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A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting.

Publication ,  Journal Article
Sadarangani, T; Missaelides, L; Eilertsen, E; Jaganathan, H; Wu, B
Published in: Policy, politics & nursing practice
August 2019

Multimorbidity affects 75% of older adults (aged 65 years and older) in the United States and increases risk of poor medical outcomes, especially among the poor and underserved. The creation of a Medicaid option allowing states to establish health homes under the Affordable Care Act was intended to enhance coordinated care for Medicaid beneficiaries with multimorbidity. The Community-Based Health Home (CBHH) model uses the infrastructure of the Adult Day Health Center (ADHC) to serve as a health home to improve outcomes for medically complex vulnerable adults. Between 2017 and 2018, we used a sequential explanatory mixed-methods approach to (a) quantitatively examine changes in depression, fall risk, loneliness, cognitive function, nutritional risk, pain classification, and health care utilization over the course of 12 months in the program and (b) qualitatively explore the perspectives of key stakeholders (registered nurse navigators, participants, ADHC administrators, and caregivers) to identify the most effective components of CBHH. Using data integration techniques, we identified components of CBHH that were most likely driving outcomes. After 12 months in CBHH, our racially diverse sample (N = 126), experienced statistically significant (p < .05) reductions in loneliness, depression, nutritional risk, poorly controlled pain, and emergency department utilization. Stakeholders who were interviewed (n = 40) attributed positive changes to early clinical intervention by the registered nurse navigators, communication with providers across settings, and a focus on social determinants of health, in conjunction with social stimulation and engagement provided by the ADHC. CBHH positions the ADHC as the locus of an effective health home site and is associated with favorable results. CBHH also demonstrates the unique capacity and skill of registered nurses in integrating health and social services across community settings. Continued exploration of CBHH among diverse populations with multimorbidity is warranted.

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Published In

Policy, politics & nursing practice

DOI

EISSN

1552-7468

ISSN

1527-1544

Publication Date

August 2019

Volume

20

Issue

3

Start / End Page

131 / 144

Related Subject Headings

  • United States
  • Nursing
  • Nurse-Patient Relations
  • Nurse's Role
  • Multiple Chronic Conditions
  • Multimorbidity
  • Male
  • Leadership
  • Humans
  • Home Care Services
 

Citation

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ICMJE
MLA
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Sadarangani, T., Missaelides, L., Eilertsen, E., Jaganathan, H., & Wu, B. (2019). A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting. Policy, Politics & Nursing Practice, 20(3), 131–144. https://doi.org/10.1177/1527154419864301
Sadarangani, Tina, Lydia Missaelides, Emily Eilertsen, Harini Jaganathan, and Bei Wu. “A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting.Policy, Politics & Nursing Practice 20, no. 3 (August 2019): 131–44. https://doi.org/10.1177/1527154419864301.
Sadarangani T, Missaelides L, Eilertsen E, Jaganathan H, Wu B. A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting. Policy, politics & nursing practice. 2019 Aug;20(3):131–44.
Sadarangani, Tina, et al. “A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting.Policy, Politics & Nursing Practice, vol. 20, no. 3, Aug. 2019, pp. 131–44. Epmc, doi:10.1177/1527154419864301.
Sadarangani T, Missaelides L, Eilertsen E, Jaganathan H, Wu B. A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting. Policy, politics & nursing practice. 2019 Aug;20(3):131–144.
Journal cover image

Published In

Policy, politics & nursing practice

DOI

EISSN

1552-7468

ISSN

1527-1544

Publication Date

August 2019

Volume

20

Issue

3

Start / End Page

131 / 144

Related Subject Headings

  • United States
  • Nursing
  • Nurse-Patient Relations
  • Nurse's Role
  • Multiple Chronic Conditions
  • Multimorbidity
  • Male
  • Leadership
  • Humans
  • Home Care Services