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Uchmanowicz I, Wleklik M, Foster M, Olchowska-Kotala A, Vellone E, Kaluzna-Oleksy M, Szczepanowski R, Uchmanowicz B, Reczuch K, Jankowska EA. Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being? Front Psychol 2022; 13:940088. [PMID: 36275212 PMCID: PMC9580561 DOI: 10.3389/fpsyg.2022.940088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Ercole Vellone
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marta Kaluzna-Oleksy
- Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Bartosz Uchmanowicz
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Bartosz Uchmanowicz,
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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Kilaru AS, Illenberger N, Meisel ZF, Groeneveld PW, Liu M, Mondal A, Mitra N, Merchant RM. Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure. Circ Cardiovasc Qual Outcomes 2022; 15:e009001. [PMID: 36073354 PMCID: PMC9489651 DOI: 10.1161/circoutcomes.122.009001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients who are discharged from the emergency department (ED) after an encounter for acute heart failure are at high risk for return hospitalization. These patients may benefit from timely outpatient follow-up care to reassess volume status, adjust medications, and reinforce self-care strategies. This study examines the incidence of outpatient follow-up care after ED encounters for acute heart failure and describes patient characteristics associated with obtaining timely follow-up care. METHODS We conducted a retrospective cohort study using an administrative claims database for a large US commercial insurer, from January 1, 2012 to June 30, 2019. Participants included adult patients discharged from the ED with principal diagnosis of acute heart failure. The primary outcome was obtaining an in-person outpatient clinic visit for heart failure within 30 days. We also examined the competing risk of all-cause hospitalization within 30 days and without an intervening outpatient clinic visit. We estimated competing risk regression models to identify patient characteristics associated with obtaining outpatient follow-up and report cause-specific hazard ratios. RESULTS The cohort included 52 732 patients, with mean age of 73.9 years (95% CI, 73.8-74.0) and 27 395 (52.0% [95% CI, 51.5-52.4]) female patients. Within 30 days of the ED encounter, 12 279 (23.2%) patients attended an outpatient clinic visit for heart failure, with 8382 (15.9%) patients hospitalized before they could obtain an outpatient clinic visit. In the adjusted analysis, patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. CONCLUSIONS Few patients obtain timely outpatient follow-up after ED visits for heart failure, although nearly 20% require hospitalization within 30 days. Improved transitions following discharge from the ED may represent an opportunity to improve outcomes for patients with acute heart failure.
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Affiliation(s)
- Austin S Kilaru
- Center for Emergency Care Policy and Research, Department of Emergency Medicine (A.S.K., R.M.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.K., R.M.M., P.W.G.), Wharton School, University of Pennsylvania Philadelphia
- Perelman School of Medicine, and Leonard Davis Institute of Health Economics (A.S.K., R.M.M., P.W.G., A.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
| | - Nicholas Illenberger
- Department of Population Health, NYU Grossman School of Medicine (N.I.), New York, New York
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, Department of Emergency Medicine (A.S.K., R.M.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
- Perelman School of Medicine, and Leonard Davis Institute of Health Economics (A.S.K., R.M.M., P.W.G., A.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.K., R.M.M., P.W.G.), Wharton School, University of Pennsylvania Philadelphia
- Perelman School of Medicine, and Leonard Davis Institute of Health Economics (A.S.K., R.M.M., P.W.G., A.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
| | - Manqing Liu
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University Boston, Massachusetts (M.L.)
| | - Angira Mondal
- Perelman School of Medicine, and Leonard Davis Institute of Health Economics (A.S.K., R.M.M., P.W.G., A.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics (N.M.), Wharton School, University of Pennsylvania Philadelphia
| | - Raina M Merchant
- Center for Emergency Care Policy and Research, Department of Emergency Medicine (A.S.K., R.M.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.K., R.M.M., P.W.G.), Wharton School, University of Pennsylvania Philadelphia
- Perelman School of Medicine, and Leonard Davis Institute of Health Economics (A.S.K., R.M.M., P.W.G., A.M., Z.F.M.), Wharton School, University of Pennsylvania Philadelphia
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Seale DE, LeRouge CM, Kolotylo-Kulkarni M. Professional Organizers’ Description of Personal Health Information Management Work with a Spotlight on the Practices of Older Adults: A Qualitative e-Delphi Study (Preprint). J Med Internet Res 2022; 25:e42330. [PMID: 37000478 PMCID: PMC10131782 DOI: 10.2196/42330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Personal health information (PHI) is created on behalf of and by health care consumers to support their care and wellness. Available tools designed to support PHI management (PHIM) remain insufficient. A comprehensive understanding of PHIM work is required, particularly for older adults, to offer more effective PHIM tools and support. OBJECTIVE The primary objective of this study was to use the Patient Work System model to provide a holistic description of PHIM work from the perspective of professional organizers with experience assisting health care consumers, including older adults, in managing their PHI. A secondary objective was to examine how factors associated with 4 Patient Work System components (person, tasks, tools and technologies, and context) interact to support or compromise PHIM work performance. METHODS A modified e-Delphi methodology was used to complete 3 web-based rounds of open-ended questions and