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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
Supporting Home Care Nurse Decision Making at
the Point of Care Through Clinical Dashboard
Dawn W Dowding, PhD, RN
1, 2
, Nicole Onorato, BS
, Yolanda Barrón, MS
, Jacqueline A. Merrill, PhD, RN
, Robert J.
Rosati, PhD
, David Russell, PhD
eedback provided to clinicians on their performance is important for improving health care quality
and is
a key component of the IHI triple aim initiative.
Dashboards are a form of Health Information Technology
(HIT) that display information in a visualized format which can be used to help provide feedback on quality
performance measures. In this presentation we will present the preliminary results from the rst phase of our
study, which is focused on (a) identifying existing quality measures related to the care of patients with congestive heart failure
(CHF) that are relevant to home care nurses and that are under their control (actionable) and (b) to explore if and how
nurses’ numeracy and graph literacy impact their ability to comprehend data presented in a visualized format. The results
of this phase will be used to develop a prototype dashboard for home care nurses at the point of care to help implement
evidence based guidelines for the care of CHF patients.
Methods: To identify existing quality indicators that were meaningful and actionable by home care nurses, 6 focus groups
were conducted with 61 nurses working in a large not for prot home care agency in the Northeast region of the United
States between November 2015 and February 2016. Focus group participants were provided with a list of 23 statements
derived from evidence based practice guidelines on the management of patients with heart failure and asked to identify the
top 5 statements that they felt were a priority in terms of receiving feedback and rank them from 1 (top priority) to 5 (least
priority). The focus group discussion then explored the rationale for priority rankings and how a dashboard could be designed
to provide that feedback. Data was analyzed using thematic analysis.
To explore nurses’ numeracy and graph literacy and their ability to comprehend visualized data a multi-factorial experimental
research design using an online survey was used. Graph literacy was measured using the graph literacy scale
which was
developed specically for the health domain and measures graph reading skills and comprehension across dierent types of
graphs. Numeracy was measured using the expanded numeracy scale.
196 nurses from two home care agencies located in
the North East region of the USA were randomly allocated to 1 of 4 experimental conditions. Outcomes include knowledge
and understanding of the information presented in the visualized dashboard.
Results: Quality indicators related to the tracking of vital signs, symptoms and weight changes were ranked the highest
by nurses (e.g. identication of weight gain). The second highest ranked quality indicator related to ensuring a patient had
received education to support self-management. Themes arising from the discussions included how feedback could improve
workow and communication between visits.
Nurses answered approximately 10 of 13 graph literacy items and 7 of 8 numeracy items correctly-slightly higher than average
scores for the U.S. population. Across the whole sample, nurses most easily understood information presented in the format
of a bar graph. There was an interaction between numeracy, graph literacy and comprehension. Nurses with low numeracy
were less able to interpret line graphs, those with low graph literacy were less able to interpret spider graphs, and those with
low literacy and numeracy were less able to understand information presented as a table.
Discussion: This study has identied specic elements of feedback on the care of CHF patients that home care nurses
would nd valuable for improving care. These elements of care are exclusively at individual patient level, and are required
by nurses in real time. The ndings demonstrated that nurses’ numeracy and graph literacy have a signicant impact on
their comprehension of information presented in visual formats.
Conclusion: The results will be used to develop dashboards that provide feedback on quality indicators to home care nurses,
in real time, at the point of care. The dashboards will be dynamic; presenting the same information in dierent formats,
to enable nurses’ to comprehend the data eectively. Future research will evaluate the eectiveness of the dashboards in
improving care processes and patient outcomes.
Columbia University School of Nursing, New York, NY
Visiting Nurse Service of New York, NY
VNA Health Group, NJ
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H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
1. Ivers, N, Jamtvedt, G, Flottorp, S, et al. Audit and feedback: eects on professional practice and healthcare outcomes.
The Cochrane Library 2012.
2. Berwick, DM, Nolan, TW, and Whittington, J. The triple aim: care, health, and cost. Health aairs 2008;27:759–769.
3. Galesic, M and Garcia-Retamero, R. Graph literacy: A cross-cultural comparison. Medical Decision Making 2011;31:444–
4. Lipkus, IM, Samsa, G, and Rimer, BK. General performance on a numeracy scale among highly educated samples.
Medical decision making 2001;21:37–44.
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