Penny Feldman

• BA, MA, PhD
• Managing Director at Visiting Nurse Service of New York

Background: Although home health aides and attendants (HHAs) frequently provide care to community-dwelling adults with heart failure (HF), they have rarely been the focus of interventions aimed at improving patient outcomes. Engaging HHAs and other key home health care stakeholders in the research process is essential to designing user-friendly int...

Throughout the COVID-19 pandemic New York City home health aides continuously provided care, including to patients actively infected or recovering from COVID-19. Analyzing survey data from 1316 aides, we examined factors associated with perceptions of how well their employer prepared them for COVID-19 and their self-reported availability for work (...

Background: Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. Objective: The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alter...

Home health aides provide care to homebound older adults and those with chronic conditions. Aides were less likely to receive COVID-19 vaccines when they became available. We examined aides’ perspectives towards COVID-19 vaccination. Qualitative interviews were conducted with 56 home health aides at a large not-for-profit home care agency in New Yo...

Background Each year, approximately 100,000 individuals receive home health services after a stroke. Evidence has shown the benefits of home-based stroke rehabilitation, but little is known about resource-efficient ways to enhance its effectiveness, nor has anyone explored the value of leveraging low-cost home health aides (HHAs) to reinforce repet...

Background In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. Objective To determine if home care patients’ language prefe...

Background: Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality. Objective: The objective of this study was to examine the association between continuity of nursing care in HHC and reho...

Background: Despite improvements in hypertension treatment in the United States, Black and Hispanic individuals experience poor blood pressure control and have worse hypertension-related outcomes compared to Whites. Objective: The aim of the study was to determine the effect on hospitalization of supplementing usual home care (UHC) with two hype...

Background: Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in Black and Hispanic post-stroke, home health patients, an understudied group. Methods: A three-arm randomized controlled trial desig...

Background: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission. Objective: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early phys...

Significant racial and ethnic disparities in stroke risk factors, occurrence, and outcomes persist in the USA. This article examines socio-economic and health disparities in a diverse, hypertensive sample of 495 post-stroke Black, non-Hispanic and Hispanic home health patients at risk of a recurrent stroke due to elevated systolic blood pressure (S...

Improved training and support are thought to improve retention among direct care workers. However, few studies have examined actual retention. This study examined satisfaction and retention among home health aides enrolled in the "Homecare Aide Workforce Initiative" (HAWI) at three New York agencies. Data included surveys of HAWI trainees and new h...

Approximately one in five households in the United States speaks a language other than English at home. This exploratory, descriptive study sought to examine language-concordant visit patterns in an urban home health care agency serving a diverse and multilingual population. Patient care record data combined with administrative data facilitated the...

Objective: To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care. Data sources: National Medicare administrative, claims, and patient assessme...

Background/Purpose: One in five households in the United States speaks a language other than English at home. Limited English Proficiency is a known risk factor for increased length of stay in hospitals and 30 day readmissions. Home healthcare services can help limited English proficiency patients avoid rehospitalization if language translation is...

Aim: Assess the comparative effectiveness of two blood pressure (BP) control interventions for black patients with uncontrolled hypertension. Patients & methods: A total of 845 patients were enrolled in a three-arm cluster randomized trial. On admission of an eligible patient, field nurses were randomized to usual care, a basic or augmented inte...

African-Americans (AAs) have a high prevalence of hypertension and their blood pressure (BP) control on treatment still lags behind other groups. In 2004, NHLBI funded five projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of AA patients with controlled BP...

Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variati...

To use natural language processing (NLP) of text from electronic medical records (EMRs) to identify failed communication attempts between home health nurses and physicians, to identify predictors of communication failure, and to assess the association between communication failure and hospital readmission. Retrospective cohort study. Visiting Nurse...

To assess the outcomes of a clinical decision support (CDS) intervention designed for home care patients with high medication regimen complexity (MRC) and to examine correlates of CDS use. The CDS consisted of a computerized algorithm that identified high MRC patients, electronic alerts and a care management module. Nurses were randomized upon iden...

Background: Racial and ethnic disparities persist in stroke occurrence, recurrence, morbidity and mortality. Uncontrolled hypertension (HTN) is the most important modifiable risk factor for stroke risk. Home health care organizations care for many patients with uncontrolled HTN and history of stroke; however, recurrent stroke prevention has not be...

Abstract Frontloading of skilled nursing visits is one way home health providers have attempted to reduce hospital readmissions among skilled home health patients. Upon review of the frontloading evidence, visit intensity emerged as being closely related. This state of the science presents a critique and synthesis of the published empirical evidenc...

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for...

