Exploring Reasons for Delayed Start-of-Care Nursing Visits in Home Health Care: Algorithm Development and Data Science Study.
Maryam Zolnoori, Jiyoun Song, Margaret V McDonald and 7 others
PMID 34967749WHAT IT FOUND
Structured fields captured reasons for only 19.1% of late home health nursing visits.
Free-text notes showed unreachable patients, family postponement, and scheduling problems, but the study did not test whether fixing these reduces delays.
Key findings
01About one-third of home health episodes had a start-of-care visit more than 2 days after hospital discharge, and 72.2% of identified delay reasons were documented in clinical notes.
02The most common delay reason was no answer at the door or phone (46.3%), followed by patient or family postponement or refusal (35.5%) and administrative or scheduling issues (18.2%).
03In more than 40% of delayed episodes, two or more reasons were documented.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data came from one large home health agency in the northeastern United States, so reasons for delay may differ elsewhere. Delay was measured in days, not hours, so episodes may not match the 48-hour CMS rule exactly. The text algorithm had precision 0.8 and recall 0.75, so some identified reasons were wrong and some were missed. The study describes documentation patterns and algorithm performance; it does not test whether any intervention reduces delayed visits or improves outcomes.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that using this text algorithm will reduce delayed visits or hospitalizations. The study only developed and tested the algorithm and described documented reasons; it did not test an intervention or patient outcomes.