Search Results (857)

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services. Full article

Background: Rural communities face persistent healthcare barriers related to workforce shortages, geographic isolation, transportation limitations and constrained emergency response capacity. Nurse-led mobile clinics may support healthcare access, continuity of care, and disaster preparedness in underserved settings. This study examined the Texas A&M University (TAMU) nurse-led mobile clinic model with respect to rural service delivery, health equity, operational considerations, and disaster preparedness. Methods: A mixed-methods descriptive program evaluation was conducted using programmatic operational data, survey responses, and preparedness-planning records. The TAMU mobile clinic serves six rural counties through primary, preventive, and behavioral healthcare delivery using in-person care, telehealth, and home visits. Disaster preparedness activities were integrated through the annual Disaster Day interprofessional simulation involving approximately 600–700 learners. A 2025 Central Texas flooding event served as a case study to evaluate operational preparedness and system readiness. Results: Mobile clinic operations supported healthcare access, continuity of care, and community engagement in rural settings. Interprofessional education simulation findings demonstrated perceived gains in teamwork, triage, communication, and rapid decision-making. During the 2025 flooding event, activation protocols were initiated; however, deployment was not authorized, highlighting system-level constraints related to administrative approval pathways despite operational readiness and workforce preparedness. Conclusions: Nurse-led mobile clinics may serve as an adaptable infrastructure for improving rural healthcare access, supporting continuity of care, and strengthening disaster preparedness. Findings further emphasize that clinical preparedness alone is insufficient without coordinated administrative processes, interoperable systems, and governance structures capable of supporting rapid emergency deployment. Full article

Background/Objectives: People aged 65 years and older who live alone and have limited functional abilities need support in many circumstances and for a variety of activities. This study was conducted to explore the available formal and informal help for seniors, using findings from the “Inclusive Ageing in Place” (IN-AGE) study. Methods: This descriptive study was carried out in 2019 in three Italian regions, i.e., Lombardy in the north, Marche in the centre, and Calabria in the south, and involved 120 older people who lived at home, either alone or with a personal/private care assistant (PCA). Using a mixed-methods approach revealed both qualitative (thematic/content analysis of narratives) and quantitative (quantifications of statements) results. Results: This study identified several needs of seniors in different circumstances concerning basic and instrumental activities of daily living (ADL and IADL), health, and mobility in/outside the home. The seniors reported that support was provided primarily by their families, followed by friends and neighbours. Public home services were considered insufficient. The participants also reported using mobility aids and instances of self-sufficiency. Conclusions: These results highlight the need to improve support services for frail seniors and to better integrate formal and informal caregiving to facilitate ageing in place and promote the well-being of older people. Adequate interventions should be implemented for both older people and their family caregivers, who play a central role in care. Full article

Based on Social Learning Theory, the Health-oriented Leadership Model posits leaders as SelfCare role models. While this modeling influence is established for general SelfCare, its applicability to sensitive behaviors—such as disclosing mental health problems—remains unclear. Additionally, the role of interactional and contextual factors is insufficiently understood. The present paper investigates whether leaders’ role modeling extends to disclosure and whether communication aspects and Working from Home (WfH) intensity moderate these effects. Two cross-sectional studies were conducted among employees working partly from home. Employees rated their own and leaders’ SelfCare; Study 2 (pharmaceutical company; N = 198) additionally assessed disclosure. Both studies included communication frequency and WfH intensity; Study 1 (public service; N = 227) measured informal communication, and Study 2 assessed communication barriers. Results confirmed that leaders’ SelfCare and disclosure were related to employees’ corresponding behaviors. Communication frequency and WfH intensity showed no moderating effects. Informal communication was associated with a stronger leader SelfCare role model effect, whereas communication barriers were associated with weaker role model effects. Findings suggest an association between leaders’ and employees’ health behavior, consistent with role modeling processes. Based on these preliminary findings, organizations may raise leaders’ awareness of their impact, while leaders should hold informal check-ins and promote barrier-free communication. Future longitudinal and experimental research should validate these findings. Full article

