Effectiveness of Pediatric Concurrent Hospice Care to Improve Continuity of Care

Background The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care. Objective The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care continuity among Medicaid beneficiaries. Methods Using national Medicaid data, we conducted a quasi-experimental designed study to estimate the effect of concurrent vs standard hospice care to improve end-of-life care continuity for children. Care continuity (i.e., hospice length of stay, hospice disenrollment, emergency room transition, and inpatient transition) was measured via claims data. Exposures were concurrent hospice vs standard hospice care. Using instrumental variable analysis, the effectiveness of exposures on care continuity was compared. Results Concurrent hospice care affected care continuity. It resulted in longer lengths of stays in hospice ( β = 2.76, P < .001) and reduced hospice live discharges ( β = −2.80, P < .05), compared to standard hospice care. Concurrent care was not effective at reducing emergency room ( β = 2.09, P < .001) or inpatient care ( β = .007, P < .05) transitions during hospice enrollment. Conclusion Our study provides critical insight into the quality of care delivered for children at end of life. These findings have policy implications.

Multi-Objective Optimization of Home Healthcare with Working-Time Balancing and Care Continuity

The ageing population in most parts of the world becomes a grand challenge for healthcare decision-makers. The care of elderly persons and general hygienic care at patients’ homes are two main reasons to motivate an optimization problem, namely, home healthcare (HHC). A robust plan for caregivers to have sustainable HHC operations management is to consider working-time balancing of caregivers, care continuity and uncertainties, e.g., the uncertainty of patients’ availability in addition to service and travel times as well as the regulations of companies to meet the standards of high-quality home care services. Based on these motivations and challenges to this field, this study firstly established a multi-objective robust optimization of the HHC which is multi-depot, multi-period and multi-service. The demand of each patient in each period may be different due to promptness of services. Each caregiver plays one of the roles of nurses, doctors, physiotherapists and nutritionists. The types of services are directly related to these roles. The objectives were optimizing the total cost of logistic activities as well as the total unemployment time of caregivers and care continuity. As a complicated optimization problem, this study innovated efficient heuristics and an enhanced nature-inspired metaheuristic. Finally, an extensive comparison with regards to the criteria of the multi-objective algorithms’ assessment was conducted. Some sensitivity analyses were conducted to conclude some practical insights.

Experience of chronic noncommunicable disease in people living with HIV: a systematic review and meta-aggregation of qualitative studies

Background An increasing number of people living with HIV (PLWH) have had chronic noncommunicable diseases (NCDs) over the last 5 years. However, robust evidence regarding the perception and challenges of having NCDs among PLWH is limited. Therefore, this study aimed to synthesize qualitative evidence regarding the experiences of PLWH with NCDs. Methods We used a meta-aggregation approach to synthesize qualitative studies. Peer-reviewed and gray literature published in English and Chinese from 1996 to November 2020 was searched using electronic databases. Two reviewers independently appraised the methodological quality and extracted data from the included studies. The Joanna Briggs Institute (JBI) meta-aggregation approach was used to synthesize the findings. Results In total, 10,594 studies were identified in the initial database search. Fourteen eligible studies were included in the meta-synthesis. Among these studies, nine synthesized findings regarding the following topics were identified: fragmented healthcare systems, care continuity, manifestations of multiple conditions, financial hardship, stigma and discrimination, polypharmacy burden and adherence, reciprocal relationships between HIV and NCDs, and coping strategies. Conclusions In recent years, attempts have been made to institutionalize NCD preventive and control services in HIV long-term care. However, considering the growing problem of HIV and NCD comorbidity globally, integrated primary health care systems are needed to address the problems of PLWH with NCDs. Healthcare professionals should help PLWH develop strategies to better monitor their polypharmacy burden and adherence, stigma and discrimination, financial hardship, and manifestations of multiple conditions to achieve high levels of care continuity.