Columbia University School of Nursing, New York City, New York, USA.
Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, New York, USA.
J Am Med Inform Assoc. 2022 Apr 13;29(5):805-812. doi: 10.1093/jamia/ocac023.
To identify the risk factors home healthcare (HHC) clinicians associate with patient deterioration and understand how clinicians respond to and document these risk factors.
We interviewed multidisciplinary HHC clinicians from January to March of 2021. Risk factors were mapped to standardized terminologies (eg, Omaha System). We used directed content analysis to identify risk factors for deterioration. We used inductive thematic analysis to understand HHC clinicians' response to risk factors and documentation of risk factors.
Fifteen HHC clinicians identified a total of 79 risk factors that were mapped to standardized terminologies. HHC clinicians most frequently responded to risk factors by communicating with the prescribing provider (86.7% of clinicians) or following up with patients and caregivers (86.7%). HHC clinicians stated that a majority of risk factors can be found in clinical notes (ie, care coordination (53.3%) or visit (46.7%)).
Clinicians acknowledged that social factors play a role in deterioration risk; but these factors are infrequently studied in HHC. While a majority of risk factors were represented in the Omaha System, additional terminologies are needed to comprehensively capture risk. Since most risk factors are documented in clinical notes, methods such as natural language processing are needed to extract them.
This study engaged clinicians to understand risk for deterioration during HHC. The results of our study support the development of an early warning system by providing a comprehensive list of risk factors grounded in clinician expertize and mapped to standardized terminologies.
确定家庭医疗保健（HHC）临床医生认为与患者恶化相关的风险因素，并了解临床医生如何应对和记录这些风险因素。
我们于 2021 年 1 月至 3 月采访了多学科 HHC 临床医生。将风险因素映射到标准化术语（例如，奥马哈系统）。我们使用定向内容分析来识别恶化的风险因素。我们使用归纳主题分析来了解 HHC 临床医生对风险因素的反应以及对风险因素的记录。
15 名 HHC 临床医生总共确定了 79 个风险因素，这些风险因素都映射到了标准化术语上。HHC 临床医生最常通过与处方提供者沟通（86.7%的临床医生）或跟进患者和护理人员（86.7%）来应对风险因素。HHC 临床医生表示，大多数风险因素都可以在临床记录中找到（即，护理协调（53.3%）或就诊（46.7%））。
临床医生承认社会因素在恶化风险中起作用，但这些因素在 HHC 中很少被研究。虽然大多数风险因素都在奥马哈系统中有体现，但还需要其他术语来全面捕捉风险。由于大多数风险因素都记录在临床记录中，因此需要使用自然语言处理等方法来提取它们。
本研究让临床医生参与了解 HHC 期间的恶化风险。我们的研究结果支持开发早期预警系统，该系统提供了基于临床医生专业知识并映射到标准化术语的全面风险因素清单。
