A qualitative study of home health care experiences among Chinese homebound adults

BMC Geriatrics - Tập 21 Số 1 - 2021
Rui Zhou1, Joyce Cheng2, Shuangshuang Wang1, Nengliang Yao3
1Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China
2University of Virginia, College of Arts and Sciences, Charlottesville, VA, USA
3NHC Key Lab of Health Economics and Policy Research(Shandong University), Jinan, 250012, China

Tóm tắt

Abstract Background Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China. Methods This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi’s method was used to generate qualitative codes and identify themes. Results The evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly. Conclusions Findings from this study suggested that the HHC model benefited Chinese older adults—primarily homebound adults—in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.

Từ khóa


Tài liệu tham khảo

Qiu WQ, Dean M, Liu T, George L, Gann M, Cohen J, et al. Physical and mental health of homebound older adults: an overlooked population. J Am Geriatr Soc. 2010;58(12):2423–8. https://doi.org/10.1111/j.1532-5415.2010.03161.x.

Jing L-W, Wang F-L, Zhang X-L, Yao T, Xing F-M. Occurrence of and factors influencing elderly homebound in Chinese urban community: a cross-sectional study. Medicine; 96. Epub ahead of print June 2017. doi:https://doi.org/10.1097/MD.0000000000007207.

Bloom DE, Boersch-Supan A, McGee P, Seike A. Population aging: facts, challenges, and responses. Benefits Compens Int. 2011;41(1):22.

Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54. https://doi.org/10.1016/s0140-6736(15)00516-4.

Musich S, Wang SS, Hawkins K, Yeh CS. Homebound older adults: prevalence, characteristics, health care utilization and quality of care. Geriatr Nurs. 2015;36(6):445–50. https://doi.org/10.1016/j.gerinurse.2015.06.013.

Li C, Zhou R, Yao N, Cornwell T, Wang S. Health care utilization and unmet needs in Chinese older adults with multimorbidity and functional impairment. J Am Med Dir Assoc. 2020;21(6):806–10. https://doi.org/10.1016/j.jamda.2020.02.010.

Strayer MS. Perceived barriers to oral health care among the homebound. Spec Care Dent. 1995;15(3):113–8. https://doi.org/10.1111/j.1754-4505.1995.tb00492.x.

Norman GJ, Wade AJ, Morris AM, Slaboda JC. Home and community-based services coordination for homebound older adults in home-based primary care. BMC Geriatr. 2018;18(1):241. https://doi.org/10.1186/s12877-018-0931-z.

Salinas RC, Madison SD. Home health care. In: Fenstemacher PA, Winn P, editors. Post-acute and long-term medicine. Cham: Springer International Publishing; 2016. p. 1–11. https://doi.org/10.1007/978-3-319-16979-8_1.

Edes T, Kinosian B, Vuckovic NH, Olivia Nichols L, Mary Becker M, Hossain M. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc. 2014;62(10):1954–61. https://doi.org/10.1111/jgs.13030.

Boling PA, Chandekar RV, Hungate B, Purvis M, Selby-Penczak R, Abbey LJ. Improving outcomes and lowering costs by applying advanced models of in-home care. Optimizing Home Health Care Enhanced Value Improved Outcomes. 2013;7(1 e-suppl 1):e-S7–e-S14. https://doi.org/10.3949/ccjm.80.e-s1.03.

Eric De Jonge K, Jamshed N, Gilden D, Kubisiak J, Bruce SR, Taler G. Effects of home-based primary care on Medicare costs in high-risk elders. J Am Geriatr Soc. 2014;62(10):1825–31. https://doi.org/10.1111/jgs.12974.

Brumley RD, Enguidanos S, Cherin DA. Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med. 2003;6(5):715–24. https://doi.org/10.1089/109662103322515220.

Shafir A, Garrigues SK, Schenker Y, Leff B, Neil J, Ritchie C. Homebound patient and caregiver perceptions of quality of Care in Home-Based Primary Care: a qualitative study. J Am Geriatr Soc. 2016;64(8):1622–7. https://doi.org/10.1111/jgs.14244.

Inner Mongolia Autonomous Region Health and Family Planning Commission. Inner Mongolia Autonomous Region government portal website business work Notice of Inner Mongolia Autonomous Region Health and Family Planning Commission on matters related to medical institutions launching home-based medical services. Available at: http://wjw.nmg.gov.cn/doc/2016/11/02/99506.shtml. Accessed 15 Mar 2021.

