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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
Engaging Home Care Patients And Caregivers For
Better Fall Risk Management: Challenges,
Opportunities, And Leveraging Information
Dari Alhuwail
, Jennifer Callaghan-Koru
, Brandt Braunschweig
, Güneş Koru
mergency room visits due to falls constitute the largest group of potentially avoidable events in home care.
addition to increasing healthcare costs,
all injuries can easily lead to further serious health problems and even
death for home care patients who are often elderly and vulnerable.
Therefore, achieving better fall-risk man-
agement (FRM) becomes critical in improving the quality of care provided by home health agencies (HHAs).
In working towards this goal, better engaging home care patients and caregivers in FRM can be both eective and ecient
because they are often the least utilized resources in healthcare.
Information technology (IT) can play a catalyst and even
an enabler role in improving the quality of care.
Therefore, this qualitative research identied the prominent challenges and
opportunities asso ciated with engaging the patients and their caregivers in FRM during home care episodes, and it explored
how IT solutions can be leveraged to positively impact their engagement in FRM. On these topics, there has been a lack of
evidence prior to this study.
Methods: After obtaining the ethics approval, four focus groups were conducted to elicit the perspectives of a professionally
diverse group of home care professionals in Maryland. Twenty participants were recruited based on maximum variation
strategy by considering the participants’ professional background as well the characteristics of their organization
(e.g., size, business model, geographical areas served). The discussion was audio-recorded and run by an experienced facil-
itator assisted by a scribe. Each participant reected his or her notes individually on the provided handout sheets before
discussing within their focus group. Each focus group summarized their ideas on a ip chart. Raw data were collected
from the participants’ individual handouts, group ip charts, transcripts of the audio recordings, and the scribe notes. The
method was used to analyze the raw data resulting in a number of recurring themes.
Results: Challenges and Opportunities The participants noted that while physiological problems such as gait and
balance issues increased fall risks, some patients with such problems also had cognitive issues preventing them from fully
comprehending the FRM advice. This combination requires an even higher degree of caregiver involvement in home care.
Additionally, the participants noted that some of the caregivers did not fully understand their role in FRM or what was
required of them to keep the patients safe either. Among the challenges for FRM was the lack of physical presence of care-
givers with the patient most of the time. The participants also noted that some patients fall because they are in denial of
their physical abilities and limitations. Additionally, cultural dierences and language barriers hindered the clinicians from
providing eective FRM advice to both the patients and their caregivers. The participants also reported that the lack of
knowledge and literacy among some patients and caregivers increased fall risks due to their inability to understand and follow
directions. Some home environments did not support eective FRM; these homes had uneven surfaces, poor lighting, and
no hand-rails. Leveraging IT The participants noted that making patient portals available to patients and caregivers on
mobile devices, such as smart-phones, can increase their engagement in FRM. Patient portals have the potential to make the
FRM information easily available as well as keep the patients and their caregivers informed of the care plan and progress.
However, the acquisition, maintenance, and training costs limited the adoption of portals. Cellular network coverage limi-
tations and the Internet aordability were also mentioned as barriers to patient portal use. Sensors, such as those installed
in the home or integrated into devices, can possibly increase engagement by providing the patients and caregivers with data
about activity levels as well as movement and gait patterns. However, cost and privacy issues still impede their adoption to
reduce fall risks. The participants b elieved that if telehealth solutions can b e economically feasible and adopted widely, they
can help clinicians address FRM-related questions in a timely manner, such as those about durable medical equipment use.
Discussion: Similar to other studies,
the results indicate that for eective engagement in FRM using IT, clinicians
must consider the literacy and comprehension levels of patients and caregivers. HHAs should consider involving the motivated
patients and caregivers more directly in some of the FRM-related quality improvement discussions and meetings. As the IT
adoption for FRM increases, it will be important to provide patients and caregivers proper training and continuous support
to use the adopted solutions.
Conclusion: This study provided evidence about the issues related to eectively engaging patients and caregivers in FRM
during home care episodes. It also identied patient portals, sensors, and telehealth as the most promising solutions to
University of Maryland, Baltimore County
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H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
increase patient and caregiver engagement in FRM.
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