‘Variations on a Theme’ revisited for cancer care
October 1, 1999 4 minutes read
Variations on a Theme’ revisited for cancer care
Anne Hackman, RN, MPA, says she began her hospital-based, private duty home care oncology program in early 1994 because patients were receiving different health care information from hospital and home health nurses. Hackman, who is director of Cancer Services at St. Mary’s Medical Center in Jefferson City, MO, figured that having the patients seen by one of her oncology nurses in both places would prevent the confusion and anxiety conflicting information can bring.
Because a literature search showed no documented precedent for such a program, criteria and standards had to be developed without benefit of experience. Initially, Hackman’s program required nurses to be on the inpatient unit floor for four hours, then spend the next four hours doing inpatient home visits.
"The patients loved this because they could see the same nurse in the hospital as they did at home," Hackman says. "But we had to change that a bit because when you get a high volume of clients in an area as geographically broad as ours, you may have to drive an hour or more to reach some of them. It just isn’t cost-effective to have one nurse for both locales."
Her staff have increased from three to five oncology nurses, four full-time and one part-time. The cancer nurses operate under the license of the hospital’s home health agency. However, they report to director of cancer services, who develops their schedules and assignments.
"We went to full-time nurses in each locale, but we did retain the integrity of the program," she says. "We have a care conference every Monday morning that includes all of the home care nurses, our inpatient social worker, and the home care social workers. When we see patients at the hospital who need placement or have patients coming in from home for chemotherapy, this makes a nice communication bridge for us."
On Wednesdays, the home care nurse who is taking calls for the weekend comes into the inpatient unit and attends a care conference for full briefing on any inpatients who will be leaving the hospital and needing home care.
Making positive change
Hackman believes the most important part of her program is the cross-training of staff and sharing of educational materials and teaching tools so patients receive the same information whether they are in the hospital or at home.
As she pointed out in Variations on a Theme: Structuring an Inpatient-Based Home Health Agency, co-authored with Joy Stair, MS, BSN, in 1997, home care was an element of cancer care that had traditionally been excluded from the interdisciplinary care models. There were compelling reasons for changing this.1
• Today, most integrated health delivery systems are seeking to add or strengthen the community-based services essential to a full product line. These services include all variants of home care, hospice, home IV, adult day care, and assisted living.2
• Increases in managed care’s share of the marketplace and capitated payment models require alignment of services across the health care continuum.
The Congressional Budget Office (CBO) released a report that examines the growth in Medicare spending for post-acute care services, along with policy options to slow the rate of growth in this area. The report places special emphasis on how payments for post-acute care services might be bundled. Under the CBO’s approach, hospitals would be paid a single prospective payment for both inpatient care and some amount of post-acute care services — typically, all services provided within 60 days of hospital discharge.3
Shortened hospital lengths of stay are moving patients with increasingly complex care needs into the home, which has required home care agencies to develop nursing specialists in a variety of areas rather than continuing the generalist focus of the past.4
A disease management model is increasingly being accepted as the health care delivery design that most effectively addresses today’s needs. In this model, the appropriate level of care is delivered in the appropriate setting by providers with appropriate skill levels. As disease management is defined and implemented, it requires formal links among health care providers in all settings.
The on-call and weekend coverage requirements, which were minimal at first, soon grew with St. Mary’s caseload. However, Hackman hasn’t brought in nurses from other agencies.
"One of the biggest problems we had in using other agencies was that the nurses might not be oncology-qualified and would give the client information that applied more to general medical/surgical patients, but wasn’t necessarily appropriate for the cancer patient," she explains. "Also, we have an outpatient center at St. Mary’s, so we groom our own nurses. They get their training as inpatient nurses. We have an educator who is right there at their side. When the inexperienced nurses have learned oncology as inpatient nurses, then they move to outpatient services, which is more independent, and finally to private duty home care."
Having a specialty has brought Hackman’s program almost all of the oncology home care referrals from nearby practices, because they know her nurses are oncology-trained. "We never planned to do this on a big scale," she says. "It wasn’t a grand strategy; it was just something that made sense."
References
1. Stair J, Hackman A. Variations on a Theme: Structuring an Inpatient-Based Home Health Agency. Rockville, MD: Association of Community Cancer Centers; 1997.
2. Randall DA. Five major legal issues in 1997 for the home care provider. Remington Report 1997; p. 6.
3. National Association of Home Care. NAHC Report No. 698. Washington, DC. February 14, 1997.
4. Christiansen KE. Reengineering home care: Moving from functional fixes to process improvements. Ambulatory Outreach 1997; pp. 10-12.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content