BACKGROUND Delayed start-of-care nursing visits in home health care (HHC) can result in negative ... more BACKGROUND Delayed start-of-care nursing visits in home health care (HHC) can result in negative outcomes, such as hospitalization. No previous studies have investigated why start-of-care HHC nursing visits are delayed, in part because most reasons for delayed visits are documented in free-text HHC nursing notes. OBJECTIVE The aims of this study were to (1) develop and test a natural language processing (NLP) algorithm that automatically identifies reasons for delayed visits in HHC free-text clinical notes and (2) describe reasons for delayed visits in a large patient sample. METHODS This study was conducted at the Visiting Nurse Service of New York (VNSNY). We examined data available at the VNSNY on all new episodes of care started in 2019 (N=48,497). An NLP algorithm was developed and tested to automatically identify and classify reasons for delayed visits. RESULTS The performance of the NLP algorithm was 0.8, 0.75, and 0.77 for precision, recall, and F-score, respectively. A total of one-third of HHC episodes (n=16,244) had delayed start-of-care HHC nursing visits. The most prevalent identified category of reasons for delayed start-of-care nursing visits was no answer at the door or phone (3728/8051, 46.3%), followed by patient/family request to postpone or refuse some HHC services (n=2858, 35.5%), and administrative or scheduling issues (n=1465, 18.2%). In 40% (n=16,244) of HHC episodes, 2 or more reasons were documented. CONCLUSIONS To avoid critical delays in start-of-care nursing visits, HHC organizations might examine and improve ways to effectively address the reasons for delayed visits, using effective interventions, such as educating patients or caregivers on the importance of a timely nursing visit and improving patients’ intake procedures.
Many healthcare organizations buy their microcomputers and software packages in a piece-meal fash... more Many healthcare organizations buy their microcomputers and software packages in a piece-meal fashion. As a result, single microcomputers cannot share information with other microcomputers, networks, or the central computer system. Designating compatible software packages and machines as standards for the institution ensures that hardware and software can communicate. These standards should be implemented across the institution and regularly updated so that users' needs are met.
Annual Symposium on Computer Application in Medical Care, Nov 8, 1989
ABSTRACT Children's Seashore House a 70 bed pediatric rehabilitation hospital located in ... more ABSTRACT Children's Seashore House a 70 bed pediatric rehabilitation hospital located in Atlantic City and Philadelphia, will move into its new hospital in the Philadelphia Center for Health Care Sciences in June 1990. Children's Seashore House has a 3 part mission patient care, teaching, and basic and clinical research.
In home health care, the patient problem list is an important component of the admission and care... more In home health care, the patient problem list is an important component of the admission and care planning processes and determines the subsequent care received. We examined the information received from the referring facilities and its relationship with the final patient problem list generated at home health care admission. Researchers observed 12 admissions and collected available documents related to the admission and care planning process. Problems identified in documents provided to admission nurses (input documents) and in documents subsequently created by those nurses (output documents) were coded to form a standardized set of problem terms across the documents. Documents available, distribution of problems within the documents, and concordance between input and output documents were assessed. A varying number of the 17 unique problems found across the documents were distributed by document type. Patients were referred to home health care with more clinical problems than were documented in the output documents.
Journal of the American Medical Directors Association, Nov 1, 2021
OBJECTIVES Home health care patients have critical needs requiring timely care following hospital... more OBJECTIVES Home health care patients have critical needs requiring timely care following hospital discharge. Although Medicare requires timely start-of-care nursing visits, a significant portion of home health care patients wait longer than 2 days for the first visit. No previous studies investigated the pattern of start-of-care visits or factors associated with their timing. This study's purpose was to examine variation in timing of start-of-care visits and characterize patients with visits later than 2 days postdischarge. DESIGN Retrospective cohort study. SETTING/PARTICIPANTS Patients admitted to a large, Northeastern US, urban home health care organization during 2019. The study included 48,497 home care episodes for 45,390 individual patients. MEASUREMENT We calculated time to start of care from hospital discharge for 2 patient groups: those seen within 2 days vs those seen >2 days postdischarge. We examined patient factors, hospital discharge factors, and timing of start of care using multivariate logistic regression. RESULTS Of 48,497 episodes, 16,251 (33.5%) had a start-of-care nursing visit >2 days after discharge. Increased odds of this time frame were associated with being black or Hispanic and having solely Medicaid insurance. Odds were highest for patients discharged on Fridays, Saturdays, and Mondays. Factors associated with visits within 2 days included surgical wound presence, urinary catheter, pain, 5 or more medications, and intravenous or infusion therapies at home. CONCLUSIONS AND IMPLICATIONS Findings provide the first publication of clinical and demographic characteristics associated with home health care start-of-care timing and its variation. Further examination is needed, and adjustments to staff scheduling and improved information transfer are 2 suggested interventions to decrease variation.