Feng W, Ge Y. Accelerate the development of on-site medical and emergency assistance services. Soc Governance R. 2019;(11):52–8. https://doi.org/10.16775/j.cnki.10-1285/d.2019.11.015.

National Health Commission of the People’s Republic of China. Notice on Strengthening Home Health Care Services for the Older Adults, Available at: http://www.nhc.gov.cn/yzygj/s7653pd/202012/19a2617ba8e641bea9ac2472ea04c82a.shtml. Accessed 15 Mar 2021.

Yao N. Research on the Service Mode of Home Care Medicine in China.Chinese Gen Pract. 2020;23(12):1455–8. https://doi.org/10.12114/j.issn.1007-9572.2019.00.487.

Ornstein KA, Leff B, Covinsky KE, Ritchie CS, Federman AD, Roberts L, et al. Epidemiology of the homebound population in the United States. JAMA Intern Med. 2015;175(7):1180–6. https://doi.org/10.1001/jamainternmed.2015.1849.

Content Analysis Method and Examples | Columbia Public Health, Available at: https://www.publichealth.columbia.edu/research/population-health-methods/content-analysis. Accessed 15 Mar 2021.

Lee T-Y, Landy CK, Wahoush O, Khanlou N, Liu Y-C, Li C-C. A descriptive phenomenology study of newcomers’ experience of maternity care services: Chinese women’s perspectives. BMC Health Serv Res. 2014;14(1):114-22. https://doi.org/10.1186/1472-6963-14-114.

Morrow, R., Rodriguez, A, King N. Colaizzi’s descriptive phenomenological method Available at: https://pdfs.semanticscholar.org/4f7f/7b13a83444292cf2da1a88198111b7a936ef.pdf?_ga=2.121289992.1631737805.1594878565-1020762033.1594878565. Accessed 22 Apr 2020.

Wirihana L, Welch A, Williamson M, Christensen M, Bakon S, Craft J. Using Colaizzi’s method of data analysis to explore the experiences of nurse academics teaching on satellite campuses. Nurse Res. 2018;25(4):30–4. https://doi.org/10.7748/nr.2018.e1516.

Shosha GA. Employment of Colaizzi’s strategy in descriptive phenomenology: a reflection of a researcher. Eur Sci J. 1857;8:13.

Beck RA, Arizmendi A, Purnell C, Fultz BA, Callahan CM. House Calls for Seniors: building and sustaining a model of Care for Homebound Seniors: HOUSE CALLS FOR SENIORS. J Am Geriatr Soc. 2009;57(6):1103–9. https://doi.org/10.1111/j.1532-5415.2009.02278.x.

Chen L. The research on homebased medical care services. Today Nurse. 2020;27:175–8. https://doi.org/10.19791/j.cnki.1006-6411.2020.07.082.

Hao X, Bo T, Zheng Y, Liu Z. Analysis of the status and development path of home medical care services. Health Econ Res. 2020:7–9. https://doi.org/10.14055/j.cnki.33-1056/f.2020.02.002.

Klein S, Hostetter M, McCarthy D. An overview of home-based primary care: Learning from the field. Issue Brief (Commonw Fund). 2017;15:1–20.

Chen T, Yao N, Su M, Nong S, Bai M, Ma Z. Challenges of home-based medical Care in China:a telephone interview from the perspectives of home care providers. Chin Gen Pract. 2020;23:1459–65. https://doi.org/10.12114/j.issn.1007-9572.2020.00.214.

Ge C, Fu J, Chang Y, Wang L. Factors associated with job satisfaction among Chinese community health workers: a cross-sectional study. BMC Public Health. 2011;11(1):884. https://doi.org/10.1186/1471-2458-11-884.

Tao L, Guo H, Liu S, et al. Work stress and job satisfaction of community health nurses in Southwest China. Biomed Res; 29. Epub ahead of print 2018. doi: https://doi.org/10.4066/biomedicalresearch.29-17-2604.

Wan H, Yu F, Kolanowski A. Caring for aging Chinese: lessons learned from the United States. J Transcult Nurs. 2008;19(2):114–20. https://doi.org/10.1177/1043659607312971.

Norman GJ, Orton K, Wade A, Morris AM, Slaboda JC. Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies. BMC Health Serv Res. 2018;18(1):45. https://doi.org/10.1186/s12913-018-2855-x.