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A Guide for Intentional Home Telehealth Assessment: Patient and Caregiver Perceptions
Abstract
Telehealth can provide expanded access to healthcare. The Comprehensive Patient Assessment for Using Telehealth at Home is a comprehensive approach for an intentional remote patient meeting that provides a high-quality patient encounter when using technology. In this study, we describe the perspectives of seriously ill older adults and their caregivers on the usability of the Comprehensive Patient Assessment for Using Telehealth at Home using technology to meet remotely and assess patients in their own homes. This study used qualitative description with semistructured interviews to explore participants' user experience of the telehealth visit using the Comprehensive Patient Assessment for Using Telehealth at Home. The overarching theme of participants' experiences with the Comprehensive Patient Assessment for Using Telehealth at Home intervention was of a continuum of acceptance of technology use. Participants felt that a combination of in-person and telehealth visits was ideal, and telehealth visits were appropriate for routine visits. In-person assessments would be necessary if the communication was not adequately received through remote technology. Other themes were satisfaction and detractors, usability of the technology, privacy and confidentiality, and timing of the telehealth visit. Telehealth presents new opportunities for patients to engage and connect with providers, allowing them to seek care in the comfort of their own home. In some circumstances, telehealth is appropriate but is not a permanent replacement for in-person visits.
Introduction
Pre-discharge home assessments by occupational therapists facilitate safe and timely discharge from hospital and are associated with better health outcomes. Digital technology offers the potential to reduce duplication of documentation and improve communication and sharing of home assessment findings.
Objective
This quality improvement project evaluated time-cost; clinician satisfaction and confidence; and acceptability of the use of a digital approach to home assessments.
Methods
A prospective, cross-sectional design was used to compare usual practice with the digital approach across two sub-acute wards in a large metropolitan hospital in Queensland, Australia. Time to document and conduct home assessments as well as clinician satisfaction and confidence were compared using descriptive statistics. Clinician perspectives about the home assessment approaches were collected through a survey and analyzed using content analysis.
Results
Home assessment and documentation time were significantly lower for the home assessments conducted using the digital approach compared with usual practice assessments. Clinician satisfaction with using digital technology was higher.
Conclusions
The introduction of this simple technology reduced clinicians’ time to conduct home assessments and document home assessment reports. The project was well received by occupational therapy clinicians.
Spanish abstract
http://links.lww.com/IJEBH/A187
Background: The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualized care. The videoconferencing camera is a proxy for home visit provider's eyes. However, cameras limit views, thereby reducing environmental cues. The Novice to Expert Theory of skill acquisition supports the use of an intentional viewing guide to assure a comprehensive patient assessment using telehealth in the home (CPATH). This study advances the development of a CPATH framework to guide providers to be intentional when using televideo technology.
Methods: A quantitative content validity approach was used to determine the validity of a priori items within domains that were in the original protocol framework. A content validity determination requires 5–10 experts to rate agreement (range 1–5) on items within domains. Our sample was composed of seven expert home health providers. More than five experts had to agree to achieve statistical significance (p < 0.05) for validity.
Results: Of the 15 items in the protocol, only 8 items had significant agreement for the sample size. These items were breathing, nonverbal gesturing, positioning, oxygen, safety, and types, dosages, and administration guidance of medication. Other items were added within the existing domains of Patient Characteristics, Treatment and Equipment Functioning, Medications and Environmental Quality, with the exception of Caregivers.
Conclusion: The domains triggered considerations for existing or additional items that require assessment, thereby developing the intentional guide framework that permits individualization of a telehealth home-based visit.
This article critically analyses the hermeneutic commitment of interpretative phenomenological analysis (IPA). In the theoretical framework of IPA, the role of preconceptions and prejudices is consistently downplayed; priority is given to the participant's own words. Paley has argued that IPA’s interpretative phase is always and necessarily determined by the researcher's fore‐conceptions, as opposed to the participant's narrative. I demonstrate that IPA’s failure to recognize the importance of an external frame of reference in interpretation may arise from the misunderstanding of the method's hermeneutic underpinnings. I essentially argue that bracketing the researcher's fore‐conceptions during the initial phases of IPA is merely an illusion. While it is beyond the scope of this article to dispute whether IPA is genuinely phenomenological, my claim ultimately poses a challenge to IPA’s phenomenological commitment on its own terms. The article concludes with a proposal to substantially improve IPA’s consistency with hermeneutic tradition and its grounding in phenomenological philosophy.
All qualitative research is contextual; it occurs within a specific time and place between two or more people. If a researcher clearly describes the contextual intersecting relationships between the participants and themselves (reflexivity), it not only increases the creditability of the findings but also deepens our understanding of the work. The issues surrounding the researchers’ reflexivity are many and complex; however, journal space for discussing them may be very limited. Therefore the researcher has the responsibility of succinctly and clearly addressing these issues, so the reader can evaluate the research. Some of the ways that researchers can address reflexivity are discussed.
This paper traces the evolution of sociotechnical systems design from its origins in the coal mines of Great Britain to the present day and beyond, into our digital future. Conceived as a means of enhancing productivity while simultaneously providing more meaningful work, sociotechnical thinking gained ground in machine-driven work settings and later took a leap forward to aid the effectiveness of knowledge work. After a period of stagnation as popular fads such as total quality, reengineering and lean six sigma took hold, sociotechnical thinking is poised to reemerge as capabilities associated with new technologies are rapidly outpacing the development of new organizational designs. A recent sociotechnical systems design lab brought together a diverse group of academics, thinkers and practitioners to discuss the future of organization design, producing tantalizing insights into the world that is about to take shape. Finally, implications for change management in sociotechnical transformation are discussed.