obtain consensus among a panel of 16 experts in professional organizing. Data were collected between April and December 2017. The Patient Work System model was used as a coding schema and guided the interpretation of findings during the analysis. RESULTS The PHIM work of adults who sought assistance focused on the tasks of acquiring, organizing, and storing 3 classifications of PHI (medical, financial, and reference) and then processing, reconciling, and storing the medical and financial classifications to tend to their health, health care, and health finances. We also found that the complexities of PHI and PHIM-related work often exceeded the abilities and willingness of those who sought assistance. A total of 6 factors contributed to the complexity of PHIM work. The misalignment of these factors was found to increase the PHIM workload, particularly for older adults. The life changes that often accompanied aging, coupled with obscure and fragmented health care provider- and insurer-generated PHI, created the need for much PHIM work. Acquiring and integrating obscure and fragmented PHI, detecting and reconciling PHI discrepancies, and protecting PHI held by health care consumers were among the most burdensome tasks, especially for older adults. Consequently, personal stakeholders (paid and unpaid) were called upon or voluntarily stepped in to assist with PHIM work. CONCLUSIONS Streamlining and automating 2 of the most common and burdensome PHIM undertakings could drastically reduce health care consumers' PHIM workload: developing and maintaining accurate current and past health summaries and tracking medical bills and insurance claims to reconcile discrepancies. Other improvements that hold promise are the simplification and standardization of commonly used financial and medical PHI; standardization and automation of commonly used PHI acquisition interfaces; and provision of secure, Health Insurance Portability and Accountability Act (HIPAA)-certified PHI tools and technologies that control multiperson access for PHI stored by health care consumers in electronic and paper formats.
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Affiliation(s)
- Deborah E Seale
- Department of Public Health, College of Health Sciences, Des Moines University, Des Moines, IA, United States
| | - Cynthia M LeRouge
- Department of Information Systems & Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Malgorzata Kolotylo-Kulkarni
- Department of Information Management & Business Analytics, Zimpleman College of Business, Drake University, Des Moines, IA, United States
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Holden RJ, Carayon P. SEIPS 101 and seven simple SEIPS tools. BMJ Qual Saf 2021; 30:901-910. [PMID: 34039748 PMCID: PMC8543199 DOI: 10.1136/bmjqs-2020-012538] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Collins SP, Liu D, Jenkins CA, Storrow AB, Levy PD, Pang PS, Chang AM, Char D, Diercks DJ, Fermann GJ, Han JH, Hiestand B, Hogan C, Kampe CJ, Khan Y, Lee S, Lindenfeld J, Martindale J, McNaughton CD, Miller KF, Miller-Reilly C, Moser K, Peacock WF, Robichaux C, Rothman R, Schrock J, Self WH, Singer AJ, Sterling SA, Ward MJ, Walsh C, Butler J. Effect of a Self-care Intervention on 90-Day Outcomes in Patients With Acute Heart Failure Discharged From the Emergency Department: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:200-208. [PMID: 33206126 DOI: 10.1001/jamacardio.2020.5763] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Up to 20% of patients who present to the emergency department (ED) with acute heart failure (AHF) are discharged without hospitalization. Compared with rates in hospitalized patients, readmission and mortality are worse for ED patients. Objective To assess the impact of a self-care intervention on 90-day outcomes in patients with AHF who are discharged from the ED. Design, Setting, and Participants Get With the Guidelines in Emergency Department Patients With Heart Failure was an unblinded, parallel-group, multicenter randomized trial. Patients were randomized 1:1 to usual care vs a tailored self-care intervention. Patients with AHF discharged after ED-based management at 15 geographically diverse EDs were included. The trial was conducted from October 28, 2015, to September 5, 2019. Interventions Home visit within 7 days of discharge and twice-monthly telephone-based self-care coaching for 3 months. Main Outcomes and Measures The primary outcome was a global rank of cardiovascular death, HF-related events (unscheduled clinic visit due to HF, ED revisit, or hospitalization), and changes in the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) summary score (SS) at 90 days. Key secondary outcomes included the global rank outcome at 30 days and changes in the KCCQ-12 SS score at 30 and 90 days. Intention-to-treat analysis was performed for the primary, secondary, and safety outcomes. Per-protocol analysis was conducted including patients who completed a home visit and had scheduled outpatient follow-up in the intervention arm. Results Owing to slow enrollment, 479 of a planned 700 patients were randomized: 235 to the intervention arm and 244 to the usual care arm. The median age was 63.0 years (interquartile range, 54.7-70.2), 302 patients (63%) were African American, 305 patients (64%) were men, and 178 patients (37%) had a previous ejection fraction greater than 50%. There was no significant difference in the primary outcome between patients in the intervention vs usual care arm (hazard ratio [HR], 0.89; 95% CI, 0.73-1.10; P = .28). At day 30, patients in the intervention arm had significantly better global rank (HR, 0.80; 95% CI, 0.64-0.99; P = .04) and a 5.5-point higher KCCQ-12 SS (95% CI, 1.3-9.7; P = .01), while at day 90, the KCCQ-12 SS was 2.7 points higher (95% CI, -1.9 to 7.2; P = .25). Conclusions and Relevance The self-care intervention did not improve the primary global rank outcome at 90 days in this trial. However, benefit was observed in the global rank and KCCQ-12 SS at 30 days, suggesting that an early benefit of a tailored self-care program initiated at an ED visit for AHF was not sustained through 90 days. Trial Registration ClinicalTrials.gov Identifier: NCT02519283.
