Needs assessment for hospital-based home care services

Careful needs assessment is a prerequisite to addressing issues of health care program effectiveness and program planning from a population‐based perspective. Home care program evaluation literature is lacking in examples of strategies for such assessment. A nurse‐screening of admissions was conducted at an acute care general hospital to estimate need for hospital‐based home care (HBHC) services among the 2,613 patients discharged from medical and surgical services over a 5‐‐month period. After careful delineation of inclusion and exclusion criteria for identifying HBHC patients and participant‐observer training, the nurse's judgments on patient appropriateness for HBHC care were shown to agree reliably with those of the HBHC staff (k = +.45). In the study hospital under current conditions, an estimated 64% of discharged patients appropriate for home care do not receive these services. A comparison of the incidence according to service of HBHC‐appropriate patients and patient‐referral rates to HBHC suggests that one service over‐refers (neurology), but most under‐refer. Screening nurse salary expenditures constitute the major costs of this approach to home care needs assessment, which is recommended only for addressing major, infrequent programmatic policy issues.