Developing a Clinical Decision Support Tool to Enhance Home Care

An EHR-implemented clinical decision support tool can influence the standardization and customization of home care nurse decision making and also improve patient care in the home care setting by decreasing hospital readmissions, according to a study published in JMIR Publications.

Although home care provides care to over 5 million patients a year, it remains an understudied healthcare setting. According to the study authors, roughly one in five home care patients are readmitted to the hospital during home care and nearly two-thirds are hospitalized during the first two weeks of home care services.

The research team said the timing of the first home care visit is crucial to prevent hospital readmissions. However, home care nurses have limited or inaccurate patient data, meaning they don’t have a lot of information off which they can base decisions about when that first home care visit should take place.

Researchers developed an EHR-integrated CDS tool, Priority for the First Nursing Visit Tool (PREVENT), to help nurses flag which patients they should visit in the home first. Complex patients might get a home care visit sooner than patients with fewer medical complications, for example.

The research team aims to evaluate if patients would receive more-timely initial home care visits and if the tool could reduce hospitalization and hospital readmissions within 60 days. Throughout the data collection period, researchers will assess reach, adoption, and implementation by interviewing home care nurses and analyzing relevant data.

PREVENT was approved in October 2019 and it is currently being integrated into both home care and hospital EHR systems. The research team said data collection will begin in early 2021 once patients are selected for research.

The researchers said the EHR implementation will consist of three phases: preintervention, intervention, and postintervention.

In the preintervention phase, the researchers said they will identify CDS users and conduct training with users. The research team will evaluate the existing health IT infrastructure and the EHR system to develop a plan for EHR integration.

In the intervention phase, the trained clinicians will utilize PREVENT in a practice setting. The researchers will monitor the clinicians and recommend usability changes to the users. The research team would also measure the PREVENT usability and optimize the infrastructure and EHR workflow, if needed.

For the third phase, the research team will evaluate the barriers and facilitators for CDS implementation and user effectiveness. To ensure a successful implementation for field use, the research team will conduct interviews, simulations, and assessments. Furthermore, the team will evaluate appropriate resource access and both EHR workflow and health IT adjustments.

“In this study, we introduced a rigorous methodology for evaluating the implementation of an innovative CDSS, PREVENT, which was developed to assist in determining which patients should be prioritized for the first homecare nursing visit,” the study authors wrote. “This methodology was built on the RE-AIM framework and mixed methods approaches, incorporating homecare admission staff interviews, think-aloud simulations, and analysis of staffing and other relevant data.”

The research team said these steps present the outline of a study that aims to boost patient care at home care settings.

“We strongly encourage other researchers who study the effects of CDSS in clinical practice to apply similar mixed qualitative and quantitative methodologies in their studies,” concluded the study authors. “The application of mixed methods can enable researchers to gain an in-depth understanding of the complex socio-technological aspects of CDSS use in clinical practice. In turn, such comprehensive understanding can improve long-term effective use of CDSS in clinical settings.”