair in Nursing Excellence. “We’ve generated a lot — a real lot — of good evidence for the home health and hospice industries.”
VNSNY operates as a nonprofit, but even for-profit home-based care providers can draw lessons from the New York-based organization’s dedication to methodical, high-quality research projects. That’s especially true as the U.S. health care system shifts to value-based care and more innovative payment models begin to emerge.
A VNSNY study from 2016 funded by the Agency for Health Care Research and Quality (AHRQ), for example, highlighted how front-loaded home care and physician office visits could reduce hospital readmissions for heart failure patients. AHRQ is a government agency that functions as part of the Department of Health & Human Services to support research improving health care quality.
A more recent study spearheaded by VNSNY researcher Max Topaz revealed how better, technology-enabled patient prioritization upon hospital discharge could improve home care timing, offset staffing challenges and more effectively keep patients at home.
“Many of the contracts that we’ve had over the years have been from payers asking us to help them figure out what works and what doesn’t work,” Bowles said. “Quality is so important from a business standpoint. Your customers look to you, and they want to know you are a cutting-edge agency using the best evidence to provide high-quality care.”
VNSNY is not alone in touting the increasing importance of data related to home-based care.
Humana Inc. (NYSE: HUM) — a top player in the Medicare Advantage (MA) market — has repeatedly emphasized how data and understanding “what’s going on in the home” are essential for expanding home-based care’s role in the broader continuum.
Finding strength in size
VNSNY and its more than 13,000 nurses, rehabilitation therapists, social workers, home health aides and other employees provide care for about 48,500 patients and health plan members on any given day.
The most frequent diagnoses among VNSNY patients, according to the organization, are heart disease, diabetes, cancer and various wounds. VNSNY research has focused on those diagnoses, plus several others.
The Center for Home Care Policy & Research operates with a team of about 20 salaried staff members, seven of whom are investigators, or people who work with clinical staff to develop new research programs. Another 10 to 15 per diem staff members help out with implementation or data collection as needed, Margaret McDonald, associate director of the Center for Home Care Policy & Research, told HHCN.
“There are peaks and lulls depending on the grants we have going on,” McDonald said. “But the infrastructure at the Visiting Nurse Service of New York for research is very strong. Things are stable and in place, which enables us to function the way we have.”
Besides VNSNY’s ability to secure and capitalize on external funding, the nonprofit home-based care provider is also buoyed by its sheer size and the diversity of its patients. VNSNY served more than 135,000 patients in 2017, with nearly half of them speaking languages other than English.
“The size of the agency really has made it amenable to research studies,” Bowles said. “The diversity of patients — given that VNSNY services all boroughs of New York City, with all its different languages, plus ethnic and racial differences and socio-economic differences – allows for a rich sample.”
Even when VNSNY doesn’t lead the research directly, that patient diversity has appeal to other researchers as well. A 2018 study used VNSNY medical records in finding that black or African-American home health patients were 45% more likely to visit the ER and 34% more likely to be re-hospitalized compare to non-Hispanic whites.
Building a research powerhouse
Current VNSNY research includes a look at sepsis prevention in home health and various hospice-related studies, Bowles and McDonald said. In general, VNSNY has seen an uptick in hospice research that is in line with increasing demand for hospice services.
Another major benefit VNSNY has in terms of research: its close proximity to well-regarded, national research institutions, including the University of Pennsylvania, Columbia, New York University, Harvard, Yale and other prestigious public and private universities.
“There are so many collaborators right in the New York City area,” McDonald said.
The very first foundation grant to the Center for Home Care Policy & Research — launched in 1992 — came in 1995 to study ways for reducing inappropriate medication use. By 2002, the research center eclipsed more than $10 million in external grant funding awarded. By 2010, its total published articles since inception soared to more than 200.
Additionally, the Center for Home Care Policy & Research has begun formalizing — or has already formalized — collaborations with Harvard’s Dana Farber Cancer Institute, the New School, UPenn School of Engineering, Johns Hopkins university and the MET Council.
Ultimately, the investment into home-based care research is so important because, nowadays, “the home is the hub of health care,” Bowles said.
“People want to stay in their homes and don’t want to be hospitalized,” she said. “Penalties that hospitals are incurring, there’s a big push to keep people healthy and in their homes. Any supports that we can provide through home care to make that happen are really critical at this point.”
Written by Robert Holly