Problem Statement: In home care, falls rank as the top potentially avoidable event (PAE) that leads to hospital readmissions and emergency room visits. Therefore, fall-risk management becomes paramount for home health agencies (HHAs). Effective fall-risk management, defined as assessing and reducing fall risks by making the necessary and appropriate interventions, requires a careful identification of home care clinicians' information needs. Currently, home care clinicians have access to little information that can inform the coordination of care for fall-risk management. This study aimed to (1) identify clinicians' information needs for fall-risk management and how they manage missing or inaccurate data; (2) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions; and (3) offer informatics-based recommendations to improve fall-risk management.
Methods: A case study was carried out in a single not-for-profit suburban Medicare certified HHA. Qualitative data were collected through observations, semistructured interviews, and focus groups. Maximum variation sampling was adopted to recruit a diverse sample (N = 40) of full-time nurses, physical therapists, and occupational therapists. The framework method was used for analysis.
Results: Overall, the information needs for fall-risk management were categorized into six domains: physiological, care delivery, educational, social, environmental, and administrative. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, and the availability of caregivers at home. The clinicians stressed that they started the care episode with little information relevant to fall-risk management. The unavailability and inaccuracy of important information related to falls such as the weight-bearing status delayed necessary therapeutic services aimed at reducing patients' fall risks, thereby jeopardizing their safety. Most referrals were faxed, were illegible, and lacked many information critical for fall-risk management. While the electronic health record (EHR) made fall-risk assessment instruments available, locating fall-related documentation was difficult and consumed the clinicians' time. To improve the care coordination in fall-risk management, the HHA should consider interoperability and integration of its EHR with the referring organizations, redesigning its EHR to better support its fall-risk management workflows, and raising its staff and all referring organizations' awareness on the importance of capturing and exchanging information relevant to fall-risk management.
Significance: The results highlight home care clinicians' information needs for fall-risk management and identified opportunities to improve the workflows and health IT solutions to effectively and efficiently retain, exchange, and process relevant information. HHAs can use this evidence to ensure that their clinicians' fall-risk information needs are addressed by improving their workflows and currently adopted health IT solutions. The findings can also be useful to health IT vendors to understand the exchange and integration needs for fall-risk management in home care. As HHAs transition to the value-based payment system proposed by the Centers of Medicare & Medicaid Services, the results can help HHAs in their efforts that target the reduction of PAEs and the improvement in the quality of care and health outcomes.