AIDS care improved with specialty program
AIDS care improved with specialty program
Patient volume determines program's success
At the VNA of Delaware in Georgetown, becoming the main provider for people with HIV/AIDS in the state was just a matter of making AIDS care a specialty program. In addition to increasing the company's referrals, breaking HIV disease and AIDS care out of regular home care has improved the quality of care the patients get, says Georgia Smith, RN, the head of specialty care and clinical care at the VNA of Delaware.
As part of the company's specialty care service programs, which include infusion, maternal-child care, and oncology, the HIV/AIDS patient care specialty program includes services such as dietitian visits, stress management, death and dying counseling, and homemaker visits. About 12% of the company's total patient census are in the HIV/AIDS program.
The VNA of Delaware developed an addendum to its admission database form, as well as special care plans for HIV/AIDS patients. This form ensures these patients get the care they need and are put in touch with all of the resources they might require. (See VNA of Delaware's HIV/AIDS assessment addendum, enclosed in this issue.)
The care plans include orders for nurses to assess and instruct patients about universal precautions, as well as the signs and symptoms of opportunistic infections such as fever, diarrhea, weight loss, shortness of breath, dry cough, and memory loss.
The result of this program is higher quality care for AIDS patients. Overall, the VNA of Delaware's AIDS patients experience fewer repeat hospitalizations now that their care is broken out into a specialty program, Smith says. The company plans to begin tracking its patients' hospitalizations soon, to be able to quantify the effect of the HIV/AIDS specialty program.
Until this data is collected, the success of the program can be measured anecdotally in that none of the company's patients who receive special nutritional counseling are on total parenteral nutrition (TPN), while three of the patients who are not in the nutritional counseling program are on some type of enteral nutrition. The VNA of Delaware's nutritional counseling for people with HIV/AIDS is funded by the Ryan White Care Act, and only patients who are on Medicaid or Medicare are eligible to receive Ryan White funds.
"We're turning into the state's experts on AIDS," Smith says. The VNA of Delaware serves the entire state with its four branches. Its HIV/AIDS program receives referrals from all of the state's public health offices and infectious disease centers.
Is it worth it for other home care providers to create an AIDS specialty program, too? It can be, Smith says. If you're thinking of starting an AIDS specialty program at your company, here's what to do:
* Survey your patient population.
Go through the ICD-9 codes to see how many AIDS diagnoses your company has among your patients. If 5% to 10% or more of your total patient population are AIDS patients, then you have the volume to make an AIDS specialty program worth it, Smith says.
* Teach yourself about AIDS care.
Smith and her colleagues worked with their state public health officials and various infectious disease doctors to learn about the issues that affect the health of AIDS patients. The VNA of Delaware learned about AIDS patients' nutritional problems, their psychiatric needs, the clinical, social, and emotional issues that affect AIDS patients' health.
"Case management is a lot more important with AIDS patients. You're not just taking care of the disease. You're caring for the whole person and their family," Smith says.
* Train your staff to care for AIDS patients.
The VNA of Delaware brought in public health AIDS specialists to teach the company's nurses about caring for AIDS patients.
Smith's staff nurses went through four two-hour courses that covered subjects such as disease pathology, interpretation of AIDS patients' lab results, the various AIDS drugs and their side effects, case management of AIDS patients, dietary and nutritional issues for AIDS patients, and reimbursement issues.
"You don't need to send your nurses to a $400 course and seminar," Smith says. *
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