Background: Transitioning from hospital to home presents substantial challenges for patients with chronic obstructive pulmonary disease (COPD), often leading to difficulties maintaining self-management, functional independence, and psychological well-being after discharge. Although transitional care programs are increasingly implemented, their effects on multidimensional patient-centered outcomes remain insufficiently examined. This study aimed to evaluate the effectiveness of a nurse-coordinated transitional care service for patients with COPD during the transition from hospital to home and to examine its broader implications for improving continuity of care and patient-centered outcomes within the healthcare system. Methods: This randomized controlled trial was conducted in three university hospitals in South Korea between November 2022 and December 2024. A total of 465 patients were randomly assigned to either a nurse-coordinated transitional care intervention group or a usual care group. The intervention included structured self-management education during hospitalization, post-discharge home visits, and follow-up telephone consultations during the first month after discharge. Outcomes were assessed at baseline, 1 month, and 3 months. Statistical analyses included linear mixed-effects models for continuous outcomes and chi-square tests and independent t-tests for group comparisons. Results: Patients in the Transitional Care Group (TCG) showed marked improvements: disease awareness increased from 27.9% to 94.3% (vs. 35.7% in the Usual Care Group [UCG], RR = 2.64, 95% CI: 2.19–3.18, p < 0.001) and exercise adherence to 76.3% (vs. 43.0%, RR = 1.78, 95% CI: 1.49–2.11, p < 0.001). After adjusting for age, cognitive function declined in both groups but showed significantly smaller decreases in the TCG than in the UCG at 3 months (mean difference = −0.92, p < 0.001), and IADL demonstrated significantly better preservation in the TCG (mean difference = −1.77, p < 0.001). Self-efficacy declined in both groups but remained significantly higher in the TCG (mean difference = 2.65, p < 0.001). Anxiety and depression were significantly reduced in the TCG compared with the UCG (anxiety: −1.45, p < 0.001; depression: −2.72, p < 0.001). After adjusting for age, discharge preparedness and post-discharge management capacity were significantly higher in the TCG than in the UCG (adjusted mean differences = 3.25 and 4.93, respectively; both p < 0.001). Conclusions: These findings indicate that nurse-coordinated transitional care enhances patients’ self-management capacity and improves patient-centered outcomes during the transition from hospital to home. Full article

Innovative models of cancer care have emerged in response to advances in cancer treatment, expanding technologies that bring care closer to home and address COVID-19-related challenges and concerns about a shrinking healthcare workforce. Despite the advancements made, the psychosocial impact on people affected by cancer persists. The psychosocial burden of cancer underlines the need for patient access to evidence-based psychosocial oncology (PSO) and supportive care (SC) interventions. As models of care evolve, hiring practices of PSO professionals must also evolve for cancer patients to access properly staffed PSO programs that deliver high-quality and efficient services. In 2019, the Canadian Association of Psychosocial Oncology (CAPO)–Clinical Advisory Committee consulted administrators and clinicians across Canada to understand caseload volumes of PSO professionals with a goal to set staffing ratios. The engagement process revealed that there is no consistency in staffing PSO programs across Canada, let alone staffing ratios for PSO disciplines. In 2022, CAPO introduced a 10-point staffing framework and formula to calculate staffing ratios for hiring PSO professionals, beginning with the social work discipline. The goal of this paper is to provide updates to the existing framework and demonstrate how the formula can be adapted to other PSO disciplines. To our knowledge, this is the first published paper in Canada outlining the calculations for a PSO staff framework and formula. The authors advocate for greater transparency when reporting PSO staffing ratios across Canada, using this framework as a reference point. Organizations reporting on the cancer system performance are encouraged to develop PSO indicators, starting with tracking patient access to PSO services. Full article

