H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
Patient Health Goals Elicited During Home Care
Admission: A Categorization
Paulina Sockolow, DrPH, MBA, MS
1
, Kavita Radhakrishnan, RN, PhD, MSEE
2
, Edgar Chou MD, MS
1
H
ome care agencies (HCA) have numerous patient engagement opportunities to manage the patient’s symptoms
and provide much needed health services. Despite these services, HCA patient rehospitalization rates exceed
20% for numerous health conditions.
1
Patient engagement entails patient-clinician interaction and patient par-
ticipation in managing his/her health to achieve desired health goals.
2
In home care, a program of patient
self-management goal elicitation with behavioral change was shown to decrease hospital readmissions and improve health
outcomes.
3
Our objective was to categorize elicited patient health goals and identify “clinically informative” goals at a com-
munity based HCA.
Methods: The research team with a HCA partner examined patient goals that admitting clinicians documented in the
point-of-care electronic health record (EHR) during a 5-month pilot project in 2015. The closely-held for-profit HCA oper-
ates over 300 offices in 22 states. Admitting clinicians were employed by the HCA and were predominantly nurses (76%) and
physical therapists (23%). Patient goals were available in a text string in a de-identified Excel file that the HCA extracted
from their EHR. To develop a coding scheme, a researcher (PS) conducted content analysis on patient goal data: 1-assigned
themes to the first 100 patient goals; 2-grouped themes into codes; and 3-specified code categories. A home care nurse (KR)
reviewed the coding scheme. PS assigned a goal code to every 10
th
patient: Sampling was used due to resource constraints.
Records without a patient goal were tabulated. PS added new codes that emerged to the coding scheme that KR reviewed.
Subsequently, KR and the physician researcher (EC) reviewed the coding scheme independently to identify codes that were
informative to their disciplines (clinically important).
Results: Of the 1,763 patient records, 8% had no recorded
patient goal. After content analysis of 122 records, the cod-
ing scheme totaled 20 codes among 3 categories as shown in
the table. In the sample of records with patient goals, there
were 1 to 4 goals documented in each record, for a total cor-
pus of 253 goals. Most goals were phrased in clinician vernac-
ular (e.g., “increased ambulation”) and 6 were in a patient’s
voice (e.g., “to be able to walk again”). Codes identified as
clinically important to both the nurse and physician experts
were equally distributed among the Activities of Daily Living
(ADL) and the Health Management (HM) categories with no
Quality of Life codes selected. There were 5 clinically impor-
tant codes that also occurred most frequently: safety/falls
(ADL, 18%); ambulation (ADL, 9%); ADL activities (ADL,
9%); manage disease process (HM, 9%); knowledge of dis-
ease process (HM, 10%).
Discussion: The absence of the patient’s voice and less
than universal recording of home care patients’ goals indi-
cated differential clinician documentation of elicited patient
goals. Consistent communication of the intent and opera-
tionalization of patient goal elicitation by HCA leadership
may address differential documentation. In addition, clini-
cian training may be advisable to have clinicians understand
why they are asking patients about their goals.
3
Findings
also suggest that the most frequently occurring codes were
codes identified as clinically imp ortant for both home care
nurses and primary care physicians. These findings indicate a shared perspective about the importance of specific clinical
information in the treatment of home care patients; however, a Norwegian study found differences in perspectives.
4
Future
research should include perspectives from other disciplines, such as physical therapists.
Conclusion: Research is needed to identify the most effective approach to operationalize patient goal elicitation; clinically
1
Drexel University, Philadelphia, PA
2
The University of Texas, Austin, TX
Copyright © 2016 by Maryland Health Information Technology LLC — Creative Commons License c b nd 36
H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
important goals using a larger group of clinicians; and optimal dissemination of this information in patient care. Useful
research would also be to identify associations between elicited patient goals, nursing interventions, and outcomes.
References
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images/uploads/AHHQI_2015_Chartbook_FINAL_October.pdf. (Accessed on 05/06/2016). 2015.
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patient engagement and health behavior change: a systematic review of the literature. JMIR medical informatics 2016;4.
3. Wagner, EH, Austin, BT, Davis, C, Hindmarsh, M, Schaefer, J, and Bonomi, A. Improving chronic illness care: trans-
lating evidence into action. Health affairs 2001;20:64–78.
4. Hellesø, R and Sogstad, MKR. Hospital nurses’ and physicians’ use of information sources during their production of
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Copyright © 2016 by Maryland Health Information Technology LLC — Creative Commons License c b nd 37
