Date on Master's Thesis/Doctoral Dissertation

8-2015

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Meeks, Suzanne

Committee Co-Chair (if applicable)

Mast, Benjamin

Committee Member

Mast, Benjamin

Committee Member

Woodruff-Borden, Janet

Committee Member

Stetson, Barabara

Committee Member

LaJoie, Scott

Subject

Older people--Home care; Depression in old age

Abstract

Homebound older adults are a unique population of older adults with many chronic illnesses and complex care needs (Qui et al., 2010). Depression is highly prevalent in homebound older adults (Qui et al., 2010). Many Chronic Care Models (CCMs) have been developed to provide a better system of care to those with chronic health conditions (Bodenheimer, Wagner, & Grumbach, 2002; Wagner et al., 2001; Wagner, Austin, & Von Korff, 1996a, 1996b). The Chronic Care Model for Depressed Homebound Older Adults is a model that was specifically designed for the depressed homebound elderly. It addresses many areas for improvement of care including delivery system design, communication/collaboration, education of patients and caregivers, technology, training/education of providers, and specialist involvement. This dissertation examined aspects of this model in the current home health care system to test model-predicted relationships between home health system characteristics and outcomes. Outcomes of interest were hospitalizations, nursing home admissions, and emergency room visits. CCM model relevant independent variables examined include the number of services provided by each agency, the number of visits provided to each client, and caregiver involvement. This study also examined whether home health patients who are admitted from a short-term hospital stay are more likely to be depressed than those who are admitted from any other location. A five percent sample of the Home Health Outcome and Assessment Information Set (OASIS), a national database containing assessments of each Medicare home health recipient, was used. Results showed that the number of home health visits were related to an increased likelihood of ER visits, hospitalizations, and skilled nursing facility (SNF) admissions, providing support for the part of the proposed model that emphasizes communication between patients/caregivers and providers. Increased number of home health services was related to decreased ER visits, providing support for the importance of the delivery system design piece of the model. Discharge from an acute hospital stay was related to diagnosis of depression, and those with caregivers were less likely to be depressed. This provided support for caregiver involvement. Implications of these findings are discussed.

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