Title

Cardiac care: An assessment of delivery modalities--issues and potential

Date of Award

1990

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Social Sciences

Advisor(s)

William S. Pooler

Keywords

Home care, Nursing, Public health, Cardiology, Health care delivery

Subject Categories

Social and Behavioral Sciences

Abstract

The purpose of this policy study was to assess the feasibility, acceptability, safety, efficacy, and social issues surrounding the development of an alternate home based delivery modality for cardiac care; and to explore implementing such a model for a select group of cardiac patients who presently are admitted to a tertiary center. The model was developed by determining the consensus through in-depth, semi-structured interviews with the providers of cardiac care--physicians, nurses, and health administrators, and the consumers of care-cardiac patients and family members. The eighty-six participants explored the patient selection criteria, health care personnel, equipment, and home environment considered necessary for the successful development of the model as well as the political, legal, ethical, and financial issues viewed as impeding or facilitating implementation. The research questions hypothesized that as the provider's locus of practice moved from the high technology tertiary setting to less technological ambulatory one, he/she would more likely be able to perceive the utility of home care cardiac services. Younger patients were thought to be less likely to view an alternate modality as efficacious. However, all patients without adequate personal support systems were hypothesized to be less favorably inclined toward home care. Administrators whose organizations were involved in vertical integration ventures were hypothesized to view the alternate model as an opportunity and therefore would be more positively disposed.

Contrary to expectations all provider specialties perceived the model as acceptable and feasible, regardless of whether they practiced in a highly technological tertiary setting or community setting. Differences did occur based on the type of provider (nurse or physician) and on the functional specialty (cardiology, primary care or community health, for example). Greater utility for the model by age of the consumer was not supported by the data. However, the hypothesis regarding support systems was supported by the research. The hypothesis that administrators of vertically integrated institutions would find more utility in an alternate delivery model was modestly supported, even though all administrators, whether their institution was vertically or horizontally integrated, perceived the model positively.

The findings hold implications for policies governing the home health care delivery system. Of primary import is the agreement among the respondents surrounding the feasibility and acceptability of a cardiac home care model which extends existing standards of practice. The study identified factors responsible for the success or lack of success of this or any other type of health delivery model, and it suggested ways to anticipate implementation problems.

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