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Affiliation(s)
- Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dandan Liu
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cathy A Jenkins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip D Levy
- Department of Emergency Medicine, Detroit Medical Center, Detroit, Michigan
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University Medical Center, Indianapolis
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania
| | - Douglas Char
- Department of Emergency Medicine, Washington University Medical Center in St Louis, St Louis, Missouri
| | - Deborah J Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian Hiestand
- Department of Emergency Medicine, Wake Forest University Medical Center, Winston-Salem, North Carolina
| | - Christopher Hogan
- Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Christina J Kampe
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yosef Khan
- Department of Emergency Medicine, American Heart Association
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Medical Center, Iowa City
| | - JoAnn Lindenfeld
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer Martindale
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen F Miller
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kelly Moser
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Russell Rothman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jon Schrock
- Department of Emergency Medicine, Metro Health Medical Center, Cleveland, Ohio
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Sarah A Sterling
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
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Werner NE, Ponnala S, Doutcheva N, Holden RJ. Human factors/ergonomics work system analysis of patient work: state of the science and future directions. Int J Qual Health Care 2021; 33:60-71. [PMID: 33432984 PMCID: PMC7802067 DOI: 10.1093/intqhc/mzaa099] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To demonstrate the use and value of the Human Factors/Ergonomics-based Systems Engineering Initiative for Patient Safety (SEIPS) family of work system models for studying and improving patient work. DATA SOURCES We conducted a review of the published empirical literature applying the SEIPS family of work system models for patient work. STUDY SELECTION Included studies had to apply one of the SEIPS family of work system models to study patient work; be published in a peer-reviewed journal in English and include analysis of data. We identified 16 articles that met our inclusion criteria. DATA EXTRACTION For each study, we extracted settings and situations in which models were applied; research design; study methods; model(s) used; type and number of study participants; study objective(s); whether the study included an intervention; specific aspects of the model used; knowledge generated about patient work and benefits of using the models. RESULTS OF DATA SYNTHESIS Our analysis revealed that a majority of studies were conducted in the United States, used qualitative or mixed methods and employed a variety of data collection techniques to study adult patient populations with chronic illness and their informal caregivers and healthcare providers performing patient work in the home and clinical setting. The studies resulted in a variety of useful products, demonstrating several benefits of using the models. CONCLUSION Our review has demonstrated the value of using the SEIPS family of work systems models to study and improve patient and family contributions to health-related work.
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Affiliation(s)
| | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nadia Doutcheva
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
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Holden RJ, Abebe E. Medication transitions: Vulnerable periods of change in need of human factors and ergonomics. APPLIED ERGONOMICS 2021; 90:103279. [PMID: 33049545 PMCID: PMC7606579 DOI: 10.1016/j.apergo.2020.103279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 06/06/2023]
Abstract
We present a novel view of transitions from the lens of patient ergonomics (the "science of patient work"), which posits that patients and other non-professionals perform effortful work towards health-related goals. In patient work transitions, patients experience changes in, for example, health, task demands, work capacity, roles and responsibilities, knowledge and skills, routines, needs and technologies. Medication transitions are a particularly vulnerable type of patient work transitions. We describe two cases of medication transitions-new medications and medication deprescribing-in which the patient work lens reveals many accompanying changes, vulnerabilities, and opportunities for human factors and ergonomics.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
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Werner NE, Rutkowski R, Graske A, Finta MK, Sellers CR, Seshadri S, Shah MN. Exploring SEIPS 2.0 as a model for analyzing care transitions across work systems. APPLIED ERGONOMICS 2020; 88:103141. [PMID: 32421635 PMCID: PMC7400988 DOI: 10.1016/j.apergo.2020.103141] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/27/2020] [Accepted: 04/29/2020] [Indexed: 05/05/2023]
Abstract
Care transitions across healthcare settings, specifically between the emergency department (ED) and the home, are pervasive among older adults, and represent persistent healthcare quality and safety challenges. Care transitions cross multiple distinct work systems, representing a conceptual and methodological challenge for the field of Human Factors/Ergonomics - how to analyze a process that occurs across multiple work systems. As an initial step in determining how to study care transitions across work systems, we applied the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, specifically the concept of configuration, to explore older adults' ED-to-home transitions. Our results suggest that configuration is useful for identifying and modeling work system barriers that interact across systems, but does not explicitly allow for the identification and analysis of the system boundaries that are crossed. To fully capture the complexity associated with care transitions, future iterations of SEIPS should introduce a mechanism to capture specific boundary types, so that system analysis can capture when and which boundaries are crossed.