Variations in patients' self-management knowledge, skills, and confidence as measured by the Patient Activation Measure (PAM) have been linked to variations in health behavior and outcomes. In a randomized trial, we tested two blood pressure (BP) control interventions, one grounded in activation principles. Study participants were Black home care p...

Background: Highly publicized recommendations favor the use of diuretics as a first-line or add-on agent in the management of hypertension, particularly among black patients and patients with resistant hypertension. Failure to follow such guidelines might contribute to high rates of uncontrolled hypertension. This study assessed diuretic prescribi...

Objective: To adapt and automate the medication regimen complexity index (MRCI) within the structure of a commercial medication database in the post-acute home care setting. Materials and methods: In phase 1, medication data from 89 645 electronic health records were abstracted to line up with the components of the MRCI: dosage form, dosing freq...

The Patient Activation Measure (PAM) assesses people's ability to self-manage their health. Variations in PAM score have been linked with health behaviors, outcomes, and potential disparities. This study assessed the relative impacts of activation, socio-demographic and clinical factors on health care outcomes in a racially diverse sample of chroni...

Purpose of the study: Assessing preferences for daily life is the foundation for person-centered care delivery. This study tested a new measure, the Preferences for Everyday Living Inventory (PELI), with a large sample of community-dwelling older adults. We sought to evaluate the tool's convergent and divergent validity, identify the most commonly...

Most older adults are admitted to home health care with some functional impairment related to chronic illness and/or hospitalization. This article describes: (1) the impact of a quality improvement initiative (QI) on functional outcomes of older, chronically ill patients served by a large homecare organization; and (2) key implementation challenges...

Successful chronic care ideally involves patient engagement, but little is known about chronically ill older adults' ability to self-manage their health. This study examines activation among hypertensive patients older than 65 years. Almost 60% of participants scored in the bottom half of the activation scale; only 8% scored at the highest level. H...

One indicator of quality home healthcare is the prevention of rehospitalization. This study explored factors that place patients at risk for repeat hospitalizations after home healthcare admission. One year of outcomes assessment information data from a large home health agency was used to identify 7,393 patients who had at least one episode of reh...

Blood pressure (BP) control remains elusive for many Americans. Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control, hypertension (HTN) management has not been a high priority in post-acute care. To examine the effects of two home-based interventions designed to improve BP outcomes among high-risk A...

Over the last decade, in order to close the safety and health care quality chasm, there has been a growing imperative to translate evidence-based research into practice. This study examines the major facilitators and barriers of implementing in a large US insurance organization - Aetna Corporation - an evidence-based model of care, the Transitional...

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Efforts to increase blood pressure (BP) control rates in blacks, a traditionally underserved high-risk population must address both provider practice and patient adherence issues. The home-based BP Intervention for blacks study is a 3-arm randomized controlled trial designed to test 2 strategies to improve hypertension management and outcomes in a...

To examine sociodemographic, clinical, and self-management characteristics of a sample of urban, African American patients admitted to home health care with uncontrolled hypertension and to determine the extent to which these factors are associated with disease severity. We conducted a cross-sectional study of 498 hypertensive African American pati...

Little information is available about the strength of the relationship between home healthcare practices and the potential adverse events the Centers for Medicare and Medicaid Services tracks through its uniform reporting system. We examined charts of patients who experienced a hyperglycemic or hypoglycemic emergent event to learn more about how ho...

This article describes the process of the spread of improvement strategies to improve relationships between professional and paraprofessional service providers within a large home healthcare organization and its partnering home health aide vendors. We describe the method for spreading the strategies, which emerged from a learning collaborative, and...

There is growing recognition that the health care delivery system in the United States must make major changes. Intervention projects focusing on quality and patient safety offer the potential for reshaping the future of medicine. Sustainability of the Partnerships for Quality (PFQ) projects and other patient safety and quality improvement projects...

To identify relationships between variations in team structure and risk-adjusted adverse events across 86 teams in a large US home health care organization. Patient episode data were collected for two 6-month periods, January-June 2002 (N = 54,732 episodes) and January-June 2003 (N = 51,560 episodes). An adverse event was defined as having 1 or mor...

The Reducing Acute Care Hospitalization (ReACH) National Demonstration Collaborative is a two-year multi-wave initiative using a "virtual" Collaborative Learning Model to reduce acute care hospitalization rates among home care patients. ReACH aims to reduce hospitalization to 23%, as recommended by the Centers for Medicare and Medicaid Services in...

Utilizing data from 80 adult children–older parent dyads, this study examined the degree to which adult children could predict the psychosocial preferences of their older parents. Overall, children demonstrated good knowledge about parent preferences, although there was wide variability within the sample and across preference domains. Children unde...

