Kowalkowski Marc, Eaton Tara, Reeves Kelly W, Kramer Justin, Murphy Stephanie, Hole Colleen, Chou Shih-Hsiung, Aneralla Amanda, McWilliams Andrew
Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States.
Center for Health System Sciences, Atrium Health, Charlotte, NC 28204, United States.
JAMIA Open. 2024 Aug 16;7(3):ooae079. doi: 10.1093/jamiaopen/ooae079. eCollection 2024 Oct.
Hospital at Home (HaH) programs currently lack decision support tools to help efficiently navigate the complex decision-making process surrounding HaH as a care option. We assessed user needs and perspectives to guide early prototyping and co-creation of 4PACS (Partnering Patients and Providers for Personalized Acute Care Selection), a decision support app to help patients make an informed decision when presented with discrete hospitalization options.
From December 2021 to January 2022, we conducted semi-structured interviews via telephone with patients and caregivers recruited from Atrium Health's HaH program and physicians and a nurse with experience referring patients to HaH. Interviews were evaluated using thematic analysis. The findings were synthesized to create illustrative user descriptions to aid 4PACS development.
In total, 12 stakeholders participated (3 patients, 2 caregivers, 7 providers [physicians/nurse]). We identified 4 primary themes: attitudes about HaH; 4PACS app content and information needs; barriers to 4PACS implementation; and facilitators to 4PACS implementation. We characterized 3 user descriptions (one per stakeholder group) to support 4PACS design decisions. User needs included patient selection criteria, clear program details, and descriptions of HaH components to inform care expectations. Implementation barriers included conflict between app recommendations and clinical judgement, inability to adequately represent patient-risk profile, and provider burden. Implementation facilitators included ease of use, auto-populating features, and appropriate health literacy.
The findings indicate important information gaps and user needs to help inform 4PACS design and barriers and facilitators to implementing 4PACS in the decision-making process of choosing between hospital-level care options.
目前，居家医院（HaH）项目缺乏决策支持工具，难以在将HaH作为一种护理选择时，有效引导复杂的决策过程。我们评估了用户需求和观点，以指导4PACS（患者与提供者合作进行个性化急性护理选择）的早期原型设计和共创，4PACS是一款决策支持应用程序，旨在帮助患者在面对不同的住院选择时做出明智的决策。
2021年12月至2022年1月，我们通过电话对从Atrium Health的HaH项目招募的患者和护理人员，以及有将患者转诊至HaH经验的医生和一名护士进行了半结构化访谈。采用主题分析法对访谈进行评估。综合研究结果以创建说明性用户描述，以辅助4PACS的开发。
共有12名利益相关者参与（3名患者、2名护理人员、7名提供者[医生/护士]）。我们确定了4个主要主题：对HaH的态度；4PACS应用程序的内容和信息需求；4PACS实施的障碍；以及4PACS实施的促进因素。我们描述了3种用户描述（每个利益相关者群体一种），以支持4PACS的设计决策。用户需求包括患者选择标准、清晰的项目细节以及HaH组成部分的描述，以告知护理期望。实施障碍包括应用程序建议与临床判断之间的冲突、无法充分体现患者风险概况以及提供者负担。实施促进因素包括易用性、自动填充功能和适当的健康素养。
研究结果表明，在选择医院级护理选项的决策过程中，存在重要的信息差距和用户需求，有助于为4PACS的设计提供信息，以及了解实施4PACS的障碍和促进因素。