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Affiliation(s)
- Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Rachel Rutkowski
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | | | - Mary K Finta
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Craig R Sellers
- School of Nursing, University of Rochester, Rochester, NY, USA.
| | | | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Holden RJ, Daley CN, Mickelson RS, Bolchini D, Toscos T, Cornet VP, Miller A, Mirro MJ. Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA). APPLIED ERGONOMICS 2020; 87:103107. [PMID: 32310109 DOI: 10.1016/j.apergo.2020.103107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 12/21/2019] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
Personas can be used to understand patterns of variation in patients' performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons, using critical incident and fictitious scenario interviews. Qualitative analyses produced three personas but revealed that individuals exemplify different personas across situations. The Rule-Following persona seeks clear rules, exercises caution under uncertainty, and grounds actions in confidence in clinician experts. The Researching persona seeks information to gain better understanding, invents strategies, and conducts experiments independently or with clinicians. The Disengaging persona does not actively seek rules or information and does not attempt to reduce uncertainty or conduct experiments. We discuss the situational nature of personas, their use in design, and the benefits of P-CTA for studying patient decision making.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., USA.
| | - Carly N Daley
- Department of BioHealth Informatics, IUPUI School of Informatics and Computing, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | | | - Davide Bolchini
- Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | - Victor P Cornet
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA; Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Amy Miller
- Department of Radiology Oncology, Indiana University School of Medicine, USA
| | - Michael J Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
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10
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Werner NE, Tong M, Borkenhagen A, Holden RJ. Performance-Shaping Factors Affecting Older Adults' Hospital-to-Home Transition Success: A Systems Approach. THE GERONTOLOGIST 2019; 59:303-314. [PMID: 29304235 DOI: 10.1093/geront/gnx199] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Facilitating older adults' successful hospital-to-home transitions remains a persistent challenge. To address this challenge, we applied a systems lens to identify and understand the performance-shaping factors (PSFs) related older adults' hospital-to-home transition success. RESEARCH DESIGN AND METHODS This study was a secondary analysis of semi-structured interviews from older adults (N = 31) recently discharged from a hospital and their informal caregivers (N = 13). We used a Human Factors Engineering approach to guide qualitative thematic analysis to develop four themes concerning the system conditions shaping hospital-to-home transition success. RESULTS The four themes concerning PSFs were: (a) the hospital-to-home transition was a complex multiphase process-the process unfolded over several months and required substantial, persistent investment/effort; (b) there were unmet needs for specialized tools-information and resources provided at hospital discharge were not aligned with requirements for transition success; (c) alignment of self-care routines with transition needs-pre-hospitalization routines could be supportive/disruptive and could deteriorate/be re-established; and (d) changing levels of work demand and capacity during the transition-demand often exceeded capacity leading to work overload. DISCUSSION AND IMPLICATIONS Our findings highlight that the transition is not an episodic event, but rather a longitudinal process extending beyond the days just after hospital discharge. Transition interventions to improve older adults' hospital-to-home transitions need to account for this complex multiphase process. Future interventions must be developed to support older adults and informal caregivers in navigating the establishment and re-establishment of routines and managing work demands and capacity during the transition process.
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Affiliation(s)
- Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Michelle Tong
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Amy Borkenhagen
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Richard J Holden
- School of Informatics and Computing, Indiana University-Purdue University Indianapolis
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Werner NE, Tong M, Borkenhagen A, Holden RJ. Performance-Shaping Factors Affecting Older Adults' Hospital-to-Home Transition Success: A Systems Approach. THE GERONTOLOGIST 2019. [PMID: 29304235 DOI: 10.1093/geront/gnx1199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Facilitating older adults' successful hospital-to-home transitions remains a persistent challenge. To address this challenge, we applied a systems lens to identify and understand the performance-shaping factors (PSFs) related older adults' hospital-to-home transition success. RESEARCH DESIGN AND METHODS This study was a secondary analysis of semi-structured interviews from older adults (N = 31) recently discharged from a hospital and their informal caregivers (N = 13). We used a Human Factors Engineering approach to guide qualitative thematic analysis to develop four themes concerning the system conditions shaping hospital-to-home transition success. RESULTS The four themes concerning PSFs were: (a) the hospital-to-home transition was a complex multiphase process-the process unfolded over several months and required substantial, persistent investment/effort; (b) there were unmet needs for specialized tools-information and resources provided at hospital discharge were not aligned with requirements for transition success; (c) alignment of self-care routines with transition needs-pre-hospitalization routines could be supportive/disruptive and could deteriorate/be re-established; and (d) changing levels of work demand and capacity during the transition-demand often exceeded capacity leading to work overload. DISCUSSION AND IMPLICATIONS Our findings highlight that the transition is not an episodic event, but rather a longitudinal process extending beyond the days just after hospital discharge. Transition interventions to improve older adults' hospital-to-home transitions need to account for this complex multiphase process. Future interventions must be developed to support older adults and informal caregivers in navigating the establishment and re-establishment of routines and managing work demands and capacity during the transition process.
