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 two weeks of services. Timely alloca-tion 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, appro-priate timing of the first visit is crucial, especially for patients with urgent healthcare 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
To evaluate the effectiveness of the PREVENT tool on process and patient outcomes; and to exam-ine aspects of PREVENT’s reach, adoption, and implementation.
METHODS
Employing a pre post design, and survival analysis and logistic regression with propensity score matching analysis we will test the following hypotheses: Compared to not using the tool in the pre-intervention phase, when homecare clinicians use the PREVENT tool, high risk patients in the inter-vention phase will: a) receive more timely first homecare visits and b) have decreased incidence of rehospitalization and have decreased emergency department (ED) use within 60 days. Reach, adoption, and implementationwill be assessed using mixed methods including homecare admis-sion 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. PRE-VENT 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 in-depth understanding of complex socio-technological as-pects of the hospital to homecare transition. The results have the potential to (1) influence the standardization and individualization of nurse decision making thru the use of cutting-edge technol-ogy and (2) improve patient outcomes in the understudied homecare setting.
CLINICALTRIAL
ClinicalTrials.gov Identifier: NCT04136951, https://clinicaltrials.gov/ct2/show/NCT04136951?term=Maxim+Topaz&id=NCT04136951&draw=2&rank=1
The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study
