Table 5

Summary of Evidence Related to Functional Outcomes and Quality of Life

SourceSafety Issue Related to Clinical PracticeDesign TypeStudy Design & Study Outcome Measure(s)Study Setting & Study PopulationStudy InterventionKey Finding(s)
Archbold 199558Family preparednessQuasi- experimental retrospective without a control groupNonrandom trial. Outcomes: care effectiveness scale, indicating greater preparedness, enrichment, and predictability.Caregiver families referred to home care agency: n = 11 intervention and n = 11 standard home care
  1. Nursing interventions, designed to increase preparedness (PR), enrichment (E), and predictability (P) in families providing care to older people.
  2. Comparison
Intervention (PREP) group one standard deviation higher than the control group (P < .05), rated their assistance from PREP nurses significantly higher (P < .01); had lower mean hospital costs ($2,775) versus comparison group ($6,929).
Corbett 200363Diabetic foot careRandomized controlled trial, pre/post- testRandomized controlled trial pre/post test. Outcomes: patient self- report knowledge.40 home care patients with diabetes from 1 home care agency, 2 groups
  1. Intervention: individualized education about proper foot care
  2. Control
The educational intervention improved patient’s knowledge, confidence, and reported foot care behaviors.
Dougherty 200264Urinary incontinenceRandomized controlled trialRandomized controlled trial Outcomes: severity and episodes of urine loss— frequency, interval, and quality of life.218 older women from 7 rural counties in north Florida
  1. Behavior management program—self- monitoring and bladder training
  2. Control
Intervention group incontinence severity decreased by 61%.

