Defining practice variation and exploring influencing factors on needs assessment in home care nursing: A Delphi study

Author:

Van Dorst Johanna (Jose) Isabella Elisabeth1ORCID,Schwenke Marit2,Bleijenberg Nienke23,De Jong Judith Daniëlle14,Brabers Adriana (Anne) Elisabeth Maria4,Zwakhalen Sandra M. G.1ORCID

Affiliation:

1. Department of Health Services Research, CAPHRI, Care and Public Health Research Institute Maastricht University Duboisdomein 30 Maastricht 6229 GT Netherlands

2. Research Centre for Healthy and Sustainable Living, Faculty of Health Care University of Applied Sciences Utrecht Utrecht Netherlands

3. Department of General Practice, Division Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht Netherlands

4. Nivel Institute for Health Services Research Utrecht Netherlands

Abstract

AbstractAimTo describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment.DesignA Delphi study was conducted with the participation of home care representatives.MethodA Delphi questionnaire was developed, preceded by literature research and an expert meeting. The Delphi study took place between December 2020 and February 2021. The goal was to achieve a consensus level of at least 70%.ResultsAfter three rounds, 32 experts reached a consensus about definitions regarding variation in needs assessment, warranted and unwarranted variation. In total, 59 factors were determined related to (1) the client and health, (2) the clients' context, (3) nurses and (4) the nurses' context. Thirty‐four factors scored warranted of influence and 18 (of 34) were client related. Most of the factors that scored unwarranted influencing needs assessment (17 of 26) were related to the home care nurses' context.ConclusionHaving a consensus about the definition of practice variation in needs assessment and possible influencing factors support the professionals to discuss and improve the unity and quality of their decision‐making process in home care. This may contribute to more righteous care for clients in need of home care.ImpactSince 2015, home care nurses in the Netherlands are responsible for determining the amount, type and duration of care for clients in need of home care. This so‐called needs assessment legitimizes the payment by health insurers. Signals of practice variation in needs assessment are heard in home care field. Although practice variation may be justified, it can lead to over or underuse of care, which may affect clients' outcomes. If we can identify influencing factors and find patterns that contribute to practice variation, we might gain a better understanding of the process and improve home care.Patient or public contributionIn this study, there was no patient or public involvement. Client representatives were included in this research as experts in the home care field, and they participated in three rounds of the Delphi study. They contributed by sharing their expert opinion on the definitions presented and the factors possibly influencing needs assessment.

Publisher

Wiley

Subject

General Nursing

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