1. Anthony, Maureen PHD, RN

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Keeping patients out of the hospital is an important goal of home healthcare. We know that patients recover better in their familiar surroundings, the risk of infection decreases, and they eat and sleep better. It is estimated that up to 20% of hospitalized Medicare patients are readmitted within 30 days of discharge, with an annual cost to society of more than 15 billion dollars a year (Medicare Payment Advisory Commission, 2012). Hospital readmissions within 30 days also have financial implications for hospitals. Repeat hospital admissions within 30 days of discharge for heart attack, heart failure, pneumonia, hip/knee replacement, and chronic obstructive lung disease result in a loss of up to 3% of Medicare reimbursement. Much has been done in recent years to prevent these readmissions. We are learning more about effective professional communication, and the benefits of interprofessional care. Transitional care teams have been developed; we have become aware of the factors that place patients at high risk for readmission. The Joint Commission has identified seven foundations that influence safe and effective transitions of care (Labson, 2015). Patient and caregiver education has become an even greater priority. We're learning to use motivational interviewing to increase patient engagement. All these factors are important and have been used collectively to reduce unnecessary readmissions to the hospital. However, nurse researcher, Dr. Olga Jarrin et al. (2014) wondered if another factor might be influencing hospital readmissions. That factor is the work environments of home healthcare agencies. The authors described the following as necessary for a suitable work environment: adequate staffing, resources for patient care, good nurse-physician collaboration, and strong nursing leadership. They conducted a cross-sectional study using publically available outcome data from 118 home healthcare agencies in three states. A sample of 1,436 home care nurses had previously completed the Practice Environment Scale of the Nursing Work Index, which measures characteristics of the work environment. Correlational methods were used to examine the relationship between work environment and hospitalization rates of the corresponding home care agencies. As the authors suspected, the home care agencies that were rated as having good work environments had lower rates of hospital readmission and more discharges to community living than those with poorly rated work environments. Just as with work environment of hospitals, the home care work environment has a clear relationship with patient outcomes. This body of research suggests that burned out employees aren't able to provide the kind of care they would like to provide. It is in the best interest of all-employers, home care clinicians, and patients-to maximize support and resources so clinicians can do the important work of home healthcare. It would reduce costly employee turnover, reduce hospital readmissions, and improve patient and employee satisfaction.

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What are the elements of your work environment that you feel support you in your work with patients? Tell us how your agency supports you and your coworkers so that you can work with your patients to produce the best possible outcomes. E-mail me at


We have another great lineup this month! The article by Dr. Tina Haney and colleagues on video telehealth etiquette is a must-read for anyone working in an agency that utilizes telehealth technology. As we move into the summer months, author Deborah Hale is back with a timely article on West Nile Virus. Paula Chavis-Parker brings us an important article on safe administration of chemotherapy in the home. Dr. Whitney and colleagues report on a study they conducted to test a specialized fall prevention program for home care patients at risk of falls. Dr. Jennifer Rice and colleagues have written an excellent guide to comprehensive foot care in the home for patients with diabetes. These and all our regular departments, bringing you the latest on home healthcare practice.


Finally, we celebrate Nurses Week May 6th to May 12th. Happy Nurses' Week to all who do so much for patients everywhere!


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Jarrin O., Flynn L., Lake E. T., Aiken L. H. (2014). Home health agency work environments and hospitalizations. Medical Care, 52(10), 877-883. [Context Link]


Labson M. (2015). Adapting the Joint Commission's seven foundations of safe and effective transitions of care to home. Home Healthcare Now, 33(3), 142-146. [Context Link]


Medicare Payment Advisory Commission. (2012). Report to the Congress: Creating greater efficiency in Medicare. Retrieved from[Context Link]