Decision-Making Process of Home and Social Care Professionals Using Telemonitoring of Activities of Daily Living for...

Area of Science:

• Gerontology
• Health Informatics
• Clinical Decision Support

Background:

• Older adults with cognitive deficits often lack self-awareness, hindering accurate assessment of functional decline and home care needs.
• Activity of daily living (ADL) telemonitoring utilizes ambient sensors to track behaviors, offering a potential solution to gather objective data.
• A gap exists in understanding how to integrate ADL telemonitoring data into clinical reasoning for effective home care targeting.

Purpose of the Study:

• To describe how clinicians utilize ADL telemonitoring data to support older adults with cognitive deficits at home.
• To evaluate the impact of ADL telemonitoring on the delivery of home care services.

Main Methods:

• An embedded mixed-methods multiple-case study design was employed across three Quebec health institutions.
• The Innovative Easy Assistance System-Support for Older Adults' Autonomy (NEARS-SAPA) telemonitoring system was deployed for four years.
• Clinician interviews and quantitative service metadata were collected to triangulate findings.

Main Results:

• Clinicians used a four-step process: data extraction, comparison with other sources, risk assessment, and intervention plan adjustment.
• ADL telemonitoring data informed decisions to maintain or modify intervention plans, often stabilizing monthly service numbers.
• Qualitative data indicated clinicians felt reassured about risk management and service appropriateness when using telemonitoring data.

Conclusions:

• ADL telemonitoring facilitates case-by-case optimization of home care services.
• The technology can enhance clinician confidence in risk management and service delivery decisions.
• Further large-scale studies are recommended to explore the broader benefits for public healthcare systems.