Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality.

BACKGROUND Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions. OBJECTIVE To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks. METHODS Development: A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing: Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied: Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists). RESULTS The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%). CONCLUSIONS The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.

[1]  B. Leff,et al.  Skilled home healthcare clinicians' experiences in communicating with physicians: A national survey , 2021, Journal of the American Geriatrics Society.

[2]  Rachel A. Rutkowski,et al.  A scoping review of interventions for older adults transitioning from hospital to home , 2021, Journal of the American Geriatrics Society.

[3]  B. Leff,et al.  Skilled Home Healthcare Clinician and Staff Perspectives on Communication With Physicians , 2021, Home healthcare now.

[4]  A. Gurses,et al.  Home Health Services in the Time of Coronavirus Disease 2019: Recommendations for Safe Transitions , 2020, Journal of the American Medical Directors Association.

[5]  R. Konetzka,et al.  Patient Outcomes After Hospital Discharge to Home With Home Health Care vs to a Skilled Nursing Facility. , 2019, JAMA internal medicine.

[6]  A. Gurses,et al.  Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study , 2018, BMJ Quality & Safety.

[7]  C. Christmas,et al.  A Call to Bridge Across Silos during Care Transitions. , 2018, Joint Commission journal on quality and patient safety.

[8]  P. Boling.  Understanding Quality of Care in Medicare Home Health Agency Care , 2017, Journal of the American Geriatrics Society.

[9]  N. Werner,et al.  SGIM-AMDA-AGS Consensus Best Practice Recommendations for Transitioning Patients’ Healthcare from Skilled Nursing Facilities to the Community , 2017, Journal of General Internal Medicine.

[10]  A. Gurses,et al.  Improving Care Transitions Across Healthcare Settings Through a Human Factors Approach , 2016, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[11]  A. Wu,et al.  Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools. , 2016, Journal of patient safety.

[12]  Mahiyar F. Nasarwanji,et al.  Identifying Challenges Associated With the Care Transition Workflow From Hospital to Skilled Home Health Care: Perspectives of Home Health Care Agency Providers , 2015, Home health care services quarterly.

[13]  Kathryn J. Eubank,et al.  Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals. , 2014, Joint Commission journal on quality and patient safety.

[14]  Sunil Kripalani,et al.  Regardless of Age: Incorporating Principles from Geriatric Medicine to Improve Care Transitions for Patients with Complex Needs , 2014, Journal of General Internal Medicine.

[15]  P. Carayon,et al.  SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients , 2013, Ergonomics.

[16]  Kathryn J. Eubank,et al.  Clinician Roles and Responsibilities During Care Transitions of Older Adults , 2013, Journal of the American Geriatrics Society.

[17]  M. Rooney,et al.  Changing the Culture of Practice to Support Care Transitions-Why Now? , 2012 .

[18]  R. Fortinsky,et al.  Rehospitalization in a national population of home health care patients with heart failure. , 2012, Health services research.

[19]  M. McHugh.  Interrater reliability: the kappa statistic , 2012, Biochemia medica.

[20]  U. Sarkar,et al.  What Patients Say About Their Doctors Online: A Qualitative Content Analysis , 2012, Journal of General Internal Medicine.

[21]  Peter J Pronovost,et al.  Time to accelerate integration of human factors and ergonomics in patient safety , 2011, BMJ quality & safety.

[22]  L. Aiken,et al.  The care span: The importance of transitional care in achieving health reform. , 2011, Health affairs.

[23]  Karin V Rhodes,et al.  "Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions. , 2011, Annals of emergency medicine.

[24]  D. Scharfstein,et al.  The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. , 2011, Archives of internal medicine.

[25]  C. Boult,et al.  The Geriatric Floating Interdisciplinary Transition Team , 2010, Journal of the American Geriatrics Society.

[26]  Pascale Carayon,et al.  FMEA Team Performance in Health Care: A Qualitative Analysis of Team Member Perceptions , 2009, Journal of patient safety.

[27]  Stephen A. Martin,et al.  A Reengineered Hospital Discharge Program to Decrease Rehospitalization , 2009, Annals of Internal Medicine.

[28]  R. Flin,et al.  The epistemology of patient safety research. , 2008, International journal of evidence-based healthcare.

[29]  B. Leff,et al.  Medicare Home Health Patients’ Transitions Through Acute And Post-Acute Care Settings , 2008, Medical care.

[30]  R. Rosati,et al.  Development and Testing of an Analytic Model to Identify Home Healthcare Patients at Risk for a Hospitalization Within the First 60 Days of Care , 2007, Home health care services quarterly.

[31]  P. Carayon,et al.  Work system design for patient safety: the SEIPS model , 2006, Quality and Safety in Health Care.

[32]  Sung-joon Min,et al.  The care transitions intervention: results of a randomized controlled trial. , 2006, Archives of internal medicine.

[33]  P. Plsek,et al.  Real time patient safety audits: improving safety every day , 2005, Quality and Safety in Health Care.

[34]  T. Speroff,et al.  Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit , 2005, Quality and Safety in Health Care.

[35]  E. Coleman,et al.  Assessing the Quality of Preparation for Posthospital Care from the Patient's Perspective: The Care Transitions Measure , 2005, Medical care.

[36]  M. Naylor,et al.  Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial , 2004, Journal of the American Geriatrics Society.

[37]  Paper Abstracts , 2004 .

[38]  Haya R Rubin,et al.  Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. , 2004, JAMA.

[39]  C. Boult,et al.  Improving the Quality of Transitional Care for Persons with Complex Care Needs , 2003, Journal of the American Geriatrics Society.

[40]  D. Bates,et al.  What practices will most improve safety? Evidence-based medicine meets patient safety. , 2002, JAMA.

[41]  M. Naylor,et al.  Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. , 1999, JAMA.

[42]  R. Carney,et al.  A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. , 1995, The New England journal of medicine.

[43]  Peter Hoonakker,et al.  Human factors systems approach to healthcare quality and patient safety. , 2014, Applied ergonomics.

[44]  Pascale Carayon,et al.  Conducting an efficient proactive risk assessment prior to CPOE implementation in an intensive care unit , 2013, Int. J. Medical Informatics.

[45]  Rupa S. Valdez,et al.  Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. , 2009, Work.

[46]  S Shepperd,et al.  Discharge planning from hospital to home. , 2000, The Cochrane database of systematic reviews.