Introduction: There are unique challenges that underserved patients experience in attending physical therapy visits in a pro-bono setting. Thus, home exercise adherence likely plays a crucial role in patient outcomes. Purpose: The purpose of this study was to determine home exercise adherence rates associated with pro bono care, and to determine if there is a relationship between self-reported measures of change and pain with home exercise adherence. Methods: After initial evaluation, patients were assigned 4 home exercises. Instructional methods used for teaching the home exercises were standardized and based on the best available literature. On follow up visits, data was collected for home exercise adherence, self-reported pain scores (best pain, current pain, and worst pain), and self-reported global rating of change. Parametric and nonparametric statistical tests were run to determine if there were changes in self-reported outcomes over time as well as to investigate the relationships between these self-reported outcome measures and the exercise adherence rating score. Results: The investigators discovered that both the current and best pain scores were significantly decreased from pre-treatment to post treatment ( P < .016), and the median global rating of change score was improved. There were significant correlations between self-reported pain scores and the exercise adherence rating scale score( P < .05). Conclusion: Clinicians practicing in pro-bono physical therapy clinics should use known strategies to enhance home exercise adherence and encourage frequent visits to improve patient outcomes.
Introduction: Republic of Korea’s Integrated Care Act aims to coordinate home-visit medical, nursing, and social care for older people. However, whether the Act’s administrative pathway serves as the main entry route into home-based primary care (HBPC), and whether outcome information returns to the treating clinic, has not been well documented. We described referral pathways and outcome-information continuity at a single HBPC clinic before nationwide implementation of the reform. Methods: This was a single-center retrospective descriptive cohort study using de-identified secondary clinical and administrative records from 190 patients referred to a HBPC clinic in Seongnam, Republic of Korea, in 2025. Referral sources were classified as either administrative or frontline pathways. Outcome-information continuity was measured broadly (traceable outcome) and strictly (return of cross-boundary event information). Results: Of 190 patients, 178 (93.7%) were referred through the frontline channel and 12 (6.3%) through the administrative channel. Administrative pathway patients more often lived alone, received medical aid, and were functionally dependent. Outcomes were traceable for 46 patients (24.2%), of whom 29 had cross-boundary information returned to the clinic; 144 (75.8%) had none. Conclusion: Entry into HBPC was overwhelmingly frontline-driven, rather than routed through the administrative pathway the Act assumes, and outcome information returned for only a minority of patients, indicating that the linkage between HBPC and the wider care system was largely 1-directional. Two-way, information-enabled coordination is a prerequisite if integrated care is to move beyond referral linkage toward actual continuity of care.
Background: Home health care patients are frail and dependent, but which of their presentations are followed by the most intensive hospital care is unknown. Objective: To examine whether the diagnostic category recorded at emergency department (ED) presentation is associated with critical care admission, length of stay and death beyond age and triage acuity. Methods: Retrospective episode-based cohort study of every admission from the ED at a Turkish hospital among patients registered with its home health care unit, 1 June 2023 to 31 May 2024; target population: admitted episodes. Working diagnoses were grouped into 7 ICD-10 categories. Logistic and gamma regression with patient-clustered errors were fitted sequentially; death by Firth penalised regression. Results: There were 928 admission episodes among 697 patients; 158 patients (22.7%) accounted for 389 episodes (41.9%). Respiratory presentations were commonest (185, 19.9%). Critical care admitted 326 episodes (35.1%); median stay was 7 days; 39 patients (4.2%) died. Adding diagnostic category to age, sex, arrival, season and triage raised discrimination from 0.739 to 0.811. Respiratory presentation was associated with critical care admission (adjusted odds ratio 5.44, 95% CI 2.98-9.93) and 60% longer stay (1.60, 1.23-2.09) across 5 sensitivity analyses. The cardiovascular association (10.85, 5.16-22.82) reflected coronary care routeing, falling to 2.06 (0.79-5.36) when coronary care was excluded. Age was unassociated. With all categories modelled together none was associated with death; only red triage (3.08, 1.61-5.90). Conclusion: Among admitted episodes, respiratory presentation was associated with critical care admission and longer stay, independently of age and triage; these associations are hypothesis-generating.
Background: Documentation burden is essential to home health care, but excessive documentation is a recognized driver of clinician dissatisfaction and workforce attrition in home health care. Prior quantitative research has found that documentation is the single most negatively rated domain of home health practice, however, the discipline-specific lived experiences underpinning this finding remain poorly characterized. Objective: To examine documentation experiences of home health clinicians across 4 disciplines physical therapy (PT), speech-language pathology (SLP), occupational therapy (OT), and registered nursing (RN), using a convergent mixed-methods design that integrates qualitative thematic analysis with System Usability Scale (SUS) quantification. Methods: Thirty-two semi-structured interviews were conducted with home health clinicians (PT = 8, SLP = 8, OT = 8, RN = 8) between April and June 2026. Transcripts were analyzed inductively using reflexive thematic analysis. Participants concurrently completed the SUS to quantify perceived electronic medical record (EMR) usability. Qualitative themes and SUS data were triangulated within a convergent parallel framework. Results: Six themes emerged: (1) documentation burden and temporal displacement, (2) redundancy and clinically irrelevant documentation demands, (3) technology acceptance and tool friction, (4) device preference and ergonomic adaptation, (5) OASIS complexity and regulatory overreach, and (6) interdisciplinary information gaps and collaboration barriers. Mean SUS score was 67.3 (SD: 20.2, range 30-100), falling below the established above average threshold of 68. PTs reported the lowest mean SUS (64.7) and RNs the highest (70.6). Qualitative data revealed distinct discipline-specific burden profiles that SUS scores alone could not fully characterize. Conclusions: Home health EMR systems are perceived as below average in usability across all disciplines. Documentation burden manifests as temporal displacement, regulatory redundancy, scope creep beyond clinical purview, and fragmented interdisciplinary information architecture. Targeted responses, including EMR workflow redesign, ambient AI documentation, and OASIS regulatory reform are warranted to address documentation-driven attrition in home health. Clinical relevance: Home health clinicians spend up to 90% of their workday on documentation, time displaced from patients into personal hours, eroding work-life boundaries, and accelerating burnout. This study identifies 6 discipline-specific documentation burden patterns that current EMR systems fail to address, providing an actionable evidence base for targeted regulatory reform, EMR redesign, and AI implementation policy in home health.
Background: The number of people with dementia is increasing, and many are living at home longer and receiving care there. However, little is known about their participation in their own care. Aim: This mixed-methods study examined the extent to which home care clients with dementia participated in setting care goals during routine Resident Assessment Instrument (RAI) assessments and how cognitive functioning relates to the number and types of documented care goals. Methods: We analyzed RAI data collected in 2023 from Finnish home care clients aged 65 or older who participated in their own RAI assessment (N = 38 901), of whom 41% (n = 16 058) had a dementia diagnosis. We used descriptive statistics to examine the relationship between cognitive functioning and the number of goals set, and a qualitative content analysis on the goal descriptions (n = 321). Results: The results showed that people with dementia had documented care goals less frequently than those without dementia. Among home care clients with dementia, 60% (n = 9655) had set at least one goal. Goal setting was more common among those with higher cognitive functioning and declined progressively as cognitive functioning deteriorated. Three main categories characterized the content of goals: (1) maintaining independence, (2) ensuring care and safety, and (3) supporting daily well-being. Regardless of cognitive level, goals related to maintaining independence were the most common. Conclusion: Maintaining independence remained a key priority across cognitive levels, underscoring the need to identify and document goals in person-centered dementia care.
