Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study

Area of Science:

• Healthcare Management
• Nursing
• Health Informatics

Background:

• High hospital readmission rates from home care indicate suboptimal care quality, especially for heart failure patients.
• Optimizing continuity of care is crucial for reducing preventable readmissions.

Purpose of the Study:

• To investigate home care clinicians' perceived barriers to care continuity for heart failure patients.
• To identify essential information needs for improving care continuity in home care settings.

Main Methods:

• Qualitative study utilizing focus groups with home care clinicians.
• Conducted at a large certified home healthcare agency in the Northeastern United States.
• 61 participants across 6 focus groups.

Main Results:

• Key themes identified: care transition communication, continuity during home care episodes (symptom tracking, patient teaching), and health information technology (HIT) support.
• Clinicians need improved HIT to facilitate communication and maintain care continuity.
• Barriers to effective care continuity were identified.

Conclusions:

• HIT solutions require enhancement to better support heart failure patient care in home settings.
• Findings provide actionable insights for developing and implementing effective HIT systems.