Evidence Base

Below are clinical practice guidelines, meta-analyses and peer-reviewed articles that provide key evidence for the home care tools and best practices included in CHAMP.

Behavior Change and Adherence
Care Coordination
Chronic Pain Management
Clinical Coaching
Cognitive Function
Depression
Family Caregivers
Health Literacy
Health Promotion
Home Care Workforce
Medication Management
Nutrition
Palliative Care and Advanced Illness Management
Physical Function
Rehospitalization
Sleep
Transitions
Urinary Incontinence
Wound & Skin Care

Behavior Change and Adherence

Adherence to Long Term Therapies: Evidence for Action
Intended for policy-makers, health managers, and clinical practitioners, this report provides a review of the existing knowledge on adherence to long-term therapies. It discusses options for improving adherence and demonstrates the potential impact on desired health outcomes.

An overview of systematic reviews of interventions to promote the implementation of research findings
This systematic review examines the evidence on the effectiveness of different strategies to promote behavioral change among clinicians and the implementation of research findings. (Note: full text is available if you register)

Systematic Review: Effectiveness of interventions to help older people adhere to medication regimes
This article provides a critical review of interventions to improve adherence to medication for older people. Interventions include the mechanics of medication delivery and education strategies.

Care Coordination

The care transitions intervention: Results of a randomized controlled trial
This article describes a study of a care transitions intervention that included the use of a nurse "transition coach" and its effect on rehospitalization rates.

Care Coordination, Management & Transitions Evidence Brief
The current health care system poses many challenges for older adults with multiple chronic conditions who visit many health care professionals. This brief from the Framework Initiative summarizes evidence showing that older adults can benefit from better problem assessment, care planning and care coordination.

Closing the quality gap: A critical analysis of quality improvement strategies
This report summarizes evidence about the effectiveness of care coordination interventions and presents relevant frameworks for the development and evaluation of future interventions.

The Promise of Care Coordination: Models that Decrease Hospitalizations and Improve Outcomes for Medicare Beneficiaries with Chronic Illnesses
This report focuses on care coordination programs with the strongest evidence of reductions in hospitalizations and costs for patients. It was commissioned by the National Coalition on Care Coordination, written by Randall Brown, and published in March 2009.

Chronic Pain Management

2009 AGS Clinical Practice Guideline on Chronic Pain Management
An update to the 2002 guideline, the new guideline provides recommendations regarding the use of pharmacological approaches to managing persistent pain.

ACPA Resource Guide to Chronic Pain Medication and Treatment (2012 Edition)
This Resource Guide on medications and treatment for chronic pain from the American Chronic Pain Association (ACPA) is updated yearly and provides valuable information for healthcare providers and patients. It also includes links to additional resources.

Chronic Pain Management Evidence Brief
Approximately two-thirds of older home care patients suffer pain on a daily basis. This brief from the Framework Initiative outlines effective chronic pain management strategies including individualized care plans, pain assessments and patient self-report of pain.

Improving the Quality of Care Through Pain Assessment and Management
A thorough review of the evidence-base to help nurses effectively assess and manage acute pain.

Nursing Standard of Practice Protocol: Pain Management in Older Adults
A comprehensive nursing protocol for pain management for older adults, including an overview, background, assessment tools, strategies, expected outcomes and treatment guidelines.

Clinical Coaching

No current resources

Cognitive Function

2009 Progress Report on Alzheimer's Disease: Translating New Knowledge
This report summarizes current scientific directions and highlights key findings from Alzheimer’s research funded by the National Institutes of Health.

Alzheimer's Disease Facts and Figures
This report details the escalation of Alzheimer's disease, and conveys the burden of Alzheimer's and dementia on individuals, families, local and state government, and the nation's healthcare system. It includes data on Prevalence, Mortality, Costs of Alzheimer's care, Caregiving, and a Special report on race, ethnicity and Alzheimer's disease.

California Guideline for Alzheimer's Disease Management
This clinical practice guideline presents core care recommendations for Alzheimer’s disease management that are measurable, practical and based upon available scientific evidence. (Note: The Alzheimer's Association is not responsible for information or advice provided by others, including information on Web sites that link to Association sites and on third party sites to which the Association links. Please direct any questions to [email protected])

Cognitive Function Evidence Brief
Cognitive impairments such as memory loss and dementia become more common as people age. This brief from the Framework Initiative has key findings that support screening for cognitive impairments and using tailored interventions to manage symptoms and reducing family caregiver stress.

Dementia Care Practice Recommendations for Professionals Working in a Home Setting
Practice recommendations which provide evidence-based suggestions for addressing issues that are unique to people with dementia living in the community. Some of these issues include communication and decision-making, understanding behaviors, end of life care and home care provider training.