On March 31 to April 1, 2005, the Center for Home Care Policy and Research of the Visiting Nurse Service of New York assembled approximately 80 home healthcare stakeholders from across the country to advance the action strategy for measuring, improving, and assuring quality in home healthcare. A specific aim of the conference was to disseminate rel...

On March 31 to April 1, 2005, the Center for Home Care Policy and Research of the Visiting Nurse Service of New York assembled approximately 80 home healthcare stakeholders from across the country to advance the action strategy for measuring, improving, and assuring quality in home healthcare. A specific aim of the conference was to disseminate rel...

Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse e...

Transition points are the weak links in communication between providers. As an example, the discharge home often is a hurried "handoff" from inpatient physician to home care agency, whose visiting nurse admits the patient for a period of observation, medication management, rehabilitation, and teaching. The primary means of communication between phy...

Computerized drug utilization review (DUR) can potentially reduce adverse drug events. We examined automated DUR for home healthcare patients with diabetes or hypertension. Sixty-eight percent of diabetes patients and 50.7% of hypertension patients triggered severe, moderate, or duplicative alerts. Among diabetes patients, 74.3% of duplicative aler...

The summaries that follow capture important, research-based work that has been published recently and that we think may hold special interest for home healthcare nurses. The information provided is only a sample of the available findings. For additional information and insights, we suggest that readers go to the original articles. This month we foc...

To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients. Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban,...

To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients. Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF. Patients were treated by nurses randomly assigned to usual care...

The purpose of this randomized, controlled, home care intervention was to test the effectiveness of two nurse-targeted, e-mail-based interventions to increase home care nurses' adherence to pain assessment and management guidelines, and to improve patient outcomes. Nurses from a large urban non-profit home care organization were assigned to usual c...

Objectives: This project sought to compare measures of organizational climate in ongoing patient safety studies, identify similarities and setting-specific dimensions, develop a model of climate domains that are hypothesized to affect outcomes across settings, and test aspects of the model. Methods: Investigators who had surveyed health care worker...

On June 30 and July 1, 2003, the first national meeting Charting the Course for Home Health Care Quality: Action Steps for Achieving Sustainable Improvement convened in New York City. The Center for Home Care Policy & Research of the Visiting Nurse Service of New York (VNSNY) hosted the meeting with support from the Robert Wood Johnson Foundation....

Penny Hollander Feldman, PhD, is Vice President for Research and Evaluation at the Visiting Nurse Service of New York (VNSNY) and Director of the Center for Home Care Policy and Research. Prior to joining VNSNY, Dr. Feldman served on the faculties of the Kennedy School of Government and the Department of Health Policy and Management at the Harvard...

This study examines the effects of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. Participants were 371 Medicare CHF patients served by 205 nurses randomized to intervention and control groups in a large urban home healthcare agency (HHA)...

Home care organizations are relatively isolated from academic health centers, university-based schools of nursing, and centers of health services research that have advanced the knowledge base for quality improvement. Thus limited information exists about how best to promote evidence-based practice in this setting. This article examines research an...

As the US population ages and the number of older people who are "aging in place" increases, communities will face new opportunities and challenges in responding to this population's desires and needs. Qualitative research was conducted to inform the development of a model of an "elder-friendly community" and a set of indicators to measure and help...

This study explored similarities and differences in social support, home health service utilization, and health outcomes across four racial-ethnic groups of elders. 1999 Outcomes Assessment Information Set records for 7,374 home care recipients who were 75 years of age or older and who were discharged to self-care were selected for bivariate and mu...

One indicator of quality home healthcare is the prevention of rehospitalization. This study explored factors that place patients at risk for repeat hospitalizations after home healthcare admission. One year of outcomes assessment information data from a large home health agency was used to identify 7,393 patients who had at least one episode of reh...

Chronic disease and disability affect Americans of all ages, and millions rely on long-term care (LTC) services—in nursing facilities, in congregate residences, or at home—to meet their health and personal assistance needs. People who are 65 years old today have about a 40 percent chance of spending some time in a nursing home before they die (Kemp...

With an aging population and public policies that limit accessible and affordable formal care services, informal caregivers, largely women, will continue bearing the overwhelming responsibility for home and long-term care services provision. This study examined gender differences among informal caregivers in caregiving activities, intensity, challe...

Background. With an aging population and public policies that limit accessible and affordable formal care services, informal caregivers, largely women, will continue bearing the overwhelming responsibility for home and long-term care services provision. Objectives. This study examined gender differences among informal caregivers in caregiving activ...

Objectives: To test the efficacy of a medication use improvement program developed specifically for home health agencies. The program addressed four medication problems identified by an expert panel: unnecessary therapeutic duplication, cardiovascular medication problems, use of psychotropic drugs in patients with possible adverse psychomotor or a...