We conducted two mixed methods studies in community-based health care settings to examine EHR use... more We conducted two mixed methods studies in community-based health care settings to examine EHR use among nurses documenting direct patient care and EHR impact on nurse satisfaction. Quantitative methods included documentation time-to-completion data and a clinician satisfaction survey. Qualitative methods included observations and follow-up interviews. Qualitative data was merged with the quantitative data by comparing findings along themes. Results indicated nurses increased the number and timeliness of notes documented. Nurse use of the EHR as intended varied between the research sites. Barriers to EHR use included cumbersome functionalities that impacted nurse efficiency, lack of interoperability, and hardware issues. Facilitators to adoption included functionalities that provided memory prompts during the care process and enabled nurses to communicate about patient care. Interpretation of findings underscores the importance of the interaction of workflow, EHR functionality, and usability to impact nurse satisfaction, efficiency, and use of the EHR.
Home health care admission nurses need high quality patient information but that information is n... more Home health care admission nurses need high quality patient information but that information is not uniformly available. Despite this challenge, these nurses must make four critical decisions at patient admission to construct the plan of care: (1) patient problems to address in the home health care episode; (2) patient medication management; (3) services in addition to skilled nursing; and (4) skilled nursing visit pattern. We observed 12 in-home admissions at a rural home health care agency and interviewed nurses before and after about these decisions. We analyzed content and quality of documents. To evaluate quality, for each decision we assessed concordance between documents. Interview responses provided context in the analysis. Across all admissions, documents and their contents were not uniformly present. Nurses rarely received visit pattern or medication management information. There was discordance in the number of patient problems among and between available documents and the plan of care. Electronic health record design recommendations include interoperability and structured, consistent, actionable information.
The Improving Medicare Post–Acute Care Transformation Act, which mandates electronic sharing of s... more The Improving Medicare Post–Acute Care Transformation Act, which mandates electronic sharing of standardized patient data by post–acute care clinical settings, will likely spur further health information technology adoption and evaluation. To support evaluation, the study objective was to clarify components of an evidence-based health information technology evaluation framework, Health Information Technology Reference-based Evaluation Framework, by using the framework in home healthcare and incorporating a sociotechnical perspective in the health information technology evaluation. With 36 observations among three diverse home healthcare agencies, researchers conducted a recorded think-aloud process as nurses documented the home healthcare admission in the EHR. Thematic analysis revealed 15 themes that provided clarification for almost one-third of Health Information Technology Reference-based Evaluation Framework components and added a new concept. All themes reflected a sociotechnical perspective. The new theme added to the Health Information Technology Reference-based Evaluation Framework reflected the sociotechnical perspective: routine use. We anticipate the enhanced Health Information Technology Reference-based Evaluation Framework to be used by evaluators from diverse disciplines, to further facilitate context-dependent health information technology adoption in post–acute care settings.
BACKGROUND Delayed start-of-care nursing visits in home health care (HHC) can result in negative ... more BACKGROUND Delayed start-of-care nursing visits in home health care (HHC) can result in negative outcomes, such as hospitalization. No previous studies have investigated why start-of-care HHC nursing visits are delayed, in part because most reasons for delayed visits are documented in free-text HHC nursing notes. OBJECTIVE The aims of this study were to (1) develop and test a natural language processing (NLP) algorithm that automatically identifies reasons for delayed visits in HHC free-text clinical notes and (2) describe reasons for delayed visits in a large patient sample. METHODS This study was conducted at the Visiting Nurse Service of New York (VNSNY). We examined data available at the VNSNY on all new episodes of care started in 2019 (N=48,497). An NLP algorithm was developed and tested to automatically identify and classify reasons for delayed visits. RESULTS The performance of the NLP algorithm was 0.8, 0.75, and 0.77 for precision, recall, and F-score, respectively. A total of one-third of HHC episodes (n=16,244) had delayed start-of-care HHC nursing visits. The most prevalent identified category of reasons for delayed start-of-care nursing visits was no answer at the door or phone (3728/8051, 46.3%), followed by patient/family request to postpone or refuse some HHC services (n=2858, 35.5%), and administrative or scheduling issues (n=1465, 18.2%). In 40% (n=16,244) of HHC episodes, 2 or more reasons were documented. CONCLUSIONS To avoid critical delays in start-of-care nursing visits, HHC organizations might examine and improve ways to effectively address the reasons for delayed visits, using effective interventions, such as educating patients or caregivers on the importance of a timely nursing visit and improving patients’ intake procedures.
Many healthcare organizations buy their microcomputers and software packages in a piece-meal fash... more Many healthcare organizations buy their microcomputers and software packages in a piece-meal fashion. As a result, single microcomputers cannot share information with other microcomputers, networks, or the central computer system. Designating compatible software packages and machines as standards for the institution ensures that hardware and software can communicate. These standards should be implemented across the institution and regularly updated so that users' needs are met.
Annual Symposium on Computer Application in Medical Care, Nov 8, 1989
ABSTRACT Children's Seashore House a 70 bed pediatric rehabilitation hospital located in ... more ABSTRACT Children's Seashore House a 70 bed pediatric rehabilitation hospital located in Atlantic City and Philadelphia, will move into its new hospital in the Philadelphia Center for Health Care Sciences in June 1990. Children's Seashore House has a 3 part mission patient care, teaching, and basic and clinical research.