Background: Although the application of smart home technology in the Chinese eldercare market is widespread, its effectiveness from the users’ perspective remains underexplored. This qualitative study examines the perceptions and experiences of older adult users in adopting and applying the Care-on-Call services (Ping An Tong; PAT), a prominent example of smart home technology for eldercare in Mainland China. Methods: Individual and dyadic interviews were conducted with 28 older adult users from diverse physical, socioeconomic, and familial backgrounds. Thematic analysis was performed. Results: Two overarching themes were illustrated based on thematic analysis. First, the multifaceted challenges of using PAT encompass an incomplete cognition of the services, unfamiliarity with PAT systems, psycho-cultural resistance, ‘do it yourself, don’t bother others’, economic concerns of additional costs, and ethical concerns regarding information security and privacy. Second, bridging the technology divide highlights the empowerment of PAT use among older adults through a variety of educational methods to effectively utilize the services, enhancing service effectiveness through the integration of smart home technology and social service provision, and increasing service accessibility through inclusive services. The disparities in smart home technology application between China and the West are also discussed. Conclusions: Psychosocial support, organizational programs, and the integrated service model are recommended to promote the utilization of smart home technology among older adults in China. Full article

Background: Infants discharged home from a neonatal intensive care unit (NICU) often have multiple ongoing medical needs. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program provides nurse navigator-led support for caregivers of high-risk infants through their first year after transitioning from the NICU to home. The objective was to compare health care resource use and costs between CCENT and standard care control groups post-discharge. Methods: Resource use and costs were collected at 4 months and 12 months post-discharge from families enrolled in the CCENT randomized controlled trial across Canada. Infant healthcare utilization and parent mental health service use and costs were analyzed from public health care system and family payer perspectives and were compared statistically between groups and within groups over time. Results: A total of 97 and 105 infants were randomized to the intervention and control groups, respectively. Significant reductions in use of medications and equipment were observed over time in both groups while use of allied health professionals decreased and emergency department (ED) visits increased for CCENT. Annual total healthcare costs per child to the public payer were $4135 (95% CI $2825, $5709) for the CCENT group and $4578 (95% CI $2246, $8356) for controls. The cost of delivering CCENT was $669 per family (SD $362). The average annual out-of-pocket cost per family was $724 (95% CI $467, $1024) for CCENT and $728 (95% CI $479, $1007) for controls. Conclusions: This study indicates the importance of considering patterns of healthcare utilization, program costs and costs to families when implementing NICU to home care interventions. Excluding the cost of a nurse navigator, costs to the healthcare system were not increased in the intervention group. Such a program may help families access appropriate care. Full article

Postpartum depression (PPD) affects a substantial proportion of women globally and is often underdiagnosed due to barriers in screening, stigma, and limited access to care. This study presents the design and pilot evaluation of an mHealth application (“HeartHabit”) intended to support user awareness, self-monitoring, and potential identification of symptoms of PPD among Greek-speaking mothers. An alpha version of the application was evaluated through an online survey with 30 women within the first postpartum year, using a walkthrough video. The evaluation focused on perceived usability and acceptability rather than clinical outcomes or real-world use. Usability and app quality were assessed via the System Usability Scale (SUS) and a qualitative version of the user Mobile Application Rating Scale (uMARS), respectively, adopting a mixed-methods approach. Demographics, and mood and stress screening data were also captured. Quantitative data were analysed via descriptive statistics and qualitative responses via Framework Analysis. The results indicated high perceived usability (mean SUS = 83.7/100). Qualitative findings highlighted the importance of practical usability, self-regulation tools, personalisation, and connectivity with healthcare professionals. Privacy, data transparency, and user control over personal data were perceived as critical for trust. The application was perceived as a potentially useful adjunct to formal care or as at-home support when access to services is limited. Larger, controlled trials, clinical implementation protocols and clinician training are needed to promote the app’s safe integration into formal care. This mixed-methods evaluation, incorporating usability assessment and patient involvement, may offer a useful paradigm for early-stage digital mental health intervention development. Full article

Voluntary placement agreements are a less understood avenue through which children and families receive child welfare services. This article describes a qualitative exploratory study of participants who oversee and engage with children and families utilizing voluntary placement services in two states (n = 12). Thematic analysis of interviews revealed voluntary placements are used as a strategy for strengths-based engagement with families, including creative problem-solving, to help obtain resources for youth with emotional and behavioral health needs. Participants also described challenges managing ambiguity regarding the use of voluntary placements and acknowledged limitations and varied outcomes of voluntary placement. Youth in voluntary placements are often overlooked in broader child welfare and foster care practice and policy discussions. Stronger accountability and guidance on voluntary placements are needed to ensure children and families are provided adequate supports to reduce the need for out-of-home placements when possible. Full article

