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SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 3, Issue 1 (January 9, 1998)
This document has been superceded by our Online Knowledge Base on Innovative Models of HIV/AIDS Care. Click here to access the Knowledge Base. Click here to access descriptions of 27 Innovative Models of HIV/AIDS Care and the lessons learned from these projects. SPNS/Fax was written, published, and distributed by fax by The Measurement Group between 1995 and 1998. |
Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).
Introduction
Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.
Service Usage Patterns in End-Stage AIDS Care: Findings from the Visiting Nurse Foundation of Los Angeles
The Visiting Nurse Foundation of Los Angeles (VNF-LA) recently conducted a study of service usage profiles for patients with HIV/AIDS who receive different types of home care services. One of the main goals of the study was to develop a terminal care service usage profile of persons receiving home health care services for HIV/AIDS. A key feature of the VNF-LA study is that it compares care under a Traditional Hospice Model to care provided under a Transprofessional Model (see SPNS/Fax Volume 1, Issue 11). The Transprofessional Model of End-Stage AIDS Care uses an interdisciplinary, case management approach, including blending curative and palliative services, that produces a sharing of care between nurses and social workers.
The figure on the left shows the five major service usage profiles that end-stage AIDS home care patients tend to follow. The basis of comparison for the patient clusters is the number of various types of services received, indicated as z-scores in the chart below (note: z-scores are a way of presenting data that standardize different measures to a common metric; they have a mean of zero and a standard deviation of 1). The five clusters, or groups of patients, can be described as follows. Cluster 1, which included the largest group of patients (n=406), represents patients who received an average number of visits. The patients in this group tended to receive the average number of visits per day for most service categories, compared to other patients in the study. Cluster 2 (n=60) represents patients who received more social support and less regular nurse visits. Patients in Cluster 3 (n=22) received more home health aide and fewer IV nurse visits compared to the rest of the patients in the study. Patients in Cluster 4 (n =42) received more home health aide and IV nurse visits compared to the other patients. Last, patients in Cluster 5, although a small number of patients (n=19), accounted for the most intensive nursing care of the group and received the most visits of many different types of care than any patients in the study.
Additional analysis revealed that the five clusters were represented differentially (chi-square = 10.9, df = 4, and p < .03) in the Traditional Model versus the Transprofessional Model. Specifically, a significantly greater proportion of patients assigned to the Transprofessional Model belonged to Cluster 1 than those assigned to the Traditional Model. A significantly greater proportion of Traditional Model clients were in Cluster 4. These service utilization profiles also may be useful in examining issues of treatment costs and other patient outcomes.
For the full article, see Huba, G.J., Brief, D.E., Cherin, D.A., Panter, A.T, & Melchior, L.A. (in press) A Typology of Service Patterns in End-Stage AIDS Care: Relationships to the Transprofessional Model, Home Health Care Services Quarterly. For more information, contact David Cherin, Ph.D. at the Visiting Nurse Foundation of Los Angeles, 101 S. First Street #407, Burbank, CA 91502, 818.526.1780.
For more information about the Visiting Nurse Foundation see SPNS/Fax Volume 1, Issue 11.
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