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Date of Award

9-2004

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Supervisor

Gina B. Browne

Abstract

Objectives . (1) Develop and implement a new model of home care delivery for home care services that would better serve post acute clients; (2) Evaluate this process by determining the effectiveness of the new model; (3) Suggest how the model would complement and be assimilated with the acute and community health care sectors; (4) Determine if the model is a more efficient way to use nursing resources; (5) Determine the satisfaction and acceptability of the clients and nursing staff with the new model. New service . Three nursing clinics were built, equipped and staffed to operate in three geographically different areas of a large Canadian city. The clinics served post acute, ambulatory Community Care Access Centre (CCAC) clients requiring wound dressings, intravenous therapy and other complex nursing care. Research design . Randomized control trial with initial data collection immediately post randomization and six weeks post discharge from hospital. Sample size . 99 Clients (45 experimental and 54 control), average age 50.8 years, eligible for CCAC services and retained for a 6 week period post CCAC discharge. Results . Study participants treated in a nursing clinic versus at home maintained their equivalent health status on eight health dimension and two summary mental and physical component scales of the SF-36. The average number of visits per clients in either venue was not significantly different. The average treatment time in the home was 46.4% longer (p < .001) than the clinic when travel and documentation time was included. This saving translates into a potential $10 million savings and the release of 146 full time equivalent RN resources, based on 6 million home care visits annually in Ontario. In addition, the satisfaction results reveal the home group was significantly less satisfied and inconvenienced waiting to be treated in the home. Implications . This study demonstrates that nursing clinics are an effective, acceptable and more efficient alternative for home visits for certain groups of clients.

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