Permanency planning, an approach to the placement of children in out-of-home care, is central to child and family system practice, policy and law. Using the example of legislative reforms in New South Wales (NSW), Australia, this article explores how privileging legal permanence leads to ongoing failures to account for Aboriginal worldviews and child-rearing practices. Drawing on qualitative research, including Yarning Circles and semi-structured interviews that I conducted with Aboriginal community members in NSW, the findings contribute to limited evidence on permanence from Indigenous perspectives, revealing how familial and cultural connectedness shape belonging and social and emotional wellbeing and highlighting the importance of children’s ongoing connections with extended Aboriginal family, community and culture. Aboriginal understandings of permanence align more closely with cultural, relational and physical domains than with the construct of legal permanence that predominates in permanency planning approaches. Prioritizing legally permanent care arrangements above other domains poses long-term risks to Aboriginal children’s social and emotional wellbeing, demonstrating the need for “deep-level” cultural adaptation in child welfare law, policy and practice. The findings have implications for decolonizing child protection and repositioning Aboriginal conceptualizations of permanence as the foundation for legislation, policy and practice—reforms that must be Indigenous-led, culturally grounded from the outset, and anchored in full implementation of principles embedding self-determination and Indigenous children’s fundamental rights. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDPs) affect approximately one in seven hospital deliveries in the United States and increase the risk of pregnancy-associated mortality. Home blood pressure monitoring (HBPM) for patients with HDPs has emerged as a model of care poised to improve ascertainment of blood pressure and triage of care during pregnancy and postpartum periods. However, the strength of evidence supporting HBPM approaches has been variable. This rapid review aimed to understand how HBPM approaches for pregnant and postpartum populations with HDPs have been evaluated in order to strengthen future research. Methods: Search criteria included peer-reviewed literature in English and French published during 2018–2024 that assessed HBPM approaches for pregnant and postpartum populations in high-income countries. A total of 370 records were screened and reviewed to identify 52 eligible articles. Key study characteristics, methodologies, and outcome measures were extracted. Identified outcome measures were mapped by outcome type (implementation, health service, and client) to assess gaps in evaluation of HBPM approaches. Results: A range of study designs were employed to evaluate HBPM approaches: experimental (17%), observational (52%), qualitative (10%), mixed method (10%), and economic (11%) designs. Over a third employed a comparison group, most of which compared HBPM approaches to usual antepartum or postpartum care. Only 11 studies reported on impact outcomes (long-term blood pressure control, adverse maternal and perinatal outcomes). Significant gaps were identified among the implementation outcomes examined. While patient engagement measures were common, assessment of provider adherence and engagement was limited. Hospital admissions and emergency department visits were often employed as proxies to measure HBPM effectiveness, efficiency, and safety. However, no studies adequately reported effectiveness measures for remote patient triage. Conclusions: Our results call for improved HBPM metrics to ensure patients are receiving high-quality care responsive to their clinical condition. Future studies on HBPM approaches should prioritize more transparent reporting on health actor engagement. A composite measure including both patient and provider adherence to monitoring and triage processes will provide stronger evidence on the effectiveness of HBPM for pregnant and postpartum patients and share impactful learning for health systems interested in adopting HBPM approaches. Full article