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Affiliation(s)
- Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Michelle Tong
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Amy Borkenhagen
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Richard J Holden
- School of Informatics and Computing, Indiana University-Purdue University Indianapolis
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12
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Daley CN, Bolchini D, Varrier A, Rao K, Joshi P, Blackburn J, Toscos T, Mirro MJ, Wagner S, Martin E, Miller A, Holden RJ. Naturalistic Decision Making by Older Adults with Chronic Heart Failure: An Exploratory Study Using the Critical Incident Technique. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1541931218621130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults with chronic heart failure (CHF) make daily decisions to manage their disease, with some of these decisions resulting in major health outcomes such as acute decompensation, hospitalization, and death. To understand how older adults with CHF make these decisions in their natural sociotechnical system context, we analyzed data from critical incident technique interviews with 12 older adults with CHF and 6 (family or friend) support persons. We identified key decision-making barriers, strategies, and distributed activity in stages of monitoring information or data, interpreting the information, and acting as a result. Our findings contribute to the broader research literature on CHF self-care as a naturalistic phenomenon and can aid in the exploration of design requirements for the development of technologies and interventions to assist in heart failure self-management.
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Affiliation(s)
- Carly N. Daley
- Health Innovation Laboratory, Indianapolis, IN, USA
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA
| | - Davide Bolchini
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Anagha Varrier
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Kartik Rao
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Pushkar Joshi
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | | | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Michael J. Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Shauna Wagner
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Elizabeth Martin
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Amy Miller
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard J. Holden
- Health Innovation Laboratory, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis IN, USA
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13
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Waterson P, Wooldridge A, Wooldridge A, Sesto M, Gurses A, Holden R, Werner N, Fray M, Carman EM, Waterson P. Improving Care Transitions in Healthcare: A Human Factors/Ergonomics (HFE) Approach. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1541931218621126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patient’s home (WHO Collaborating Centre for Patient Safety Solutions 2007). The aim of the panel will be to discuss different types of care transitions and how HFE can assist in improving patient safety and efficiency of the process. The panel will discuss and share lessons learnt from a range of projects involving care transitions for pediatric trauma care (Woolridge), and barriers and facilitators to follow-up care for bone marrow transplant survivors (Sesto). In addition, the work system elements for care transitions for elective orthopedic patients (Carman), elderly patients after heart failure hospitalization (Holden) and risks to elderly patients’ safe medication management (Gurses) when transitioning from hospital to home will be discussed.
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Affiliation(s)
| | | | | | - Mary Sesto
- University of Wisconsin-Madison, Madison, WI, USA
| | - Ayse Gurses
- Johns Hopkins University, Baltimore, MD, USA
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14
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Xu J, Arruda S, Gallo JJ, Wenzel J, Nolan MT, Flowers D, Szanton SL, Dennison Himmelfarb C, Han HR. Using vignettes to understand heart failure self-care. J Clin Nurs 2018; 27:3554-3560. [PMID: 29943481 DOI: 10.1111/jocn.14581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To explore hospitalised heart failure (HF) patients' self-care decisions. BACKGROUND Heart failure self-care is integral to maintain and manage health, and may prevent unnecessary HF hospitalisations. Nevertheless, self-care remains challenging for patients, and using vignettes offer a new perspective to understand patient HF self-care decision-making. DESIGN This qualitative descriptive analysis was conducted as part of a mixed methods study. METHODS We conducted semi-structured interviews (N = 20) to elicit patient decisions about self-care in responses to three vignettes, which varied in symptom severity. Content analysis was used to extract quotes describing participant responses. RESULTS Participants were on average 60 years old, primarily male, African American, unemployed and highly symptomatic (NYHA Class III or IV). Overall, participants were able to identify when symptoms required a decision to seek urgent medical attention, but had difficulty identifying the appropriate decision to make in response to less acute symptoms such as swelling. CONCLUSIONS Symptoms other than shortness of breath were challenging for patients to interpret and manage appropriately. Understanding how to apply HF knowledge to alleviate symptoms was also difficult. RELEVANCE TO CLINICAL PRACTICE Vignettes may be a helpful tool to prompt patient-healthcare provider communication about self-care management and prompt discussions about appropriate self-care decisions in response to varying levels of symptom severity.
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Affiliation(s)
- Jiayun Xu
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Joseph J Gallo
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Jennifer Wenzel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland
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15
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Mickelson RS, Holden RJ. Medication management strategies used by older adults with heart failure: A systems-based analysis. Eur J Cardiovasc Nurs 2018; 17:418-428. [PMID: 28901787 PMCID: PMC7728464 DOI: 10.1177/1474515117730704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. AIM Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. METHODS This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. RESULTS Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. CONCLUSIONS Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.
