Page 271 - Encyclopedia of Nursing Research

238 n HOMe HeAlTH SySTeMS

resulting in an increase of health care costs
HoMe HealtH systeMs that required cost containment. As a result,
H health care began to shift from acute short-
term hospital care to community home-based
Home health systems primarily support and chronic long-term care. patients began to
home health and hospice programs provided be discharged from inpatient settings “sicker
by home health agencies (HHAs). Home and quicker” and required more health care
health is more than “care in the home.” It services in the home.
focuses on the continuity of care from the hos- As the number and type of HHA
pital to the community, public health concepts increased, technological systems were
of disease prevention and health promotion, needed to manage the flow of informa-
and out-of-hospital acute illness services. tion in the proper time frame and to assist
Home care is the oldest form of health in the decision-making process. They were
care and yet the newest. Home health nursing, designed to furnish the information required
previously called care of the sick in the home, for payment by Medicare, Medicaid, and
is one of the earliest developments in the field other third-party payers for reimbursement
of public and community health. care of the for services. They were developed for the
sick at home traditionally has been provided sole purpose of improving cash flow, holding
by voluntary nonprofit agencies, such as vis- down costs, and addressing the federal regu-
iting nurse associations, organized to provide latory needs for HHAs.
out-of-hospital services (Martinson, Widmer, Systems were generally developed by
& portillo, 2002). However, care is now also commercial vendors who obtained the com-
provided by profit-based organizations. puter system hardware and developed the
The systems involved in the delivery of software to process the services data provided
patient care in the home have changed since by the HHAs. The computer vendors owned
1883 when lillian Wald established the first the home health system and were responsible
home health nursing agency in the United for maintaining and updating them. Home
States (Martinson et al., 2002). However, the health computer vendors were usually con-
principles that guide home care continue to tracted by the HHAs to provide billing ser-
be holistic and focused on helping people vices and financial management, without the
remain in their homes despite or following HHAs having to develop their own system.
a serious or acute illness or condition. In the With the introduction of the microcomputer
beginning, services were provided as charity and online communication systems, local area
to the poor. Today, in many HHAs, provision networks and wide area networks were intro-
is made for a small group of people who do duced, designed to advance and enhance the
not have insurance and who cannot afford home health systems. They were used to link
fee-for-service care. However, visits are usu- state and local units, to share hardware and
ally very limited, and patients are provided software, and to integrate information.
with resources to help them once they are These systems are designed not only
discharged from the agency. to collect and process home health data
In 1966, after Medicare and Medicaid leg- required by the federal government and
islation were introduced, home health pro- third-party payers for reimbursement of
grams began to increase in number and in size. services but also for the efficient manage-
They increased faster than all other organized ment of the HHA. They focus on billing and
providers in the health care industry because financial applications, such as general led-
Medicare primarily addressed the health care ger, accounts receivable, accounts payable,
needs of the aging population. As this popula- billing, reimbursement management, and
tion grew, more health services were required, cash management. They also may include