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Tunnard I, Gillam J, Harvey C, Davies N, Vickerstaff V, Ellis-Smith C, Evans CJ. The acceptability and effectiveness of eHealth interventions to support assessment and decision-making for people with dementia living in care homes: A systematic review. FRONTIERS IN DEMENTIA 2022; 1:977561. [PMID: 39081472 PMCID: PMC11285551 DOI: 10.3389/frdem.2022.977561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 08/02/2024]
Abstract
Introduction As dementia progresses, care needs increase leading many to require 24-h care in care homes. eHealth interventions have the potential to improve care processes of assessment and decision-making for people with dementia. However, little is known on the acceptability and effectiveness in care homes. Aim To identify and explore the components, acceptability and effectiveness of eHealth interventions for people with dementia, families and staff to support assessment and decision-making in care homes. Methods A mixed methods systematic review using narrative synthesis. Four databases were searched (Embase, PsycINFO, MEDLINE, and CINAHL) from 2000 to July 2021. Quality appraisal used validated assessment tools appropriate for the study design. Results Twenty-six studies met eligibility criteria. Study designs and interventions were heterogeneous. Overall quality was high to moderate. Interventions that promoted supportive, practical learning through integrated working and provided staff with language to communicate resident symptoms were favored by staff. We found evidence that indicated residents were willing to use video consultations; however, families preferred face-to-face consultations. Fifteen studies considered effectiveness. Use of eHealth interventions indicates an improvement in resident outcomes in appropriate prescribing and advance care planning. Staff knowledge, confidence, and wellbeing were also improved. Hospitalisations were reduced when a video consultation component was implemented. Discussion Care home staff require support to meet the often multiple and changing care needs of residents with dementia. eHealth interventions can improve outcomes for staff and residents and facilitate integrated working with external professionals to support assessment and management of care. Further work is required to understand acceptability for residents and their families and effectiveness on family outcomes, particularly in non-Western cultures and low-middle income countries. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254967, identifier: CRD42021254967.
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Affiliation(s)
- India Tunnard
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Juliet Gillam
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Catherine Harvey
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Clare Ellis-Smith
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Catherine J. Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
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Using health information technology in residential aged care homes: An integrative review to identify service and quality outcomes. Int J Med Inform 2022; 165:104824. [DOI: 10.1016/j.ijmedinf.2022.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
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Kukafka R, Davies N, Aworinde J, Yorganci E, Anderson JE, Evans C. Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review. J Med Internet Res 2022; 24:e29837. [PMID: 35113029 PMCID: PMC8855285 DOI: 10.2196/29837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. OBJECTIVE The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. METHODS A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. RESULTS A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. CONCLUSIONS Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care.
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Affiliation(s)
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.,Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | | | - Emel Yorganci
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Janet E Anderson
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute, King's College London, London, United Kingdom.,Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Brighton, United Kingdom
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Vest JR, Jung HY, Wiley K, Kooreman H, Pettit L, Unruh MA. Adoption of Health Information Technology Among US Nursing Facilities. J Am Med Dir Assoc 2018; 20:995-1000.e4. [PMID: 30579920 DOI: 10.1016/j.jamda.2018.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. DESIGN Cross-sectional survey. SETTING & PARTICIPANTS We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations' health information technology usage and characteristics. MEASUREMENTS Using questions adopted from existing instruments, the survey measured nursing home's EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for 8 determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources, and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. RESULTS 84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39, 95% confidence interval = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). CONCLUSIONS/IMPLICATIONS An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policy makers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.
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Affiliation(s)
- Joshua R Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN.
| | - Hye-Young Jung
- Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY
| | - Kevin Wiley
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN
| | - Harold Kooreman
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN
| | - Lorren Pettit
- Healthcare Information and Management Systems Society (HIMSS), Chicago, IL
| | - Mark A Unruh
- Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY
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Ko M, Wagner L, Spetz J. Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018778902. [PMID: 29888677 PMCID: PMC6050994 DOI: 10.1177/0046958018778902] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation.
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Kruse CS, Mileski M, Vijaykumar AG, Viswanathan SV, Suskandla U, Chidambaram Y. Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review. JMIR Med Inform 2017; 5:e35. [PMID: 28963091 PMCID: PMC5640822 DOI: 10.2196/medinform.7958] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. OBJECTIVE The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. METHODS The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. RESULTS Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. CONCLUSIONS Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making.
