Article| Volume 57, ISSUE 5, P266-273, September 2009

Download started.


Project ¡ÉXITO!: Success through diversity and universality for outcomes improvement among Hispanic home care patients

      The National Health Disparities Report notes that Hispanics have poorer quality of care in 23 of 38 core measures. The result of this disparity is great personal and health system costs, which could be reduced. Prior studies have focused on access and language. We studied outcomes improvement.
      The purpose of this project was to develop a replicable theory-based outcomes improvement model for delivery of nursing care to Hispanic patients.
      The Leininger Sunrise Enabler approach was used to design a program specific to the cultural needs of a home care population. Outcome and Assessment Information Set (OASIS) data from 125 unduplicated home care patients were tracked. Nursing care delivery was analyzed using ethnographic research techniques.
      Delivery of nursing care using a culturally congruent approach reduced acute hospitalization and emergent care visits. Medication management and customer and nursing satisfaction also improved.
      National standards for culturally and linguistically appropriate services in health care help reduce healthcare disparities, but improving Hispanic outcomes requires moving beyond symptoms and symptom management to transcultural care. The estimated savings to the health care system are significant.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. US Census Bureau. U.S. interim projections by age, sex, and Hispanic origin, 2004. Available at: Accessed on October 20, 2008.

      2. Agency for Healthcare Research and Quality. National health disparities report. (AHRQ Publication No. 08-0041).
        US Department of Health and Human Services, Washington, DC2008
        • Romeo C.
        Caring for culturally diverse patients: One agency's journey toward cultural competence.
        Home Healthcare Nurs. 2007; 25: 206-213
      3. U.S. Census Bureau. American community survey, 2007. Available at: Accessed on October 20, 2008.

        • Pacquiao L.
        • Archeval L.
        • Shelley E.
        Transcultural nursing study of emic and etic care in the home.
        J Transcult Nurs. 1999; 10: 112-119
        • Leininger M.M.
        Culture care diversity and universality theory and evolution of the ethnonursing method.
        in: Leininger M.M. McFarland M.R. Cultural care diversity and universality. A worldwide nursing theory (2nd ed). Jones & Bartlett Publishers, Boston, MA2006: 1-41
        • National Center for Healthcare Statistics
        The health literacy of America's adults. Results from the 2003 National Assessment of Adult Literacy. (NCES Publication No. 2006-483). U.S. Department of Education, Washington, DC2006
      4. Strategic Healthcare Programs. SHP for data mining and data management, undated. Available at: Accessed on October 7, 2008.

        • Keepnews D.
        • Capitman J.A.
        • Rosati R.J.
        Measuring patient-level clinical outcomes of home health care.
        J Nurs Scholarsh. 2004; 36: 79-85
        • Schneider J.S.
        • Barkauskas V.
        • Keenan G.
        Evaluating home health care nursing outcomes with OASIS and NOC.
        J Nurs Scholarsh. 2008; 40: 76-82
        • Madigan E.A.
        • Tullai-McGuinness S.
        • Fortinsky R.H.
        Accuracy in the outcomes and assessment information set (OASIS): Results of a video simulation.
        RINAH. 2003; 26: 273-283


      Louise Woerner, MBA, FAAN, is Chairman & CEO, Home Care of Rochester (HCR), Rochester, NY.


      Javier Espinosa, PhD, is an Associate Professor, Rochester Institute of Technology, Rochester, NY.


      Susan Bourne, RN, MSN, is Director of Clinical Specialty Programs, Home Care of Rochester (HCR), Rochester, NY.


      Marie O'Toole, EdD, RN, FAAN, is Chair, Department of Nursing, Nazareth College, Rochester, NY.


      Gail L. Ingersoll, EdD, RN, FAAN, is a Loretta Ford Professor & Director, Center for Outcomes Measurement & Practice Innovation, University of Rochester School of Nursing, Rochester, NY.