DRG Ripple Effects on Community Health Nursing

Abstract

Prospective payment by diagnosis-related groups (DRGs) has influenced hospital care in at least two ways: patients are experiencing shorter hospital stay and they are being discharged in a less healthy state than in the past. As a result, home health agencies are reporting an increase in the number of patients needing services, with the majority of these patients being sicker, older, and requiring more complex care. As hospital-based care shifts to community care, the impact on community home health agencies continues to increase. To date, little has been written about role changes for community health nurses, especially home health nurses, as a result of the ripple effect of DRGs. The authors suggest likely changes in the caring, counseling, and coordination aspects of the nurse's role. The community health nurse's role is evolving into one that requires expertise in advanced technologies, more sophisticated assessment and counseling skills, and a more comprehensive case management component. Concomitant alterations must be made in resource requirements and distribution. Such changes provide opportunities for innovative and creative nursing strategies. Elayne Kornblatt Phillips is Associate Professor of Nursing and Assistant Professor of Epidemiology at the University of Virginia. Patricia Cloonan is a doctoral student at rhe University of Virginia School of Nursing. Address correspondence to Elayne Kornblan Phillips, R. N . , University of Virginia School of Nursing, McLeod Hall, Charlonesville, V A 22903. Telephone (804) 924-0124.

Specialty Roles in Community Health Nursing: A National Survey of Educational Needs

“…Similarly, the finding that home health agencies are expected to have a great need for CHN services is consistent with the findings and recommendations of others (ANA, 1987;Fahy, 1986;Hanchett & Chambers, 1987;Jones, Davis, & Davis, 1987;Kinder, 1987;Phillips & Cloonan, 1987). Academic and research institutions also were seen as important employment settings for master's-level CHNs.…”

“…pleted; thus, the concurring findings validate the need to continue to prepare nurses for roles in governmental health agencies, and support the need for a revitalization of public health nursing. Similarly, the finding that home health agencies are expected to have a great need for CHN services is consistent with the findings and recommendations of others (ANA, 1987;Fahy, 1986;Hanchett & Chambers, 1987;Jones, Davis, & Davis, 1987;Kinder, 1987;Phillips & Cloonan, 1987). Academic and research institutions also were seen as important employment settings for master's-level CHNs.…”

“…For example, the U.S. Surgeon General's 1990 health goals for the nation, the statements of professional societies and leaders in health care and the work of numerous researchers indicate that certain populations require tar-geted programs and that certain health conditions warrant concerted action by the health care system (ANA, 1987;Berkseth, 1985;Bernal & Froman, 1987;Carter Center, 1984;Fahy, 1986;Forni, 1987;Kelley & Lakin, 1988;Phillips & Cloonan, 1987;Pletsch & Leslie, 1988, Smithwick, 1986United States Public Health Service [USPHS], 1980;U.S. Surgeon General, 1987;Ward & Fletcher, 1984).…”

The Relationship Between Demographic Characteristics and Nursing Problems in Home Health Care

“…Moreover, patients required more frequent home visits of longer duration (Kornblatt & Fisher, 1985). This shift of illness care from hospital to home settings, labeled the "DRG ripple effect" (Phillips & Cloonan, 1987), provided impetus for nursing research to focus on establishing a relationship between nursing diagnoses and use or length of stay among hospitalized patients (Van Ruiswyk et al, 1992), and on the relationship between nursing problems and use of home health services (Peters, 1988;Helberg, 1988).…”

A Basis for Prospective Payment for Home Care

“…It has been proposed that a diagnosis related group (DRG) "ripple effect" has changed the home care client's profile, and plans for care are becoming increasingly complex (Phillips & Cloonan, 1987). Additionally, earlier hospital discharges and decreased admissions have been noted (Thompson, 1985); they may be contributing to the introduction of technology into the home care arena.…”