1. Greenberg, E. Liza MPH, RN

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How much time does your agency spend preparing patients for a successful stay at home after discharge from home healthcare? With the implementation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, it's time to think about that handoff from home healthcare to the community. The Visiting Nurse Associations of America (VNAA), in partnership with the Association for Home Health Quality and Innovation (AHHQI), recently launched a new "Discharge to Community" module on our best practice website, the VNAA Blueprint for Excellence ( to help agencies plan and develop effective discharge strategies. Home healthcare agencies (HHAs) began reporting the IMPACT Act "Discharge to Community" performance measure on January 1, 2017. The Centers for Medicare and Medicaid Services (CMS) states the claims-based measure captures:


HHA's risk-standardized rate of Medicare FFS patients who are discharged to the community following a HH episode, and do not have an unplanned readmission to an acute care hospital or LTCH [long term care hospital] in the 31 days following discharge to community, and who remain alive during the 31 days following discharge to community (CMS, 2016).


Therefore, HHAs are evaluated not on the absolute number of readmissions, but on the excess, or risk-standardized rate based on the projected rate.


The VNAA-AHHQI Work Group began by examining current agency practices used to identify risk factors for readmission and prepare patients for discharge. The group reviewed current evidence and found little research specific to readmissions after home healthcare discharge. Expert consensus identified a number of key priorities. The VNAA/AHHQI group determined that helping patients successfully remain in the community requires:


* A comprehensive home healthcare discharge plan developed with patient and family


* Connections to community resources for support and engagement


* Working with upstream referral sources to ensure appropriate initial placements of patients in home care, palliative/hospice care, or skilled nursing facilities.



Discharge Planning

Now more than ever, agencies need to engage patients and caregivers in the planning process. The patient or caregiver should be able to articulate the name of their provider, when their next visit will be, how they will get there, and questions to ask. They need to be able to recognize worsening symptoms and state a plan for accessing urgent care services without having to visit an emergency department. Importantly, the plan should include detailed information on medication management, refills, and how and where they will get their medications.


Connecting to Community Resources

Home healthcare social workers have an increasingly important role with this extended postdischarge accountability. Particularly for high-risk patients, HHAs need to make a social work referral early after HHA admission. Social workers assess comprehensive social needs including food security, transportation, financial means, and caregiver capability. A key social work role is to create handoffs to community-based organizations. Agencies should proactively develop relationship with community organizations to meet nutrition, caregiving assistance, transportation, and other needs.


The VNAA-AHHQI initiative on Discharge to Community demonstrated the opportunity to further engage social workers and community resources to improve community stay. A few, such as one large northeastern agency, have already adopted programs. This agency employs Community Resource Specialists to assist clinicians in supporting the patient at home. These specialists identify resources for personal care, transportation, lifeline, prefilled medication systems, assistance with medical forms and applications, and connecting patients with disease support services.


The Discharge to Community measure demonstrates CMS's expectations for HHA accountability for patients after discharge. VNAA's Blueprint for Excellence offers expert recommendations from peers to help agencies understand these strategies and take steps to improve successful community stays.


NIH Designates $42.7 Million for Food Allergy Research Consortium

The National Institutes of Health (NIH) intends to award $42.7 million over 7 years to the Consortium of Food Allergy Research (CoFAR) (link is external) so it may continue evaluating new approaches to treat food allergy. Established in 2005, the CoFAR has been continuously funded by the National Institute of Allergy and Infectious Diseases, part of NIH. The first year of funding has been awarded, and awards will be made in subsequent years based on the availability of funds.

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An estimated 4% of adults and 5% of children in the United States have food allergy, a condition in which the immune system reacts abnormally to a component of a food. Allergic symptoms can range from mild reactions, such as hives or stomach cramps, to severe and life-threatening anaphylaxis, characterized by swelling of the larynx, difficulty breathing, and fainting from low blood pressure. The prevalence of food allergy is rising without a known cause, and no U.S. Food and Drug Administration-approved treatment for food allergy is yet available.


To address this problem, CoFAR scientists are working to develop immunotherapy approaches to treat food allergy. Immunotherapy involves exposing the immune system to an allergen in a controlled way to eventually reduce immediate allergic symptoms and ultimately bring about long-term relief. This technique can take many forms, and the CoFAR is investigating different approaches.


Among its accomplishments to date, the CoFAR has demonstrated the clinical benefit of egg oral immunotherapy for treating egg allergy and has identified the most promising routes, doses, and durations of egg and peanut immunotherapy for further study. In addition, the CoFAR has identified genes associated with an increased risk for peanut allergy among Americans of European descent.




Centers for Medicare and Medicaid Services. (2016). Measure specifications for measures in the CY 2017 HH QRP final rule. Retrieved from[Context Link]