This report is from a 1998 national survey of 1,002 informal caregivers. Each year 23 percent of Americans provide unpaid assistance to ill, disabled, or elderly persons. Most caregivers (71 percent) do not live with care recipients. Primary caregivers provide more care of all types. Nonprimary caregivers also provide substantial care and services....

This study examined the characteristics, activities, and challenges of high-risk informal caregivers. Telephone interviews were conducted with a nationally representative cross-section of 1002 informal caregivers. Vulnerable caregivers with poor health or a serious health condition were compared with nonvulnerable caregivers. Thirty-six percent of...

This practice brief highlights the results of two home health care studies on medication errors. The first study determined how often medication errors occur in home health care. The second study tested a strategy to reduce these errors. Although nearly one third of home care patients are at risk for potential medication errors, adding a simple, pr...

This study examined commonalities and differences in the experiences and challenges of White, Black, and Hispanic informal caregivers in New York, NY. A randomly selected representative cross-section of 2,241 households was contacted through telephone interviews. Complete data were available for 380 eligible participants, who were classified as Whi...

OBJECTIVE: To determine the frequency of possible medication errors in a population of older home healthcare patients according to expert panel objective criteria. DESIGN: A cross-sectional survey. SETTING: Two of the largest urban home healthcare agencies in the United States. PARTICIPANTS: Home healthcare patients age 65 and older admitted to sel...

This policy brief reports the results of a study that examined how policy makers acquire information about long-term care (LTC) and why research findings in the field often don't filter through to them. It describes the "brokers" that provide LTC research information to policy makers and outlines what can be done to make certain such information re...

We examine the implications of the positive correlation of mortality and disability for the benefits of combining an immediate income annuity with long-term care disability coverage at retirement ages. Specifically, we show that combining the two products could reduce the cost of both coverages and make them available to more persons by reducing ad...

Six New York State Department of Health tuberculosis (TB) directly observed therapy (DOT) programs in public, private and community facilities in New York City. A key feature of the TB DOT program was provision of incentives to motivate patients and increase adherence to therapy. The study hypothesis was that adherence will improve as the value of...

Extensive research was conducted to develop the proposed Prospective Payment System (PPS) and to ensure that it will adequately cover the costs of care for Medicare beneficiaries receiving the home health benefit. However, there is tremendous variation among the patients served by agencies, meaning that the system will impact each agency somewhat d...

To determine whether daily videotelephone or regular telephone reminders would increase the proportion of prescribed cardiac medications taken in a sample of elderly individuals who have congestive heart failure (CHF). The authors recruited community-dwelling individuals age 65 and older who had the primary or secondary diagnosis of CHF into a rand...

In response to rising demand and increased costs for home care services for frail elderly and disabled Medicaid clients, New York City implemented cluster care, a shared-aide model of home care. Our objective: to evaluate the effects of cluster care on home care hours and costs, client functioning, depressive symptoms, and satisfaction. Client inte...

To determine the usefulness of the Center for Epidemiological Studies Depression Scale (CES-D) as a measure of depressive symptoms among frail and disabled elderly, we conducted a first-and second-order confirmatory factor analysis testing the four-factor structure of the CES-D and the existence of a single underlying second-order factor. We also e...

In this theme issue, 18 articles discuss the motivation for and benefits of working with old and dying people, nursing homes, ethical issues, and the training of home health care workers. Employee recruitment and retention and the economics of health care for the frail elderly are also addressed. (JOW)

Increasing demands for home health aides to the frail elderly and disabled, coupled with a high rate of turnover among these aides, has led to growing concerns over worker recruitment and retention in the home care industry. This paper therefore describes a model developed to explain job satisfaction and turnover among home health aides. The model...

A Ford Foundation demonstration project intended to improve the quality of work life and reduce turnover among homemakers/home health aides in the home care industry was evaluated. The project supported three separate work life demonstration at home care agencies in New York City and Syracuse, New York and in San Diego, California. The demonstratio...

With the history of the U.S. federal budget for fiscal year 1986 as a vehicle, the usual processes in the executive branch and the Congress that establish health research priorities and the unusual developments that have shaped priorities for AIDS are described. In the 3 years between the initial formulation of the AIDS budget and its execution, th...

Shifting financial risk from the public to the private sector is an increasingly attractive option to policymakers seeking to constrain Medicaid costs. This paper discusses the potential advantages and disadvantages of private insurance arrangements for Medicaid recipients and examines the Texas Purchased Health Services Program, the oldest and lar...

This article has no abstract; the first 100 words appear below. This book is a report of the findings of a major comparative study of health-manpower policies and practices, funded by the United States Bureau of Health Manpower. The purpose of the study was "to gain insights for health policy in the United States." Thus, the authors chose to study...