Evidence-based practice guideline: Wandering
This guideline aims to assist caregivers in dealing with dementia patients who have wandering behavior in a community dwelling or in an institution.

Health Literacy as a Tool to Improve the Public Understanding of Alzheimer’s Disease
The purposes of this article are to familiarize readers with the concept of health literacy; demonstrate how health literacy can serve as a tool to improve the public’s understanding of Alzheimer’s disease; and suggest generally applicable strategies for clinicians.

Preventing Alzheimer’s Disease and Cognitive Decline (AHRQ Evidence Report/Technology Assessment No. 193; April 2010)
An evidence report prepared by the Duke Evidence-based Practice Center that reviews the literature on factors associated with reducing the risk of cognitive decline and Alzheimer's Disease.

Depression

Addressing Depression in Older Adults: Selected Evidence-Based Programs (2009)
This brief highlights three successful evidence-based programs for addressing depression in older adults in the community setting. It was released by the Healthy Aging Program at the Centers for Disease Control and Prevention (CDC) and the National Association of Chronic Disease Directors (NACDD).

Depression. In: Evidence-based geriatric nursing protocols for best practice
This guideline provides a standard of protocol practice for assessment and management of depression by nurses.

Evidence-based guideline: Detection of depression in older adults with dementia
This guideline includes a three-step assessment procedure that can be used across health care settings to screen for the presence of depressive symptoms in older adults with dementia.

Family Caregivers

Caregiver Assessment: Principles, Guidelines and Strategies for Change
This guideline aims to advance caregiver assessment as a basic component of practice. It provides a summary of fundamental principles and practice guidelines to support family caregivers.

Caregiver Intervention Database - Rosalynn Carter Institute for Caregiving
This database provides detailed information on interventions that have been tested in a randomized control trial (RCT) and have been found to positively impact family caregiver outcomes.

Caregiving in the U.S.: Executive Summary (2009)
This report provides a national profile of family caregivers, based on key findings from interviews with 1,480 caregivers.

Family Caregiving. In: Evidence-based geriatric nursing protocols for best practice
This guideline summary provides nurses with a standard of practice for supporting family caregivers. It includes key aspects of a caregiver assessment and practical nursing care interventions.

State of the Science: Professional Partners Supporting Family Caregiving
A report to help better prepare professionals in nursing and social work who are at the forefront of supporting family caregivers. Developed as a result of a collaborative effort of the American Journal of Nursing, the AARP Foundation, the Council on Social Work Education, the Family Caregiver Alliance, and the Rutgers Center for State Health Policy, it provides best practices to help families care for older adults.

Health Literacy

Health Literacy and Functional Health Status among Older Adults
This article describes a study of community-dwelling older adults that provides further evidence of the likelihood that inadequate health literacy detrimentally affects health.

Health Literacy PowerPoint
This PowerPoint presentation from the U.S. Department of Health & Human Services provides an overview of health literacy, why it is important, how the government is addressing it, and strategies for improving health literacy.

Improving Health Literacy for Older Adults: Expert Panel Report 2009
An expert panel report by the Centers for Disease Control and Prevention that describes key health literacy issues for older adults and identifies opportunities for health professionals to better meet their needs.

Health Literacy Interventions and Outcomes: An Update of the Literacy and Health Outcomes Systematic Review of the Literature
An update to a 2004 summary of a systematic review that consolidates and analyzes existing literature on the relationship between literacy and health outcomes, and the evidence about interventions intended to improve the health of people with low literacy. Click here to read a press release about this report.

Making Health Communication Programs Work (the "pink book")
This book published by the National Cancer Institute describes a practical approach for planning and implementing health communication efforts.

National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards)
A list of 14 standards to help health professionals respond to cultural and linguistic issues presented by diverse populations. Published by the Office of Minority Health, U.S. Department of Health and Human Services.

IOM Report—Health Literacy: A Prescription To End Confusion (2004)
This report published by the Institute of Medicine examines the body of knowledge that applies to the field of health literacy and recommends actions to promote a health-literate society.

Quick Assessment of Literacy: The Newest Vital Sign (Ann Fam Med. 2005)
An article that describes the validation of a quick literacy assessment instrument available in both English and Spanish.

White Paper: “What Did the Doctor Say?”: Improving Health Literacy to Protect Patient Safety
A public policy report from The Joint Commission that discusses specific strategies for addressing health literacy and protecting patient safety, including suggestions for health care leaders and staff to make effective communication an organizational priority.

Health Promotion

Best Practices Report: Immunizing Healthcare Personnel Against Influenza
The National Foundation for Infectious Diseases (NFID) provides this collection of best practices for and news clips about immunizing healthcare personnel against influenza. They were developed out of a roundtable discussion with field experts.

Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza
A 5-page brief from the National Foundation for Infectious Diseases (NFID) that serves as a resource for health care providers to increase awareness of the benefits and safety of influenza vaccination among older adults.

Home Care Workforce

An Overview of Home Health Aides: US, 2007
The report provides information on demographics, training, work environment, pay and benefits, use of public benefits, and injuries for home health aides. The findings may be useful in informing initiatives to train, recruit, and retain home health and hospice aides.

Best Practices in Home and Residential Care
Learn from what others have already achieved. These 20 profiles compiled by PHI describe specific employer practices to improve recruitment and retention of direct-care workers, staff satisfaction, and quality of care.

Report Brief: The Future of Nursing: Leading Change, Advancing Health (October 2010)
The Institute of Medicine report is designed to serve as a framework for changes in the nursing profession and the health care delivery system. To learn more about the Initiative on the Future of Nursing, click here.

Retooling for an Aging America: Building the Health Care Workforce
The Institute of Medicine's (IOM) Committee on the Future Health Care Workforce for Older Americans sought to determine the health care needs of Americans 65 and older, and to analyze the forces that shape the health care workforce. This report discusses the Committee's findings and recommendations.

The role of training and education in solving the direct care workforce crisis
This article summarizes recommendations related to direct-care worker training and education. Recommendations include: integrating ongoing education into daily practice; tailoring training to specific settings; developing supervisory training that emphasizes coaching and mentoring; enhancing communication, teamwork, and cultural sensitivity.

Medication Management

A Review of Barriers to Medication Adherence: A Framework for Driving Policy Options
A literature review by the RAND Corporation that identifies barriers to medication adherence and provides recommendations to improve medication adherence.

Medication Management Evidence Brief
Most older home care patients take multiple medications that often lead to medication errors when not taken correctly. This brief from the Framework Initiative describes various effective methods, programs and models for increasing medication adherence and reducing adverse events.

Nursing Standard of Practice Protocol: Reducing Adverse Drug Events
A protocol for reducing adverse drug events in older adults, including assessment tools and strategies, interventions, expected outcomes, and references. Provided by the Hartford Institute for Geriatric Nursing.

Reducing Adverse Drug Events
Excerpt of a guideline that describes assessment tools used to evaluate the patient’s ability to self-administer medications and the clinician’s assessment for potential medication-related problems.

Nutrition

Mealtime difficulties. In: Evidence-based geriatric nursing protocols for best practice
This guideline aims to improve nutritional intake for older persons at meals that provide pleasure in eating while respecting cultural and personal preferences.

Nutrition. In: Evidence-based geriatric nursing protocols for best practice
The objective of this guideline is to improve nutritional status indicators to optimize the functional status and well-being of older individuals.

Nursing Standard of Practice Protocol: Nutrition in Aging
This standard of practice protocol from the Hartford Institute for Geriatric Nursing provides an overview of nutrition in the elderly and related nursing care strategies.

Palliative Care and Advanced Illness Management

Advance care planning: Preferences for care at end of life
A report discussing how physicians and other health care professionals can help their patients with advance care planning and assess patient preferences for care at the end of life.

Geriatric Nursing Standard of Practice: Advance Directives Protocol
A guideline for assisting older adults to make decisions and provide directions about the kind of medical care they do or do not want if they become unable to make decisions or communicate their wishes.

NCP Clinical Practice Guidelines for Quality Palliative Care, Second Edition
The National Consensus Project's (NCP) guideline provides the core structures of clinical palliative care programs. These programs provide assessment and treatment of pain and other symptoms, help with patient communication and the coordination of care among various care settings. The updated second edition represents a consensus achieved among national experts on evidence-based guidelines.

Palliative Care & Advanced Illness Management Evidence Brief
Advanced planning along with improved coordination can provide many potential benefits for older adults suffering from advanced chronic illnesses. This brief from the Framework Initiative includes various communication and care mechanisms to support the best quality of life for patients regardless of the stage of their disease.

Quality Indicators for End-of-Life Care in Vulnerable Elders
Fourteen quality indicators developed to identify quality end-of-life care for vulnerable elders. The indicators address patient care preferences and palliation.

Physical Function

AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons (2010)
This is an update to the 2001 guideline aimed at preventing serious falls among older adults. The new guideline includes recommended interventions to eliminate falls risk factors found in the home and prevent falls among older persons living in the community.

Efficacy of Progressive Resistance Training on Balance Performance in Older Adults-Abstract Only
This systematic review discusses the effectiveness of progressive resistance training (PRT) on balance performance in older adults. Abstract only.