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Affiliation(s)
- Robin S. Mickelson
- Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Veterans Affairs, Tennessee Valley Healthcare System Nashville, TN
| | - Richard J. Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, United States
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16
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Lim SL, Chan SP, Lee KY, Ching A, Holden RJ, Miller KF, Storrow AB, Lam CS, Collins SP. An East-West comparison of self-care barriers in heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:615-622. [PMID: 29283270 DOI: 10.1177/2048872617744352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Barriers in heart failure self-care contribute to heart failure hospitalizations, but geographic differences have not been well-studied. We aimed to compare self-care barriers in heart failure patients managed at tertiary centers in an Eastern (Singapore) versus a Western (USA) nation. METHODS Acute heart failure patients were prospectively assessed with a standardized instrument comprising of 47 distinct self-care barriers. The multi-equation generalized structural equation model was used to evaluate for geographic differences in barriers experienced, and association of barriers with outcomes. RESULTS Patient-related factors accounted for six out of 10 most prevalent self-care barriers among the 90 patients, with a median number of 11 barriers reported per patient. The Western patients reported a higher level of barriers when compared with their Eastern counterparts (median (interquartile range) 15 (9-24) versus 9 (4-16), p=0.001), after adjusting for demographics and co-morbidities. Many of these differences could be explained by geographic differences between the countries. There was no significant difference identified in all-cause mortality (19.4% versus 10.2%) and heart failure re-hospitalization (41.9% versus 45.8%) at six months between the groups. CONCLUSIONS Self-care barriers are highly prevalent among acute heart failure patients, and differ substantially between East and West, but were not associated with geographic differences in outcomes.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore
| | - Siew Pang Chan
- Department of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Center, Singapore
| | - Kim Yee Lee
- Department of Cardiology, National University Heart Center, Singapore
| | - Anne Ching
- Department of Cardiology, National University Heart Center, Singapore
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, USA.,Indiana University Center for Aging Research, USA
| | | | | | - Carolyn Sp Lam
- Department of Cardiology, National Heart Center, Singapore.,Duke-NUS Graduate Medical School, Singapore
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17
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Holden RJ, Kulanthaivel A, Purkayastha S, Goggins KM, Kripalani S. Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure. Int J Med Inform 2017; 108:158-167. [PMID: 29132622 PMCID: PMC5793874 DOI: 10.1016/j.ijmedinf.2017.10.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Personas are a canonical user-centered design method increasingly used in health informatics research. Personas-empirically-derived user archetypes-can be used by eHealth designers to gain a robust understanding of their target end users such as patients. OBJECTIVE To develop biopsychosocial personas of older patients with heart failure using quantitative analysis of survey data. METHOD Data were collected using standardized surveys and medical record abstraction from 32 older adults with heart failure recently hospitalized for acute heart failure exacerbation. Hierarchical cluster analysis was performed on a final dataset of n=30. Nonparametric analyses were used to identify differences between clusters on 30 clustering variables and seven outcome variables. RESULTS Six clusters were produced, ranging in size from two to eight patients per cluster. Clusters differed significantly on these biopsychosocial domains and subdomains: demographics (age, sex); medical status (comorbid diabetes); functional status (exhaustion, household work ability, hygiene care ability, physical ability); psychological status (depression, health literacy, numeracy); technology (Internet availability); healthcare system (visit by home healthcare, trust in providers); social context (informal caregiver support, cohabitation, marital status); and economic context (employment status). Tabular and narrative persona descriptions provide an easy reference guide for informatics designers. DISCUSSION Personas development using approaches such as clustering of structured survey data is an important tool for health informatics professionals. We describe insights from our study of patients with heart failure, then recommend a generic ten-step personas development process. Methods strengths and limitations of the study and of personas development generally are discussed.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | - Anand Kulanthaivel
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Kathryn M Goggins
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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18
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Heiden SM, Holden RJ, Alder CA, Bodke K, Boustani M. Human factors in mental healthcare: A work system analysis of a community-based program for older adults with depression and dementia. APPLIED ERGONOMICS 2017; 64:27-40. [PMID: 28610811 PMCID: PMC5535802 DOI: 10.1016/j.apergo.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/16/2017] [Accepted: 05/03/2017] [Indexed: 06/07/2023]
Abstract
Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes.
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Affiliation(s)
- Siobhan M Heiden
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA.
| | - Catherine A Alder
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA
| | - Kunal Bodke
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Eskenazi Health, Indianapolis, IN, USA
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19
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Cornet VP, Daley CN, Srinivas P, Holden RJ. User-Centered Evaluations with Older Adults: Testing the Usability of a Mobile Health System for Heart Failure Self-Management. ACTA ACUST UNITED AC 2017; 61:6-10. [PMID: 30930610 DOI: 10.1177/1541931213601497] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many older adults living with heart failure struggle to follow recommended self-management routines. To help older adults with heart failure more effectively and efficiently self-manage their disease, we developed Engage, a mobile health application promoting the performance, logging, and sharing of routine self-management behaviors. This paper reports on the usability evaluation of the Engage system with 15 older adults with heart failure and informal caregivers. In two phases, participants used Engage during a task-based usability test (n=5) and a scenario-based usability test (n=10). Usability and performance data were assessed through video-recorded observation and the administration of the system usability scale (SUS) and NASA Task Load Index (TLX). We found that task-based testing was useful in quickly identifying problems within our application, but scenario-based testing elicited more valuable feedback from older adults. A comparison of the different evaluation methods used and the discussion of the challenges encountered provide multiple implications for the practice of usability testing of mobile health products with older adults.
