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Home Health Patient Assessment Tools

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4. Discussion

Most larger home health agencies (HHAs) that provided information use some sort of patient risk categorization tool; smaller HHAs are less likely to use such tools.

Although many tools appear to be similar (e.g., most have three levels of risk), they are used quite differently in practice. For example, two HHAs located in the same State both use a three-level patient risk categorization system, but the proportion of their patients who were placed in the highest risk category widely differed; one reported that only 1 percent of their clients were at highest risk, while the other reported that 21 percent of their clients were in the highest risk category. The two tools were either designed or implemented quite differently, or both.

Some HHAs' patient risk tools categorize so many patients at the highest risk level that the tools are impractical during an emergency—it is not possible to focus resources on so many patients at once. In an emergency, these HHAs use the list only as a "first sort"; they then must review each case individually to prioritize nurse time and to direct local emergency responders. This ad hoc review seems to work when there is advance warning of an emergency (e.g., approaching snow storm or hurricane), but in a situation without advance warning (e.g., earthquake), this approach would not suffice. Moreover, the clinicians who know the most about each patient's status may not be available during an emergency. The existing patient risk categorization tools may need additional tiers or subcategories to further distinguish those who are at highest risk.

In addition to these concerns, the frequency with which patient risk ratings are reviewed and revised is inconsistent, but important. A patient who is considered low risk one month could deteriorate to become high risk the next month; if the assessment is not repeated/revised, this patient would be incorrectly classified. In addition to greater consistency in terms of the rating categories, and more tiers that distinguish urgent from non-urgent needs, it would be helpful to have more uniformity in terms of the frequency of patient assessment.

In terms of other community service providers, there appears to be little or no use of risk categorization tools; this would be a new concept for adult day care programs, oxygen suppliers, Meals on Wheels programs, and the like. Some providers may have sufficient information about their clients to use such a system, and could supply information about highest risk patients to local emergency responders, but others may not.

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