Nurse-researcher's grant

For more information, contact Judith Bailey, 216-368-4442 or jcb4@po.cwru.edu.

Posted 9-30-99

NIH gives $1.2 million to nurse-researcher

Are patients who receive a high number of home healthcare visits more likely to improve their health status? Does it make any difference if the patient lives in an urban or rural area?

These are some of the issues Elizabeth Madigan will examine in a $1.2 million study funded by the National Institutes of Health's National Institute of Nursing Research.

Madigan, assistant professor of nursing at Case Western Reserve University's Frances Payne Bolton School of Nursing, and principal investigator Richard Fortinsky, director of the Center on Aging at the University of Connecticut, are exploring the links between patient outcome and home care resource consumption. Fortinsky was formerly professor of health care policy in medicine at CWRU's School of Medicine.

The incidence of home healthcare in the U.S. is on the rise, and that has prompted major efforts to contain costs and assure quality care for America's elderly, Madigan said.

Medicare, the largest insurer of home care, saw its costs nearly quadruple between 1989 and 1994. Regulations and legislative changes have caused 14 percent of the nation's home care agencies and 20 percent of Ohio's agencies to close since 1997, according to statistics from the General Accounting Office.

"Home health care under Medicare is under the gun because of new regulations," Madigan said. "We are trying to sort out the relationship between resource use and outcomes. We hope to shed some light on a very murky topic."

With this in mind, the researchers have begun to study 1,500 people from 30 randomly selected home care agencies in Ohio.

Trained home care staff, who are primarily nurses, will collect data from assessments at the patient's first and final home care visits. They will also record information about resource use at each home visit, and document whether the patients' functional abilities are getting better or worse with the home care visits.

The researchers will analyze the length and intensity of care, the total number of visits, the period of time the visits encompass, and the staff who are providing the home care visits.

"I believe most patients benefit from home visits, and these visits often diminish the use of hospital and emergency room care," Madigan said. Some patients, however, do not get better, and all we can do is to try to keep them stable. We are hoping to take our findings to healthcare policy makers."

Madigan and Fortinsky are basing this study on some research they did on the topic a few years ago. In a 1996 pilot study, they found that resource consumption patterns were similar regardless of whether patients' clinical and functional health improved or declined. Patients who had been hospitalized used twice the number of visits as those who remained at home over the same period.

The researchers plan to create a model based on patient factors, geographic market, and the type of home care agency used -- such as a hospital or Visiting Nurses Association agency -- to see how they influence patient outcome.

Other researchers involved in the three-year study are Dorothy Brooten, dean of the Bolton School; Avi Dor, associate professor of economics at the Weatherhead School of Management; Susan Payne, associate professor of epidemiology and biostatistics in the School of Medicine; and JoAnne Youngblut, associate dean of research at the Bolton School.