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Journal article
Improving Patient Prioritization During Hospital-Homecare Transition: Protocol for a Mixed Methods Study of a Clinical Decision Support Tool Implementation
JMIR research protocols, v 10(1), e20184
Jan 2021
PMCID: PMC7864770
PMID: 33480855
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Homecare settings across the United States provide care to more than 5 million patients every year. About one in five homecare patients are rehospitalized during the homecare episode, with up to two-thirds of these rehospitalizations occurring within the first 2 weeks of services. Timely allocation of homecare services might prevent a significant portion of these rehospitalizations. The first homecare nursing visit is one of the most critical steps of the homecare episode. This visit includes an assessment of the patient's capacity for self-care, medication reconciliation, an examination of the home environment, and a discussion regarding whether a caregiver is present. Hence, appropriate timing of the first visit is crucial, especially for patients with urgent health care needs. However, nurses often have limited and inaccurate information about incoming patients, and patient priority decisions vary significantly between nurses. We developed an innovative decision support tool called Priority for the First Nursing Visit Tool (PREVENT) to assist nurses in prioritizing patients in need of immediate first homecare nursing visits.
Objective: This study aims to evaluate the effectiveness of the PREVENT tool on process and patient outcomes and to examine the reach, adoption, and implementation of PREVENT.
Methods: Employing a pre-post design, survival analysis, and logistic regression with propensity score matching analysis, we will test the following hypotheses: compared with not using the tool in the preintervention phase, when homecare clinicians use the PREVENT tool, high-risk patients in the intervention phase will (1) receive more timely first homecare visits and (2) have decreased incidence of rehospitalization and have decreased emergency department use within 60 days. Reach, adoption, and implementation will be assessed using mixed methods including homecare admission staff interviews, think-aloud observations, and analysis of staffing and other relevant data. Results: The study research protocol was approved by the institutional review board in October 2019. PREVENT is currently being integrated into the electronic health records at the participating study sites. Data collection is planned to start in early 2021.
Conclusions: Mixed methods will enable us to gain an in-depth understanding of the complex socio-technological aspects of the hospital to homecare transition. The results have the potential to (1) influence the standardization and individualization of nurse decision making through the use of cutting-edge technology and (2) improve patient outcomes in the understudied homecare setting.
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Details
- Title
- Improving Patient Prioritization During Hospital-Homecare Transition: Protocol for a Mixed Methods Study of a Clinical Decision Support Tool Implementation
- Creators
- Maryam Zolnoori - Columbia Univ, Sch Nursing, New York, NY USAMargaret McDonald - Visiting Nurse Serv New York, Ctr Home Care Policy & Res, 5 Penn Plaza,12th Floor, New York, NY 10001 USAYolanda Barron - Visiting Nurse Serv New York, Ctr Home Care Policy & Res, 5 Penn Plaza,12th Floor, New York, NY 10001 USAKenrick Cato - Columbia Univ, Sch Nursing, New York, NY USAPaulina Sockolow - Drexel University, Health SciencesSridevi Sridharan - Visiting Nurse Serv New York, Ctr Home Care Policy & Res, 5 Penn Plaza,12th Floor, New York, NY 10001 USANicole Onorato - Visiting Nurse Serv New York, Ctr Home Care Policy & Res, 5 Penn Plaza,12th Floor, New York, NY 10001 USAKathryn Bowles - Merseburg University of Applied SciencesMaxim Topaz - Columbia University
- Publication Details
- JMIR research protocols, v 10(1), e20184
- Publisher
- JMIR PUBLICATIONS, INC; TORONTO
- Number of pages
- 12
- Grant note
- Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR018831. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Sciences
- Web of Science ID
- WOS:000639613000034
- Scopus ID
- 2-s2.0-85100445930
- Other Identifier
- 991021860657104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Health Care Sciences & Services
- Public, Environmental & Occupational Health