JMIR Publications

ABSTRACT

Background:

Homecare settings across the United States provide care to more than 5 million patients every year. About one in five of 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 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 examination of the home environment, a discussion regarding whether a caregiver is present, an assessment of the patient's capacity for self-care, and medication reconciliation. Hence, the appropriate 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 efficacy of the PREVENT in a pre-post intervention study.

Methods:

For the study aims: Aim 1) Evaluate the effectiveness of the PREVENT tool on the process and patient outcomes, using survival analysis and logistic regression with propensity score matching 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 intervention 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. Aim 2) Examine aspects of PRE-VENT’s reach, adoption, and implementation. Aim 2 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. Data collection is planned to start in early 2021.

Conclusions:

Mixed methods will enable us to gain an in-depth understanding of complex socio-technological aspects of the hospital to homecare transition. The results may have the potential to (1) standardize and individualize nurse decision making by using cutting-edge technology and (2) improve patient outcomes in the understudied homecare setting. Clinical Trial: ClinicalTrials.gov Identifier: NCT04136951, https://clinicaltrials.gov/ct2/show/NCT04136951?term=Maxim+Topaz&id=NCT04136951&draw=2&rank=1