Control group incontinence severity increased by 184%.
Feldman 200466Quality of life and patient satisfaction with careRandomized controlled trialRandom assignment of nurses. Outcomes: service use and quality of life, satisfaction with care.371 patients with CHF and 205 nurses from a large, urban, nonprofit home care agency
  1. Formal nurse protocol of “Health Outcomes Management & Evaluation,” patient self-care guide, and nurse training in teaching and support skills
  2. Usual care
No difference in physician visit, patient mortality, quality of life, or patient satisfaction.
Feldman 200560Functional status, quality of life, and service use (see also Table 3)Randomized controlled trialRandomized controlled trial Outcome: clinical, functional, and quality of life status.1,242 patients from a large, urban, nonprofit home care agency: 390 basic 404 augmented 448 control
  1. Nurse e-mails highlighting clinical recommendations
  2. Augmented: e-mails and additional clinician and patient resources
  3. Usual care
Both intervention groups demonstrated improved patient clinical and functional outcomes (symptoms, physical limitations, quality of life, and social limitations) (P ≤ .05).
Both intervention groups demonstrated better management of medications (P ≤ .05)
Intervention group 1 scored higher on quality of life relative to control (P ≤ .05).
Hughes 200045Functional ability, quality of life, patient satisfaction, and cost (see also Table 3)Randomized controlled trialRandomized controlled trial. Patient functional status, patient and caregiver HR-QoL and satisfaction, caregiver burden, hospital readmissions, and costs over 12 months.1,966 patients average age of 70 with 2 or more ADL impairments or terminally ill, CHF or COPD 981intervention 985 control
  1. Home-Based Primary Care: with team manager, 24- hour contact, prior approval readmissions, and team discharge planning
  2. Home-Based Primary Care VA and private sector care
Significant improvements were seen in terminal intervention group (TM/HBPC) patients in HR-QoL scales of emotional role function, social function, bodily pain, mental health, vitality, and general health. TM/HBPC nonterminal patients had significant increases of 5 to 10 points in 5 of 6 satisfaction-with-care scales. The caregivers of terminal patients in the TM/HBPC group improved significantly in HR-QoL measures. Caregivers of nonterminal patients improved significantly in QoL measures and reported reduced caregiver burden (P = .008).
Johnston 200069Quality of patient care and costQuasi- experimental study with random assignmentRandomized controlled trial. Outcomes: medication compliance, knowledge of disease, self- care ability, service use, patient satisfaction, and costs.212 patients with CHF, COPD, cerebral vascular accident, cancer,diabetes, anxiety, or need for wound care
  1. Routine care and video visits, nurses and patients interact in real time, included equipment for assessing cardiopulmonary status
  2. Routine care
No differences in the intervention or control groups in quality indicators, patient satisfaction, or use. No health care cost savings realized.
Mann 199967Functional ability (independence), quality of life (pain reduction), and costsRandomized controlled trialRandomized controlled trial. Functioning and pain, measured with valid and reliable instruments; health care costs.Frail elderly persons referred from community agencies, hospitals, and home care agencies in New York State: n = 52 intervention, n = 52 control
  1. Usual care, assistive technology, (canes, walkers, etc.), and environmental interventions (ramps, removal of rugs, etc.)
  2. Usual care control
Both groups showed significant decline in functional motor score, with a significantly greater decline for the control group. Pain scores were significantly higher for the control group. Treatment group expended more costs than the control group. Control group had significantly more expenditures for institutional care and significantly greater expenditures for nurse visits and case manager visits.
McDonald 200559Quality of life (pain management) through provider behavior changeRandomized controlled trialRandomized controlled trial. Outcome measure: Estimate of treatment effect on nurse- documented care practices and patient’s pain management.Nurses, from a large, urban, nonprofit home care agency: n = 121 basic, n = 97 augmented, and n = 118 control
  1. Basic group – nurse e-mails highlighting clinical recommendations
  2. Augmented group – additional clinician and patient resources
  3. Usual care
Patients in augmented intervention improved significantly over the control in ratings of pain intensity at its worse (P = 0.05).
Patients in basic intervention had better ratings of pain intensity on average (P < 0.05).
In both intervention groups, evidence of nurse assessment increased.
McDowell 199965Functional ability (urinary continence)Prospective, randomized controlled clinical trial with cross- over designRandomized controlled trial, observational study with controls. Outcomes: bladder diaries, urinary accidentsHome health care patients ages 60 and older with urinary incontinence: n = 53 intervention, n = 52 control
  1. Nurse practitioner delivered behavioral therapy of biofeedback-assisted pelvic floor muscle training, urge and stress strategies, and bladder retraining
  2. Control
Intervention group had a significantly greater reeducation in urinary accidents per day (P < .001). Average number of accidents decreased from 4.0 to 1.7 after treatment (P < .001).
Naylor 200440Mortality, quality of life, and satisfactionRandomized controlled trialRandomized controlled clinical trial. Outcomes: patient report, physical and emotional quality of life, functional status, and satisfaction.Patients 65 years of age or older with CHF discharged from Philadelphia academic and community hospitals: n = 118 intervention, n = 121 control
  1. Transitional care intervention – 3- month APN-directed discharge plan and home care followup
  2. routine care (1/2 home care)
Intervention had improvement in quality of life (P < .05), in functioning (P < .05), and in satisfaction (P < .001) vs. control group.
Neff 200346Quality of patient outcomesNon-randomized trial controlledNonrandomized controlled trial. Outcomes: ADLs, IADLs, dyspnea, anxiety, and depressionMedicare patients from a large home care agency: n = 41 urban control group n = 39 rural
  1. Transitional Care Model: APN pulmonary disease management team
  2. Routine home care
Intervention group experienced fewer depressive feelings (P < .05) and better ADL status (P < .05).
There were no differences in IADLs or dyspnea in the groups.
Scott 200462Quality of life and mental healthRandomized controlled trialRandomized controlled trial. Outcomes: Mental Health Inventory and Quality of Life Index.88 patients with heart failure from 2 nonprofit home care agencies in the MidwestAll got routine care and
  1. Mutual goal setting,
  2. Supportive educative
  3. Placebo
Mutual goal setting group had significantly higher mental health scores (P = .003) at 6 months.
Mutual goal setting and supportive education groups had significantly higher quality of life (P = .01) at 6 months.
Tinetti 199968Functional status – self-care ADLsRandomized controlled trialRandomized controlled trial. Outcomes: a battery of self- report and performance- based measures of physical and social function.304 persons age 65 who had undergone surgical repair of a hip fracture at two hospitals in New Haven, CT, from 27 home care agencies
  1. Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments (physical therapy) and ADL disabilities (functional therapy)
  2. Usual care
There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months (71% vs. 75%) or 12 months (74% in both groups), or in home management ADL at 6 months (35% vs. 44%) or 12 months (44% vs. 48%). There also was no difference between the two groups in social activity levels, two timed mobility tasks, balance, or lower extremity strength at either 6 or 12 months.
Compared with participants who received usual care, those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months (P = .04) and a marginally better gait performance (P = .08).
Vallerand 200461Quality of life (pain management)Longitudinal, multilevel, randomized controlled trialRandomized controlled trial. Outcomes: nurse knowledge and attitudes of pain management, patient’s self- reported pain level.Home care nurses: n = 100 intervention, n = 102 control, from 11 home care agencies in Midwest United States 5 intervention 6 control
  1. Nurse education program – Power over Pain (POP)
  2. Control
Patients of nurses’ intervention group self-report worst pain scores decreased significantly (P < 0.04).
Nurses’ intervention group had significantly improved knowledge, attitudes, and perception of control over pain (P < 0.05).
Weaver 200371Functional status and quality of lifeRandomized controlled trialRandomized controlled trial. Outcomes: functional status, lower extremity functioning, health-related quality of life, satisfaction, use, and cost.136 patients with surgical hip or knee replacements from a hospital home care agency.
  1. Pre-op visit by nurse and physical therapist, 9 to 12 post-op home visits
  2. Usual protocol with more visits (11 to 47)
There was no difference in functioning, quality of life, or satisfaction.
Intervention group costs were 55% lower than control (due to fewer visits).

From: Chapter 13, Patient Safety and Quality in Home Health Care

Cover of Patient Safety and Quality
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.
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