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.

MedStar author(s):
Citation: BMJ Quality & Safety. 28(2):111-120, 2019 02.PMID: 30018114Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Consumer Health Information/og [Organization & Administration] | *Continuity of Patient Care/og [Organization & Administration] | *Home Care Services/og [Organization & Administration] | *Patient Discharge/st [Standards] | Aged | Aged, 80 and over | Appointments and Schedules | Consumer Health Information/st [Standards] | Female | Geriatrics | Home Care Services/st [Standards] | Humans | Insurance Coverage | Male | Middle Aged | Patient Care Planning/og [Organization & Administration] | Qualitative Research | Referral and Consultation/og [Organization & Administration]Year: 2019ISSN:
  • 2044-5415
Name of journal: BMJ quality & safetyAbstract: BACKGROUND: Middle-aged and older adults requiring skilled home healthcare ('home health') services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition.CONCLUSIONS: IM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions.Copyright (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.METHODS: Multisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams.OBJECTIVES: (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers' perspectives and (2) Identify IM-related process failures.RESULTS: We identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults' and informal caregivers' mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information).All authors: Arbaje AI, Bowles KH, Carl K, Chan K, Gurses AP, Hohl D, Hughes A, Jones K, Leff B, Werner NFiscal year: FY2019Digital Object Identifier: ORCID: Date added to catalog: 2018-07-30
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Journal Article MedStar Authors Catalog Article 30018114 Available 30018114

BACKGROUND: Middle-aged and older adults requiring skilled home healthcare ('home health') services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition.

CONCLUSIONS: IM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions.

Copyright (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

METHODS: Multisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams.

OBJECTIVES: (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers' perspectives and (2) Identify IM-related process failures.

RESULTS: We identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults' and informal caregivers' mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information).

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