Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study

Arbaje, Alicia I.; Hughes, Ashley M.; Werner, Nicole E.; Carl, Kimberly; Hohl, Dawn; Jones, Kate; Bowles, Kathryn H.; Chan, Kitty S.; Leff, Bruce; Gürses, Ayşe P.

doi:10.1136/bmjqs-2018-008163

Cited by 41 publications

(56 citation statements)

References 52 publications

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“…Agency and systems-level interventions, including those that facilitate seamless communication between hospital and HHC agency staff, are needed to ensure that nurses are well informed of patient cases prior to visits. Evidence-based interventions to improve communication between providers should include the use of health information technology, such as electronic medical records, and efficient integration of clinical records to improve information management across care settings (49). Assessments of caregivers that account for caregivers' experiences and learning preferences and incorporate evaluation of training and support gaps could be captured during the hospital discharge process and shared with post-acute providers including HHC agencies.…”

Section: Discussionmentioning

confidence: 99%

Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

Chase

Russell

Rice

et al. 2019

Journal of Patient Experience

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Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

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Section: Discussionmentioning

confidence: 99%

Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

Chase

Russell

Rice

et al. 2019

Journal of Patient Experience

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“…This deficit is of concern because making appropriate clinical decisions and providing safe patient care depends on having adequate and accurate information. 11 , 29 , 30 Patient outcomes and quality of care may be impacted by the quality and amount of information available to clinicians. 31–33…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Problems exist with information transfer during the transition to HHC, 1 , 3–9 and information needed by HHC nurses is often missing. 10 , 11 To obtain needed information, nurses tend to rely on the patient or caregivers and this information is often not reliable. 12 From a human information processing perspective, complete and reliable information is the foundation for making consistent and accurate judgments and appropriate clinical decisions 13–15 and for providing safe patient care 16 ; therefore, nurses and patients are currently disadvantaged.…”

Section: Introductionmentioning

confidence: 99%

Incorporating home healthcare nurses’ admission information needs to inform data standards

Sockolow

Bowles

Wojciechowicz

et al. 2020

Journal of the American Medical Informatics Association

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Objective Patient transitions into home health care (HHC) often occur without the transfer of information needed for critical clinical decisions and the plan of care. Owing to a lack of universally implemented standards, there is wide variation in information transfer. We sought to characterize missing information at HHC admission. Materials and Methods We conducted a mixed methods study with 3 diverse HHC agencies. Focus groups with nurses at each agency identified what information supports patient care decisions at admission. Thirty-six in-home admissions with associated documentation review determined the available information. To inform information standards development for the HHC admission process, we compared the types of information desired and available to an international standard for transitions in care information, the Continuity of Care Document (CCD) enhanced with Office of the National Coordinator for Healthcare Information Technology summary terms (CCD/S). Results Three-quarters of the items from the focus groups mapped to the CCD/S. Regarding available information at admission, no observation included all CCD/S data items. While medication information was needed and often available for 4 important decisions, concepts related to patient medication self-management appeared in neither the CCD/S nor the admission documentation. Discussion The CCD/S mostly met HHC nurses’ information needs and is recommended to begin to fill the current information gap. Electronic health record recommendations include use of a data standard: the CCD or the proposed, more parsimonious U.S. Core Data for Interoperability. Conclusions Referral source and HHC agency adoption of data standards is recommended to support structured, consistent data and information sharing.

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“…6 In another recent qualitative study by Arbaje and colleagues, a majority of caregivers described "mismatched expectations" about HHC services, in which caregivers were unclear about their role compared with the HHC role in caring for the patient. 9 Of interest, HHC clinicians in the Arbaje study described one of their key tasks to be "expectation management" for receipt of HHC services. 9 In our study, the caregivers who described unclear expectations were not able to be present for the first HHC visit, which may have been a missed opportunity for the HHC clinician to clarify and manage expectations.…”

Section: Discussionmentioning

confidence: 99%

Patient, Caregiver, and Clinician Perspectives on Expectations for Home Healthcare after Discharge: A Qualitative Case Study

Jones

Bowles

et al. 2019

Journal of Hospital Medicine

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BACKGROUNDPatients discharged from the hospital with skilled home healthcare (HHC) services have multiple comorbidities, high readmission rates, and multiple care needs. In prior work, HHC nurses described that patients often express expectations for services beyond the scope of skilled HHC.OBJECTIVEThe objective of this study is to evaluate and compare expectations for HHC from the patient, caregiver, and HHC perspectives after hospital discharge.DESIGN/PARTICIPANTSThis was a descriptive qualitative case study including HHC patients, caregivers, and clinicians. Patients were discharged from an academic medical center between July 2017 and February 2018.RESULTSThe sample (N = 27) included 11 HHC patients, eight caregivers, and eight HHC clinicians (five nurses and three physical therapists). Patient mean age was 66 years and the majority were female, white, and had Medicare. We observed main themes of clear and unclear expectations for HHC after discharge. Clear expectations occur when the patient and/or caregiver have expectations for HHC aligned with the services received. Unclear expectations occur when the patient and/or caregiver expectations are uncertain or misaligned with the services received. Patients and caregivers with clear expectations for HHC frequently described prior experiences with skilled HHC or work experience within the healthcare field. In most cases with unclear expectations, the patient and caregiver did not have prior experience with HHC.CONCLUSIONSTo improve HHC transitions, we recommend actively engaging both patients and caregivers in the hospital and HHC settings to provide education about HHC services, and assess and address additional care needs.

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Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study

Cited by 41 publications

References 52 publications

Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

Incorporating home healthcare nurses’ admission information needs to inform data standards

Patient, Caregiver, and Clinician Perspectives on Expectations for Home Healthcare after Discharge: A Qualitative Case Study

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