Objective: This study aimed to evaluate the health-related quality of life (HRQoL) of informal caregivers providing primary care to elderly chronically ill patients receiving home health care services in Türkiye and to identify patient and caregiver characteristics independently associated with HRQoL. Methods: This cross-sectional study included 499 patient–caregiver dyads enrolled in home health care services at a training and research hospital in İzmir, Türkiye. Data were collected through face-to-face interviews using a sociodemographic questionnaire, the Palliative Performance Scale (PPS), and the Short Form 36 (SF-36). One-sample t-tests compared SF-36 scores with Turkish normative values. Multivariate linear regression identified independent predictors of the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Results: Caregivers scored significantly lower than population norms across all SF-36 subdimensions (p < 0.001), with the largest impairments in Role Physical (mean difference: −53.0) and Role Emotional (−42.9). In multivariate analyses, independent predictors of poorer physical health (PCS) were severe patient functional dependence (PPS ≤ 30: β = −0.260, p < 0.001), older caregiver age (≥65 years: β = −0.089, p = 0.044), unemployment (β = −0.118, p = 0.014), additional care recipients (β = −0.095, p = 0.026), and caregiver’s own chronic illness (β = −0.169, p < 0.001). Poorer mental health (MCS) was independently associated with caregiver’s own chronic illness (β = −0.138, p = 0.002), receipt of caregiving payment (β = −0.137, p = 0.004), and university-level education (β = −0.108, p = 0.040), whereas the presence of a support person was protective (β = 0.096, p = 0.038). Conclusions: Informal caregivers of home health care-dependent elderly patients experience significantly reduced quality of life across all health domains compared with the general population. The independent determinants of caregiver health are multidimensional, encompassing patient-related factors, socioeconomic characteristics, and psychosocial resources. These findings underscore the urgent need for health systems to implement tailored interventions that address the distinct physical and mental health needs of caregivers, with particular attention to those who are elderly, chronically ill, socioeconomically disadvantaged, or highly educated. Full article

Objectives: Complex patients in need of an urgent medical assessment can contribute to crowding in the Emergency Department (ED). Optimising access to geriatric expertise for this patient group is known as ‘Geriatric Emergency Departments’. Methods: A parallel care pathway was designed to redirect frail older patients to an Urgent Geriatric Care (UGC) service rather than the ED. The UGC has access to the diagnostic facilities of the ED. This descriptive analysis reports on delivered care, diagnostics, admissions rates, discharge policy, and 30-day and 6-month outcomes concerning hospital (re)admissions, ED visits, and mortality. Results: 269 patients were analysed. The median age was 83 years, 68% had polypharmacy, 51% cognitive disorders, and 83% a gait disturbance. A median of four conclusions was drawn per patient. Evaluation at the UGC often leads to medication regimen changes (81%), initiation or expansion of care at home (46%), and initiation of dementia care (18%). The hospital admission rate was 13%; the rate of ED visits within 30 days was 5% and, within 6 months, an additional 16%; the rate of hospital readmissions within 30 days was 7%, and 11% after 6 months. The mortality rates were 9% within 30 days and 12% within 6 months. Conclusions: Evaluation of patients at the UGC led to a high degree of medication regimen changes, initiation of care at home, and multiple conclusions or diagnoses per patient. Readmission or revisiting rates were low. A direct comparison to care delivered at the ED should be made in a future study. Full article

Background: As Taiwan transitions into a super-aging society, the government has launched “Long-term Care (LTC) 3.0,” a policy initiative that marks a strategic shift from service expansion to integrated quality verification, digital oversight, and social resilience. This transition demands a robust quality verification mechanism. Ensuring perceptual consistency between service providers and external evaluators is critical for systemic fairness and sustainable service quality. Objective: This study utilized a two-dimensional gap analysis to examine the discrepancy in service quality benchmarks between home-based LTC center managers and assessment committee members, identifying critical divergence zones for institutional improvement. Methods: A cross-sectional evaluative study was conducted, involving center managers (evaluatees, n = 50) and external experts (evaluators, n = 28). The data were collected via a structured instrument covering 20 consensus benchmarks. Results: Significant perceptual gaps were identified across all dimensions (p < 0.001), with “Professional Care Quality” exhibiting the largest effect size (Cohen’s d > 1.5). Benchmarks with low external scores but high internal ratings were categorized into the “Overestimation (Management Blind Spot)” quadrant, signaling a systemic overestimation bias in administrative and clinical risk management. Conclusions: This study provides empirical evidence for the refinement of LTC 3.0 assessment systems. The results offer a strategic roadmap for policymakers to enhance organizational resilience by transitioning from subjective self-perception to objective, data-driven quality management through the two-dimensional gap model. Full article