case management, home health care, home health outcomes, rehospitalization



  1. Vasquez, Monica S. BSBA, RN, COS-C


Purpose/objectives: To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare.


Primary practice settings(s): Primarily for home healthcare but can also be a tool for all other fields in nursing.


Findings/conclusions: Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system.


Implications for case management practice: The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.