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Affiliation(s)
- Victor P Cornet
- Indiana University School of Informatics and Computing - Indianapolis
| | - Carly N Daley
- Indiana University School of Informatics and Computing - Indianapolis
| | - Preethi Srinivas
- Indiana University Center for Aging Research, Regenstrief Institute, Inc
| | - Richard J Holden
- Indiana University School of Informatics and Computing - Indianapolis.,Indiana University Center for Aging Research, Regenstrief Institute, Inc
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20
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Herber OR, Bücker B, Metzendorf MI, Barroso J. A qualitative meta-summary using Sandelowski and Barroso’s method for integrating qualitative research to explore barriers and facilitators to self-care in heart failure patients. Eur J Cardiovasc Nurs 2017; 16:662-677. [DOI: 10.1177/1474515117711007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Individual qualitative studies provide varied reasons for why heart failure patients do not engage in self-care, yet articles that aggregated primary studies on the subject have methodological weaknesses that justified the execution of a qualitative meta-summary. Aim: The aim of this study is to integrate the findings of qualitative studies pertaining to barriers and facilitators to self-care using meta-summary techniques. Methods: Qualitative meta-summary techniques by Sandelowski and Barroso were used to combine the findings of qualitative studies. Meta-summary techniques include: (1) extraction of relevant statements of findings from each report; (2) reduction of these statements into abstracted findings and (3) calculation of effect sizes. Databases were searched systematically for qualitative studies published between January 2010 and July 2015. Out of 2264 papers identified, 31 reports based on the accounts of 814 patients were included in the meta-summary. Results: A total of 37 statements of findings provided a comprehensive inventory of findings across all reports. Out of these statements of findings, 21 were classified as barriers, 13 as facilitators and three were classed as both barriers and facilitators. The main themes relating to barriers and facilitators to self-care were: beliefs, benefits of self-care, comorbidities, financial constraints, symptom recognition, ethnic background, inconsistent self-care, insufficient information, positive and negative emotions, organizational context, past experiences, physical environment, self-initiative, self-care adverse effects, social context and personal preferences. Conclusion: Based on the meta-findings identified in this study, future intervention development could address these barriers and facilitators in order to further enhance self-care abilities in heart failure patients.
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Affiliation(s)
- Oliver Rudolf Herber
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- School of Health and Population Sciences, University of Birmingham, Edgbaston, England
| | - Bettina Bücker
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Cochrane Metabolic and Endocrine Disorders Group, Düsseldorf, Germany
| | - Julie Barroso
- Medical University of South Carolina, College of Nursing, Charleston, USA
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21
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Holden RJ, Valdez RS, Schubert CC, Thompson MJ, Hundt AS. Macroergonomic factors in the patient work system: examining the context of patients with chronic illness. ERGONOMICS 2017; 60:26-43. [PMID: 27164171 PMCID: PMC5639913 DOI: 10.1080/00140139.2016.1168529] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Human factors/ergonomics recognises work as embedded in and shaped by levels of social, physical and organisational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identified 17 factors across physical, social and organisational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative or varying effects on health and health behaviour. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients' health-related activities but also specific factors to consider in future research, design and policy efforts. Practitioner Summary: Health-related activities of patients are embedded in and shaped by levels of social, physical and organisational context. This paper combined findings from three studies to specify 17 contextual or macroergonomic factors in home- and community-based work systems of chronically ill patients. These factors have research, design and policy implications.
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Affiliation(s)
- Richard J. Holden
- Indiana University School of Informatics and Computing, Indianapolis, Indiana, USA
- Corresponding author: Richard J. Holden, Walker Plaza – WK 319, 719 Indiana Avenue, Indianapolis, IN, USA 46202. . 1-317-278-5323
| | | | | | | | - Ann S. Hundt
- University of Wisconsin-Madison, Madison, Wisconsin, USA
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22
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Srinivas P, Cornet V, Holden R. Human factors analysis, design, and evaluation of Engage, a consumer health IT application for geriatric heart failure self-care. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2016; 33:298-312. [PMID: 30429638 PMCID: PMC6231419 DOI: 10.1080/10447318.2016.1265784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Human factors and ergonomics (HFE) and related approaches can be used to enhance research and development of consumer-facing health IT systems, including technologies supporting the needs of people with chronic disease. We describe a multiphase HFE study of health IT supporting self-care of chronic heart failure by older adults. The study was based on HFE frameworks of "patient work" and incorporated the three broad phases of user-centered design: study or analysis; design; and evaluation. In the study phase, data from observations, interviews, surveys, and other methods were analyzed to identify gaps in and requirements for supporting heart failure self-care. The design phase applied findings from the study phase throughout an iterative process, culminating in the design of the Engage application, a product intended for continuous use over 30 days to stimulate self-care engagement, behavior, and knowledge. During the evaluation phase, we identified a variety of usability issues through expert heuristic evaluation and laboratory-based usability testing. We discuss the implications of our findings regarding heart failure self-care in older adults and the methodological challenges of rapid translational field research and development in this domain.
