Home Health Nursing Care Time for Patients with Parkinson’s Disease

Round 1

Reviewer 1 Report

Thank you for giving me the opportunity to review this manuscript. In this study, the authors aimed 1) to obtain a comprehensive view of home health nursing or as it is currently being provided to patients with PD, 2) to determine how much variation exists in nursing care time spent with each patient, and 3) to identify patient characteristics that may account for that variation. This was an observational cohort study conducted at a single home-visit nursing agency. To begin with, I commend the authors for investigating a clinically relevant topic, due to the trying to quantify the nursing care and the role of home health care are continuously highlighted with socio-epidemiological trending. Overall, this manuscript is very well written, and very innovative, but the methods can be improved.

Specific comments:

1. Introduction

• Page 1, lines 27-33: Paragraph 1 and Paragraph 3 is somewhat overlapped. Please avoid repetition and present the same topic in the same paragraph.
• Page 1, lines 32-33: In addition, I recommend presenting that nursing care is needed to reduce disease-related stress and caregiver burden.
• Page 2, lines 43-48: There is something missing in this paragraph. Did the lack of staffing lead to investigating the time spent on PD? Was this to identify priorities?
• Page 2, lines 52-54: It seems that the authors did not consider the time spent on conversation as the nursing care. Education or consulting about the disease would also be nursing practice. Nursing care is not always about 'doing action'.
• Page 2, lines 54-55: Do the patients have other assistants or formal/informal caregivers? OR do nurses provide all assistance with eating, taking medications, or transferring in HHC?
• Page 2, lines 66: I would suggest summarizing what is the current research gaps existing.

 

2. Methods:

• Page 3, lines 80-81: A nursing home and home care are two completely different things. It seems the role of home health nurse might be difference by nation. It would be great to begin by introducing what a home health nurse does in your area (somewhere in introduction section).
• Page 3, lines 90-95: I am wondering why the patient's comorbidities was not taken into account.
• Page 3, lines 92-93: Please provide a concise explanation of the HY stage for the audience who are not familiar with the five stages of PD, as in the remarks under the Table 1.
• Page 3, lines 99-100: This sentence needs clarification, what is the unattended time? "Additionally, in Japan, unattended time study has- become increasingly common."
• Page 3, lines 103-122: Do they receive a token of appreciation for participating?
• Page 4, lines 131-147: The authors need to elaborate on this analysis. How was it coded on motion and conversation? Who coded it, what is the qualification, and if there are two coders what is the inter-rater agreement? How was the disagreement resolved? What software was used for coding?
• Page 4, lines 136-137: Please provide some examples and enclose as an appendix.
• Page 4, lines 138-140: I am wondering if it is accurate way to measure the time because the massage continues throughout the advice. It sounds as if you are contemplating intensity, but that is beyond the scope of this manuscript. In this regard, I am unsure of whether the way to measure for time spent is accurate.

 

3. Results:

• Page 5, Table 1: Please replace 20 in the first row with N = 20.
• Page 6, lines 170-173: '3.2.4.' can be incorporated into this paragraph. For example, the authors can present average.
• Page 7, Table 2: Isn't age, years since PD onset, and HY stage correlated each other? If so, the analysis should be post-hoc and the interpretation should be revised accordingly. Currently, the authors presented that only age was associated with nursing care time in the discussion.

4. Discussion:

• Page 8, lines 216-220: This is an empirical assumption. Do they have the protocol and do they follow it?
• Page 10, lines 304-309: The limitation can be expanded, including that this is single-center study that cannot be generalized.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear authors, your article belongs to the field of personalized care. You have mentioned in a simple and understandable way, how nursing care is provided in a chronic illness like PD in the community.

Here are some of my comments.

a) I think that a the sample of 20 patients is a kind of limitation. In addition to small sampling, you divided patients into 2 living environments (homes and nursing homes (11+9=20). My view is that segregation could lead to bias in the results and should be statistically investigated or reported to limitations. The daily living activities in those two different enviroments are usually different. More over that you found daily living assistance had large variability. This complicates the interpretation of the results in this field.

You can think about a possible correlation between nursing care time and kind of residence.

b) Daily living 76%, medical care 10,1%, record and admin....14%. Please make all in a total sum of 100%, and not 100,1%. maybe medical care 10%?

Generally, thank you for these useful results and conclusions.

Best regards.

Author Response

Response to Reviewer 2 Comments

Dear authors, your article belongs to the field of personalized care. You have mentioned in a simple and understandable way, how nursing care is provided in a chronic illness like PD in the community.

 

Point a) : I think that a the sample of 20 patients is a kind of limitation. In addition to small sampling, you divided patients into 2 living environments (homes and nursing homes (11+9=20). My view is that segregation could lead to bias in the results and should be statistically investigated or reported to limitations. The daily living activities in those two different enviroments are usually different. More over that you found daily living assistance had large variability. This complicates the interpretation of the results in this field.

You can think about a possible correlation between nursing care time and kind of residence.

Response a): Thank you very much for your insight. I have added a "nursing home" description to the results. In addition, I added a new Table (Table 2) to show that there is a correlation between household size and HY stage. I also added an analysis of two living environments and nursing care times in the "Discussion" section. I also noted in the "Limitations" section that the sample size was small.

Page5, Lines180-183: These nursing homes are classified as "serviced housing for the elderly" in Japan and are similar to apartment houses in a housing complex. They receive home health nursing and home care services from an outside source for a separate fee.

Page6, Line193: Table2.

Page11, Lines283-287: Patients with higher HY stage had significantly smaller household size, suggesting that they may live in nursing homes more often. However, there was no significant association between household size and nursing care time per visit. This may indicate that support other than by home health nurses was provided and that nurses did not over-provide services that could be substituted by others.

Page13, Lines347-348: The limitations of this study are that it is limited to one agency and only measures nursing time for one visit for twenty patients.

 

Point b) : Daily living 76%, medical care 10,1%, record and admin....14%. Please make all in a total sum of 100%, and not 100,1%. maybe medical care 10%?

Response b): Thank you for pointing this out. I have changed the numbers in the summary, figure, and text to 10.0%.

Round 2

Reviewer 1 Report

I appreciate you taking the effort to address the comments. The manuscript has become much clearer.