Exercise for improving balance in older people
A Cochrane systematic review describing the evidence on exercise interventions designed to improve balance in older people who live in the community or in institutional care.

Physical Function Evidence Brief
Many older adults utilizing home health care services have difficulty with physical tasks. This brief from the Framework Initiative summarizes effective interventions that can help older individuals maximize their functioning, including progressive resistance training, varied exercise training and multifaceted programs.

Screening for Osteoporosis: An Update for the U.S. Preventive Services Task Force
An update of the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening that focuses on new studies and evidence gaps that were unresolved at the time.

Systematic Review: Preventing Falls and Injuries Among Older People in Community and Emergency Care Settings
An assessment of the evidence for the use of multifactorial assessment and intervention programs to prevent falls and injuries among older adults in primary, community and emergency care settings.

Rehospitalization

Improving care transitions and reducing hospital readmissions: Establishing the evidence for community-based implementation strategies (2010)
This article summarizes implementation strategies for improving care transitions and provides supporting evidence on reducing hospital readmissions.

Rehospitalizations among Patients in the Medicare Fee-for-Service Program
This paper summarizes the frequency and patterns of rehospitalization among Medicare patients in the United States and the relation of rehospitalization to demographic characteristics of the patients and to characteristics of the hospitals.

Sleep

Excessive sleepiness. In: Evidence-based geriatric nursing protocols for best practice (2003)
This guideline provides a standard of practice protocol for the assessment and management of excessive daytime sleepiness and sleep disorders in the older adult.

Transitions

Care Coordination, Management & Transitions Evidence Brief
Reviews chronic conditions among older home care patients and evidence-based ways to improve care coordination. Describes models for transitions of care. Includes ways home care nurses and therapists can include effective care management interventions with their older patients.

Elements of Excellence in Transitions of Care
A checklist from the National Transitions of Care Coalition that provides a detailed description of effective patient transfer between practice settings.

Seven Essential Intervention Categories
This is a collection of essential care transition intervention strategies. It is categorized into seven main topics with examples to aid providers in adopting the strategies. It was developed by the National Transitions of Care Coalition (NTOCC).

The Transitions of Care Consensus Policy Statement
An article describing principles and standards developed by a coalition representing six physician professional organizations to address quality gaps in transitions of care between inpatient and outpatient settings.

Transitional Care: A Critical Dimension of the Home Healthcare Quality Agenda
This paper describes the research base for the transitional care of older adults and offers recommendations to advance the science, translate best practices into home healthcare settings, and improve the transitions of high-risk older adults to and from home healthcare.

Urinary Incontinence

Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTI), 2008
This guide, developed by the Association for Professionals in Infection Control and Epidemiology (APIC), is designed to provide evidence-based resources for the prevention of CAUTIs in acute and long-term care settings

Guideline for Prevention of Catheter-Associated Urinary Tract Infections (CAUTI), 2009
This guideline updates and expands the original Centers for Disease Control and Prevention (CDC) Guideline published in 1981. The revised version outlines high-priority recommendations for CAUTI prevention in order to offer guidance for implementation.

NIH Statement on Prevention of Fecal and Urinary Incontinence in Adults
This statement provides healthcare professionals and the general public with an assessment of the current evidence regarding the prevention of fecal and urinary incontinence in adults.

Quality Indicators for the Screening and Care of Urinary Incontinence in Vulnerable Elders
A review article that examines evidence for urinary incontinence quality indicators that may be applied when assessing and treating vulnerable adults.

Wound & Skin Care

Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease
An evidenced-based guideline to assist providers with the evaluation and management of wounds in patients with lower-extremity venous disease (LEVD).

Nursing Standard of Practice Protocol: Pressure Ulcer Prevention & Skin Tear Prevention
A comprehensive protocol for nurses on the prevention of ulcers and skin tears in older adults. It includes practical nursing care strategies and interventions.

OASIS-C Importance of Accurate Pressure Ulcer Assessment and Management in Home Health Care
An article describing an educational initiative by certified wound, ostomy, and continence nurses to strengthen clinical and documentation skills related to the Outcome and Assessment Information Set (OASIS)-C M items.

Published Clinical Guidelines for Prevention and/or Treatment of Pressure Ulcers: Annotated Bibliography
A resource from the Joint Commission's Pressure Ulcer Prevention Project that provides clinicians with an overview of the evidence base for preventing and treating pressure ulcers.

Disclaimer/Permissions: All resources posted on the CHAMP web site are provided free of charge for educational, non-profit use only. Necessary permissions have been obtained for any copyrighted materials. Links to resources outside of the CHAMP web site are subject to the host site's policies. Please note that not all resources are specific to home care and they are not intended to replace or substitute professional medical advice regarding the needs of individual patients.