In home health care, the patient problem list is an important component of the admission and care... more In home health care, the patient problem list is an important component of the admission and care planning processes and determines the subsequent care received. We examined the information received from the referring facilities and its relationship with the final patient problem list generated at home health care admission. Researchers observed 12 admissions and collected available documents related to the admission and care planning process. Problems identified in documents provided to admission nurses (input documents) and in documents subsequently created by those nurses (output documents) were coded to form a standardized set of problem terms across the documents. Documents available, distribution of problems within the documents, and concordance between input and output documents were assessed. A varying number of the 17 unique problems found across the documents were distributed by document type. Patients were referred to home health care with more clinical problems than were documented in the output documents.
Journal of the American Medical Directors Association, Nov 1, 2021
OBJECTIVES Home health care patients have critical needs requiring timely care following hospital... more OBJECTIVES Home health care patients have critical needs requiring timely care following hospital discharge. Although Medicare requires timely start-of-care nursing visits, a significant portion of home health care patients wait longer than 2 days for the first visit. No previous studies investigated the pattern of start-of-care visits or factors associated with their timing. This study's purpose was to examine variation in timing of start-of-care visits and characterize patients with visits later than 2 days postdischarge. DESIGN Retrospective cohort study. SETTING/PARTICIPANTS Patients admitted to a large, Northeastern US, urban home health care organization during 2019. The study included 48,497 home care episodes for 45,390 individual patients. MEASUREMENT We calculated time to start of care from hospital discharge for 2 patient groups: those seen within 2 days vs those seen >2 days postdischarge. We examined patient factors, hospital discharge factors, and timing of start of care using multivariate logistic regression. RESULTS Of 48,497 episodes, 16,251 (33.5%) had a start-of-care nursing visit >2 days after discharge. Increased odds of this time frame were associated with being black or Hispanic and having solely Medicaid insurance. Odds were highest for patients discharged on Fridays, Saturdays, and Mondays. Factors associated with visits within 2 days included surgical wound presence, urinary catheter, pain, 5 or more medications, and intravenous or infusion therapies at home. CONCLUSIONS AND IMPLICATIONS Findings provide the first publication of clinical and demographic characteristics associated with home health care start-of-care timing and its variation. Further examination is needed, and adjustments to staff scheduling and improved information transfer are 2 suggested interventions to decrease variation.
We conducted two mixed methods studies in community-based health care settings to examine EHR use... more We conducted two mixed methods studies in community-based health care settings to examine EHR use among nurses documenting direct patient care and EHR impact on nurse satisfaction. Quantitative methods included documentation time-to-completion data and a clinician satisfaction survey. Qualitative methods included observations and follow-up interviews. Qualitative data was merged with the quantitative data by comparing findings along themes. Results indicated nurses increased the number and timeliness of notes documented. Nurse use of the EHR as intended varied between the research sites. Barriers to EHR use included cumbersome functionalities that impacted nurse efficiency, lack of interoperability, and hardware issues. Facilitators to adoption included functionalities that provided memory prompts during the care process and enabled nurses to communicate about patient care. Interpretation of findings underscores the importance of the interaction of workflow, EHR functionality, and usability to impact nurse satisfaction, efficiency, and use of the EHR.
Home health care admission nurses need high quality patient information but that information is n... more Home health care admission nurses need high quality patient information but that information is not uniformly available. Despite this challenge, these nurses must make four critical decisions at patient admission to construct the plan of care: (1) patient problems to address in the home health care episode; (2) patient medication management; (3) services in addition to skilled nursing; and (4) skilled nursing visit pattern. We observed 12 in-home admissions at a rural home health care agency and interviewed nurses before and after about these decisions. We analyzed content and quality of documents. To evaluate quality, for each decision we assessed concordance between documents. Interview responses provided context in the analysis. Across all admissions, documents and their contents were not uniformly present. Nurses rarely received visit pattern or medication management information. There was discordance in the number of patient problems among and between available documents and the plan of care. Electronic health record design recommendations include interoperability and structured, consistent, actionable information.
The Improving Medicare Post–Acute Care Transformation Act, which mandates electronic sharing of s... more The Improving Medicare Post–Acute Care Transformation Act, which mandates electronic sharing of standardized patient data by post–acute care clinical settings, will likely spur further health information technology adoption and evaluation. To support evaluation, the study objective was to clarify components of an evidence-based health information technology evaluation framework, Health Information Technology Reference-based Evaluation Framework, by using the framework in home healthcare and incorporating a sociotechnical perspective in the health information technology evaluation. With 36 observations among three diverse home healthcare agencies, researchers conducted a recorded think-aloud process as nurses documented the home healthcare admission in the EHR. Thematic analysis revealed 15 themes that provided clarification for almost one-third of Health Information Technology Reference-based Evaluation Framework components and added a new concept. All themes reflected a sociotechnical perspective. The new theme added to the Health Information Technology Reference-based Evaluation Framework reflected the sociotechnical perspective: routine use. We anticipate the enhanced Health Information Technology Reference-based Evaluation Framework to be used by evaluators from diverse disciplines, to further facilitate context-dependent health information technology adoption in post–acute care settings.
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