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Affiliation(s)
- Clemens Scott Kruse
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Michael Mileski
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Alekhya Ganta Vijaykumar
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Sneha Vishnampet Viswanathan
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Ujwala Suskandla
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Yazhini Chidambaram
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
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Shewale AR, Johnson JT, Li C, Nelsen D, Martin BC. Net Clinical Benefits of Guidelines and Decision Tool Recommendations for Oral Anticoagulant Use among Patients with Atrial Fibrillation. J Stroke Cerebrovasc Dis 2015; 24:2845-53. [PMID: 26482369 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/16/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The 2012 American College of Chest Physicians' Evidence-Based Clinical Practice (CHEST), the 2012 European Society of Cardiology, and the 2014 American Heart Association guidelines and published decision tools by LaHaye and Casciano offer oral anticoagulant (OAC) recommendations for patients with atrial fibrillation (AF). The aim of our study was to compare the net clinical benefit (NCB) of OAC prescribing that was concordant with these decision aids. METHODS A cohort study of the 2001-2013 LifeLink claims data was used. NCB in concordance with each decision aid was defined as adverse events (thromboembolic and major bleed events) prevented per 10,000 person-years. Cox proportional hazard models were used to assess the relative risk of AF adverse events associated in concordance with each decision aid adjusted for potential confounders. FINDINGS The study included 15,129 patients with AF, contributing 33,512 person-years. The NCB of the CHEST guidelines was the highest (NCB = 30.07; 95% confidence interval [CI] = 28.66, 31.49) and the European Society of Cardiology guidelines the lowest (NCB = 7.38; 95% CI = 5.97, 8.80). Significant unadjusted decreases in the risk of AF adverse events associated with concordant OAC use/nonuse were found for the CHEST guidelines (hazard ratio [HR] = .825; 95% CI = .695, .979), Casciano tool (HR = .838; 95% CI = .706, .995), and LaHaye tool (HR = .841; 95% CI = .709, .999); however, none were significant after multivariate adjustment. CONCLUSION Concordant OAC use with any of the decision aids except for the aggressive LaHaye tool led to a positive NCB. The decision aids based on the CHA2DS2-VASc algorithm did not consistently improve the NCB compared to CHADS2-based aids. Recommending OAC use when CHA2DS2-VASc score = 1 resulted in a lower NCB when all other factors guiding recommendations were held constant.
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Affiliation(s)
- Anand R Shewale
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jill T Johnson
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David Nelsen
- Department of Family Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Bradley C Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR.
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Cook DA, Enders F, Caraballo PJ, Nishimura RA, Lloyd FJ. An automated clinical alert system for newly-diagnosed atrial fibrillation. PLoS One 2015; 10:e0122153. [PMID: 25849969 PMCID: PMC4388495 DOI: 10.1371/journal.pone.0122153] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/13/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Clinical decision support systems that notify providers of abnormal test results have produced mixed results. We sought to develop, implement, and evaluate the impact of a computer-based clinical alert system intended to improve atrial fibrillation stroke prophylaxis, and identify reasons providers do not implement a guideline-concordant response. MATERIALS AND METHODS We conducted a cohort study with historical controls among patients at a tertiary care hospital. We developed a decision rule to identify newly-diagnosed atrial fibrillation, automatically notify providers, and direct them to online evidence-based management guidelines. We tracked all notifications from December 2009 to February 2010 (notification period) and applied the same decision rule to all patients from December 2008 to February 2009 (control period). Primary outcomes were accuracy of notification (confirmed through chart review) and prescription of warfarin within 30 days. RESULTS During the notification period 604 notifications were triggered, of which 268 (44%) were confirmed as newly-diagnosed atrial fibrillation. The notifications not confirmed as newly-diagnosed involved patients with no recent electrocardiogram at our institution. Thirty-four of 125 high-risk patients (27%) received warfarin in the notification period, compared with 34 of 94 (36%) in the control period (odds ratio, 0.66 [95% CI, 0.37-1.17]; p = 0.16). Common reasons to not prescribe warfarin (identified from chart review of 151 patients) included upcoming surgical procedure, choice to use aspirin, and discrepancy between clinical notes and the medication record. CONCLUSIONS An automated system to identify newly-diagnosed atrial fibrillation, notify providers, and encourage access to management guidelines did not change provider behaviors.
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Affiliation(s)
- David A. Cook
- Knowledge Delivery Center, Mayo Clinic, Rochester, MN, United States of America
- Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
- Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Felicity Enders
- Knowledge Delivery Center, Mayo Clinic, Rochester, MN, United States of America
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Pedro J. Caraballo
- Knowledge Delivery Center, Mayo Clinic, Rochester, MN, United States of America
- Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Rick A. Nishimura
- Knowledge Delivery Center, Mayo Clinic, Rochester, MN, United States of America
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Farrell J. Lloyd
- Knowledge Delivery Center, Mayo Clinic, Rochester, MN, United States of America
- Division of Hospital Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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Davis JA, Zakoscielna K, Jacobs L. Electronic Information Systems Use in Residential Care Facilities: The Differential Effect of Ownership Status and Chain Affiliation. J Appl Gerontol 2014; 35:331-48. [PMID: 25537650 DOI: 10.1177/0733464814563605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 11/08/2014] [Indexed: 11/16/2022] Open
Abstract
The use of electronic information systems (EISs) including electronic health records continues to increase in all sectors of the health care industry. Research shows that EISs may be useful for improving care delivery and decreasing medical errors. The purpose of this project is twofold: First, we describe the prevalence of EIS use among residential care facilities (RCFs), and second, we explore utilization differences by ownership status and chain affiliation. We anticipate that RCFs that are non-profit and non-chain will use more EIS than other categories of RCFs. Data for this project come from the 2010 National Survey of Residential Care Facilities. The sample consists of 2,300 facilities. Overall use of EIS was greatest among RCFs that are non-profit and chain-affiliated. Conversely, the use was lowest among for-profit RCFs that were also non-chain affiliated. This may suggest that these facilities lack the necessary resources or motivation to invest in information systems.
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