Process Evaluation of a Nurse Home Visiting Intervention

Thursday, 15 July 2010: 1:45 PM

Dianne Veronica Liebel, RN, PhD, MSEd
School of Nursing, University of Rochester, Rochester, NY

Learning Objective 1: 1. Evaluate the specific intervention components of nurse home visiting that impacted disability status among high risk Medicare beneficiaries

Learning Objective 2: 2. Discuss the implication of applying nurse home visiting practices (intervention components) to improve chronic care management for older persons living in community settings

Background: Internationally older adults experiencing and recovering from disability prefer to remain living at home. Nurse home visiting thereby offers an effective method to deliver geriatric strategies to improve/maintain disability and promote health. The nurse intervention of the Medicare Primary and Consumer-Directed Care Demonstration is one of only six home visiting studies reporting positive disability outcomes for community dwelling elders with existing disability.
Purpose: The purpose of the study was to use the classic Donabedian conceptual model to perform process evaluation on a nurse intervention that reported statistically significant differences in disability outcomes (ADL) compared to controls and illuminate these results further using case studies to examine the barriers and facilitators of disability maintenance/improvement.Methods: Performed process evaluation using quantitative methods and case studies to determine which intervention components were most associated with disability using data from nurse notes, case studies, and Demonstration databases.
Results: Results showed high levels of participation, dose, and fidelity for intervention components. Home visits were effective in maintaining/improving disability among 60% of patients. These individuals were more limited in ADLs, younger, and had less cognitive impairment, higher SF-36 scores, and perceived their health as being unchanged. After adjusting for baseline characteristics, medication self-management and the number of intervention materials patients used were significantly associated with disability maintenance/improvement. Patients with more disability received significantly more home visits, disease self-management activities, goals, and family conferences. Sub-group analyses further revealed that patients receiving recommended doses of intervention components were more likely to maintain/improve disability. Case study analyses of patients with disability maintencen/improvement vs. worsening will be presented to elucidate how the nurse model impacted disability status and other health outcomes.
Conclusion: These analyses provide evidence to potentially reform eligibility criteria and expand nursing services to patients who need chronic homecare management not eligible under current health system guidelines.