Using stakeholder intervention refinement teams to develop approaches for real-time integration of patient-reported safety information during older adults’ hospital-to-home-health care transitions

Abstract

Background The hospital-to-home transition remains a high-risk care interval for older adults. Skilled home health (HH) agencies are uniquely positioned to address care-transitions-associated patient safety threats. We previously developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index to identify safety issues after hospital discharge. Our objective is to evaluate a participatory ergonomics process engaging stakeholders to develop strategies to implement the H3TQ into HH agency workflow to improve transition-associated safety issues in real-time. Methods Stakeholders participated in three, two-hour Intervention Refinement Team (IRT) meetings with a focus on: (1) identifying facilitators and barriers to collect H3TQ data in real-time, (2) integration of H3TQ into workflows, and (3) sharing H3TQ safety threat information to improve care transition safety outcomes. We used the human factors engineering-informed Systems Ambiguity Framework to guide the structure of IRT meetings and qualitative data analysis to evaluate the IRT process itself. Results Stakeholders (N = 9) represented patients, family caregivers, and HH staff. Stakeholders identified three key strategies for H3TQ implementation: (1) mechanism and timing of H3TQ data collection using multiple platforms; (2) data sharing conditions for safety reporting across the health system; and (3) identification of targeted care transitions outcomes for improvement. Participants highly rated IRT meetings regarding meeting usefulness, comfort, and degree of input into the discussion. Conclusions The IRT participatory ergonomics process was successful. Stakeholders identified strategies to facilitate implementation of the H3TQ implementation to improve the hospital-to-HH. IRTs have potential application to other health system issues related to the care of people with complex needs.

Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID‐19

“…To understand whether the pandemic exacerbated vulnerabilities in certain subgroups, we conducted multiple logistic regression models regressing 30-day ED visit or rehospitalization (outcome measure) on the variable of interest (phase of pandemic), and interaction terms of the two examining whether the outcome worsened for certain vulnerable subgroups, adjusted for other covariates based on our clinical expertise and prior work in the field. [11][12][13][14][15][16][17] The subgroups of particular interest included African-American patients, patients with dementia, and those with poor activities of daily living (ADL) function. We also compared patients with a COVID diagnosis (or COVID-like symptoms) to those without on the number of days between hospital discharge and the first HH visit.…”

WHO Five Moments for Medication Safety: A time to organize?

“…Arbaje and colleagues evaluated a process to engage patients, families, and home health workers to improve the safety of hospital-to-home transitions in care in the USA. 19 The ergonomics-based process was successful in helping stakeholders to integrate safety issues in realtime into their workflows.…”