This research work is focused on building and evaluating one of the first evidence-based
      clinical decision support tools for homecare in the United States. The results of this study
      have the potential to standardize and individualize nursing decision making using
      cutting-edge technology and to improve patient outcomes in the homecare setting.

Improving Patient Prioritization During Hospital-homecare Transition

Diabetes Mellitus, Type 2

Congestive Heart Failure

Obstructive Pulmonary Disease

Dyspnea

Renal Failure

Each year, more than 5 million patients are admitted to the approximately 12,000 homecare
      agencies across the United States. About 20% of homecare patients are rehospitalized during
      the homecare episode, with as many as 68% of these rehospitalizations occurring within the
      first two weeks of services. A significant portion of these rehospitalizations may be
      prevented by timely and appropriately targeted allocation of homecare services. The first
      homecare nursing visit is one of the most critical steps of the homecare episode. This visit
      includes an examination of the home environment, a discussion regarding whether a caregiver
      is present, an assessment of the patient's capacity for self-care, and medication
      reconciliation. A unique care plan is created based on this evaluation of the patient's
      needs. Hence, appropriate timing of the first visit is crucial, especially for patients with
      urgent healthcare needs. However, nurses often have very limited and inaccurate information
      about incoming patients and patient priority decisions vary significantly between nurses.

      The investigators developed an innovative decision support tool called "Priority for the
      First Nursing Visit Tool" (PREVENT) to assist nurses in prioritizing patients in need of
      immediate first homecare nursing visits. In a recent efficacy pilot study of PREVENT,
      high-risk patients received their first homecare nursing visit a half day sooner as compared
      to the control group, and 60-day rehospitalizations decreased by almost half as compared to
      the control group. The proposed study assembles a strong interdisciplinary team of experts in
      health informatics, nursing, homecare, and sociotechnical disciplines to evaluate PREVENT in
      a pre-post intervention effectiveness study. Specifically, the study aims are: Aim 1)
      Evaluate the effectiveness of the PREVENT tool on process and patient outcomes. Using
      survival analysis and logistic regression with propensity score matching the researchers will
      test the following hypotheses: Compared to not using the tool in the pre-intervention phase,
      when homecare clinicians use the PREVENT tool, high risk patients in the intervention phase
      will: a) receive more timely first homecare visits and b) have decreased incidence of
      rehospitalization and have decreased emergency department (ED) use within 60 days. Aim 2)
      Explore PREVENT's reach and adoption by the homecare admission staff and describe the tool's
      implementation during homecare admission. Aim 2 will be assessed using mixed methods
      including homecare admission staff interviews, think-aloud simulations, and analysis of
      staffing and other relevant data.

      This innovative study addresses several National Institute of Nursing Research strategic
      priorities, such as promoting innovation and using technology to improve health. Mixed
      methods will enable us to gain in-depth understanding of the complex socio-technological
      aspects of hospital-homecare transition.

PREVENT clinical decision support

Improving Patient Prioritization During Hospital-homecare Transition: A Mixed Methods Study of a Clinical Decision Support Tool

Patient outcomes include rehospitalization measure within 60 days after hospital discharge. The hypothesis is that using the PREVENT tool will result in decreased incidence of rehospitalization. Rehospitalization information will be extracted from the New York Regional Health Information Exchange (RHIO) database.

Nurses' usability perception of the clinical decision support tool (PREVENT) will be assessed by using he System Usability Scale (SUS).

Associate Professor

The PREVENT recommendation about patient homecare priority will be shared in homecare referral communication with the homecare intake coordinators. Homecare intake coordinators will be instructed to prioritize high risk patients for care.

Improving Patient Prioritization During Hospital-homecare Transition

About this trial

Study ID

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Phase

Placebo

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Not accepting

Trial Timing

What is this trial about?

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