| Families providing technologically complex health care at home can be considered a health care delivery system. Families manage resources such as time, money, and use of professionals to provide care. They also bear expenses beyond financial costs, such as psychological, physical, time, opportunity, and social costs. Efficient and effective resource use in family systems is necessary to maintain home care and prevent caregiver burnout leading to illness. The purposes of this descriptive evaluation study were to identify families that efficiently and effectively used time and personnel resources to attain best patient and caregiver health and well-being; to describe characteristics of the families on and off best practice frontier; and to estimate resources needed to assist less efficient and effective families improve.; Family systems theory and the economic model of the household provided the theoretical framework for the study (Artinian, 1991; Bryant, 1990). The longitudinal sample had 23 dyads of caregivers and patients who were receiving total parenteral nutrition (TPN) at home.; Scores from two data collection points using quality of life, life satisfaction, coping, resource utilization, and depression measures were analyzed using Data Envelopment Analysis (DEA), a nonparametric linear programming technique used in best practice frontier analysis (Charnes, Cooper, & Rhodes, 1978). Families, the unit of analysis, were compared to peer families on time resources used to achieve health and well-being outcomes. Families with best transformation of resource inputs into desired outputs were best practice families.; Five families consistently were on the best practice frontier and four consistently were not. Families on the frontier used fewer professional and caregiver hours. Families off the frontier had lower perceptions of their health status and higher patient depression scores. Wilcoxon-Mann-Whitney U results indicated best practice frontier families had significantly ({dollar}le{dollar}.05) fewer Emergency Room visits, higher satisfaction with psychological/spiritual life, higher patient life satisfaction scores, and higher patient perception of health. Interview data corroborated depression as a serious problem for some. Estimates of costs to assist families to reach the frontier were described as individualized interventions.; Future research using time series analyses may reveal high risk resource utilization patterns. Replication with financial data is needed. |