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Affiliation(s)
- Preethi Srinivas
- Indiana University Center for Aging Research (IUCAR),
Regenstrief Institute, Inc. – Indianapolis, IN, USA
| | - Victor Cornet
- Indiana University School of Informatics and Computing
– Indianapolis, IN, USA
| | - Richard Holden
- Indiana University Center for Aging Research (IUCAR),
Regenstrief Institute, Inc. – Indianapolis, IN, USA
- Indiana University School of Informatics and Computing
– Indianapolis, IN, USA
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23
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Azad N, Lemay G, Li J, Benzaquen M, Khoury L. Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality. Can Geriatr J 2016; 19:195-201. [PMID: 28050224 PMCID: PMC5178862 DOI: 10.5770/cgj.19.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. Methods The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit (GMU) during a three-month period. Results Nineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen a cardiologist or a specialist. Half of the patients did not know if they were on a special Heart-Failure (HF) diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to primary care providers (PCPs). Conclusion The results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.
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Affiliation(s)
- Nahid Azad
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Geriatrics, The Ottawa Hospital, Ottawa, ON, Canada
| | - G Lemay
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - J Li
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M Benzaquen
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - L Khoury
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Jansen Klomp WW, Brandon Bravo Bruinsma GJ, Peelen LM, Nierich AP, Grandjean JG, van 't Hof AWJ. Clinical recognition of acute aortic dissections: insights from a large single-centre cohort study. Neth Heart J 2016; 25:200-206. [PMID: 27882524 PMCID: PMC5313444 DOI: 10.1007/s12471-016-0921-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aims Acute aortic dissection (AD) requires immediate treatment, but is a diagnostic challenge. We studied how often AD was missed initially, which patients were more likely to be missed and how this influenced patient management and outcomes. Methods A retrospective cohort study including 200 consecutive patients with AD as the final diagnosis, admitted to a tertiary hospital between 1998 and 2008. The first differential diagnosis was identified and patients with and without AD included were compared. Characteristics associated with a lower level of suspicion were identified using multivariable logistic regression, and Cox regression was used for survival analyses. Missing data were imputed. Results Mean age was 63 years, 39% were female and 76% had Stanford type A dissection. In 69% of patients, AD was included in the first differential diagnosis; this was less likely in women (adjusted relative risk [aRR]: 0.66, 95% CI: 0.44–0.99), in the absence of back pain (aRR: 0.51, 95% CI: 0.30–0.84), and in patients with extracardiac atherosclerosis (aRR: 0.64, 95% CI: 0.43–0.96). Absence of AD in the differential diagnosis was associated with the use of more imaging tests (1.8 vs. 2.3, p = 0.01) and increased time from admission to surgery (1.8 vs. 10.1 h, p < 0.01), but not with a difference in the adjusted long-term all-cause mortality (hazard ratio: 0.76, 95% CI: 0.46–1.27). Conclusion Acute aortic dissection was initially not suspected in almost one-third of patients, this was more likely in women, in the absence of back pain and in patients with extracardiac atherosclerosis. Although the number of imaging tests was higher and time to surgery longer, patient outcomes were similar in both groups. Electronic supplementary material The online version of this article (doi:10.1007/s12471-016-0921-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- W W Jansen Klomp
- Department of Cardiology, Isala, Zwolle, The Netherlands.
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - L M Peelen
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A P Nierich
- Department of (Thoracic) Anaesthesia and Intensive Care, Isala, Zwolle, The Netherlands
| | - J G Grandjean
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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Abotalebidariasari G, Memarian R, Vanaki Z, Kazemnejad A, Naderi N. Self-Care Motivation Among Patients With Heart Failure: A Qualitative Study Based on Orem’s Theory. Res Theory Nurs Pract 2016; 30:320-332. [DOI: 10.1891/1541-6577.30.4.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Initiating and adhering to self-care activities necessitate self-care motivation. This study was undertaken in Iran to explore self-care motivation among patients with heart failure (HF). Methods: This qualitative study was done in 2014 and 2015. Study participants were patients with HF and their family members who were purposively selected from Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. The study data were collected from December 2014 to May 2015 by doing in-depth semistructured face-to-face interviews and were analyzed via the directed content analysis approach. Results: Eleven primary codes were generated which reflected motivations for self-care among patients with HF in the Iranian sociocultural context. To enhance the clarity of the findings, these primarily codes were summarized and grouped into 7 subcategories including fear of death and love of life, returning to previous physical health status and preventing or alleviating symptoms, understanding the value of self-care behaviors and trusting them, having the desire for remaining independent, relying on God, reassuring and supporting family members, and preventing family members from feeling irritation. Implications for Practice: The findings of this study indicate that patients with HF have different motivations for doing self-care activities. Fear of death, love of life, wish to return to previous health status, and prevention or alleviation of HF symptoms were the participants’ strongest motivations for self-care. Understanding the motivations for self-care among patients with HF, based a holistic approach and evidence-based practice, can help nurses and physicians develop motivational programs for promoting self-care behaviors.
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