Resource use among families managing technologically complex care at home.

摘要

The primary purpose of this secondary data analysis was to determine relationships among families in efficiency as determined by health services-related and family-related variables, and to describe the families that most efficiently handle the challenges of technologically complex care at home. The secondary purpose was to identify the characteristics of families that could gain the most benefit from intervention by Nursing and the helping professions.; The family system model of family resource management theory (Deacon & Firebaugh, 1988) provided the conceptual support for the study. Health services-related variables included hours of professional nursing care, total caregiver hours, visits to the physician, hospitalizations, and visits to ER/Urgent Care. Family/client-related inputs included lack of family functioning, lack of physical health, depression, and lack of family assistance. Health services utilization outputs included days not hospitalized, days without visits to the ER/urgent care, lack of hospitalizations for infection, and total expenditures for Home Parenteral Nutrition (HPN). Quality of life provided the throughput metric for effectiveness. Data Envelopment Analysis (DEA) was the econometric benchmarking technique that provided the primary data analysis for evaluating family efficiency. Overall differences and comparisons were conducted using nonparametric testing (Kruskal-Wallis and Mann-Whitney U). Analysis of results included differentiation between client responses and caregiver responses.; Results revealed a positive association between family efficiency and quality of life. Families classified as very efficient had significant potential improvements in health services utilization such as physician visits. Opportunity was shown to exist for Nursing and the helping professions to impact family efficiency and thus quality of life by assessing family needs in the areas of assistance, depression and family functioning, and making appropriate recommendations for care. DEA proved a viable method for studying these decision-making units (families).; Further research is needed to determine if family-related variables confound relationships among health services inputs, family-related inputs, and health services utilization outputs. Relationships found between potential improvements as identified by DEA and actual utilization rates also require further study. An important follow-up to this study is an evaluation of an intervention to teach problem-solving to clients and caregivers dealing with HPN.