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The Role of Human Factors in Home Health Care: Workshop Summary
The Role of Human Factors in Home Health Care
Workshop Summary
Steve Olson, Rapporteur
Committee on the Role of Human Factors in Home Health Care
Committee on Human-Systems Integration
Division of Behavioral and Social Sciences and Education
NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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The Role of Human Factors in Home Health Care: Workshop Summary
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. HHSP23320042509XI, task order HHSP233200800004T, between the National Academy of Sciences and the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-15629-5
International Standard Book Number-10: 0-309-15629-7
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
Copyright 2010 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Research Council. (2010). The Role of Human Factors in Home Health Care: Workshop Summary. Steve Olson, Rapporteur. Committee on the Role of Human Factors in Home Health Care, Committee on Human-Systems Integration. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
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The Role of Human Factors in Home Health Care: Workshop Summary
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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The Role of Human Factors in Home Health Care: Workshop Summary
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The Role of Human Factors in Home Health Care: Workshop Summary
COMMITTEE ON THE ROLE OF HUMAN FACTORS IN HOME HEALTH CARE
David H. Wegman (Chair),
School of Health and Environment, University of Massachusetts–Lowell
Sara Czaja,
College of Engineering and Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
K. Eric DeJonge,
Washington Hospital Center, Washington, DC
Daryle Jean Gardner-Bonneau,
Bonneau & Associates, Portage, Michigan
Michael Christopher Gibbons,
Johns Hopkins University Urban Health Institute, School of Medicine, and Bloomberg School of Public Health
Laura N. Gitlin,
Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University
Judith Tabolt Matthews,
Department of Health and Community Systems, University of Pittsburgh School of Nursing
Misha Pavel,
Division of Biomedical Engineering, Department of Science and Engineering, Oregon Health and Science University
P. Hunter Peckham,1
Donnell Institute of Biomedical Engineering and Orthopaedics, Case Western Reserve University
Jon Pynoos,
Ethel Percy Andrus Gerontology Center, Davis School of Gerontology, University of Southern California
Robert M. Schumacher,
User Centric, Inc., Oakbrook Terrace, Illinois
Mary Weick-Brady,2
Food and Drug Administration, Rockville, Maryland
Jennifer L. Wolff,
Johns Hopkins University Bloomberg School of Public Health and School of Medicine
Susan B. Van Hemel, Study Director
Barbara Wanchisen, Director, Committee on Human-Systems Integration
Renée L. Wilson Gaines, Senior Program Assistant
1
Resigned from the committee in March 2010.
2
Resigned from the committee in May 2010.
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The Role of Human Factors in Home Health Care: Workshop Summary
COMMITTEE ON HUMAN-SYSTEMS INTEGRATION
William S. Marras1 (Chair),
Institute for Ergonomics, Ohio State University
Deborah A. Boehm-Davis,
Human Factors and Applied Cognition Program, George Mason University
Pascale Carayon,
Department of Industrial and Systems Engineering, Center for Quality and Productivity Improvement, University of Wisconsin–Madison
Don Chaffin,1
Industrial and Operations Engineering and Biomedical Engineering, University of Michigan
Nancy J. Cooke,
Department of Applied Psychology, Arizona State University
Mary (Missy) Cummings,
Department of Aeronautics and Astronautics, Massachusetts Institute of Technology
Jonathan Grudin,
Microsoft Research, Redmond, Washington
Waldemar Karwowski,
Department of Industrial Engineering and Management Systems, University of Central Florida
Steven W.J. Kozlowski,
Department of Psychology, Michigan State University
Arthur Kramer,
Beckman Institute, University of Illinois
Matthew Rizzo,
Department of Neurology, University of Iowa Hospitals and Clinics
Thomas F. Sanquist,
Pacific Northwest National Laboratory, Seattle
Thomas B. Sheridan,1
Massachusetts Institute of Technology (Emeritus)
Philip J. Smith,
Institute for Ergonomics, Ohio State University
David H. Wegman,
University of Massachusetts–Lowell (Emeritus)
Howard Weiss,
Department of Psychological Sciences, Military Family Research Institute, Purdue University
Barbara Wanchisen, Director
Mary Ellen O’Connell, Associate Director
Matthew McDonough, Senior Program Assistant (through December 2009)
Christie R. Jones, Program Associate (from December 2009)
1
Member, National Academy of Engineering.
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The Role of Human Factors in Home Health Care: Workshop Summary
Preface
In the United States, health care devices, technologies, and care practices are rapidly moving into the home. This transition, which is likely to accelerate in the future, has raised a host of issues that have received insufficient attention in the past. Care recipients and caregivers have particular capabilities and limitations that can shape home health care processes and procedures. Very few homes have been designed for the delivery of health care, yet the aging of the population and changes in medical practice and health care reimbursement are leading to greater reliance on care at home. Medical equipment and technologies that are designed for hospitals and clinics can be ill-suited for use in the home. The community environment can support or detract from home health care.
As stated earlier, the rapid growth of home health care has raised many insolved issues and will have consequences that are far too broad for any one group to analyze in their entirety. Yet a major influence on the safety, quality, and effectiveness of home health care will be the set of issues encompassed by the field of human factors research—the discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments. For that reason, the Agency for Healthcare Research and Quality (AHRQ) asked the Committee on Human-Systems Integration of the National Research Council to conduct a wide-ranging investigation of the role of human factors in home health care. In response, the multidisciplinary Committee on the Role of Human Factors in Home Health Care was formed to examine a diverse range of behavioral and human factors issues resulting from the increasing migration of medical devices, technologies, and care practices
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The Role of Human Factors in Home Health Care: Workshop Summary
into the home. Its goal is to lay the groundwork for a thorough integration of human factors research with the design and implementation of home health care devices, technologies, and practices.
As part of its work, the committee conducted a workshop on the role of human factors in home health care on October 1-2, 2009, in Washington, DC. The workshop and this report represent the culmination of the first phase of the study. The second phase will culminate in a consensus report containing the committee’s conclusions and recommendations concerning the best use of human factors in home health care. In addition, the committee is overseeing the preparation of a designers’ guide for the use of health information technologies in home care.
The landmark report To Err Is Human: Building a Safer Health System, published in 2000 by the Institute of Medicine, found that illness, injuries, and other adverse health consequences often result from poor interactions between care recipients and the health care delivery system. By highlighting the importance of human factors in the inpatient hospital setting, that report led to a broad array of reforms aimed at improving the quality of health care delivery.
The committee’s hope is that this workshop report and its consensus report will motivate similar reforms for home health care, even as the terrain of the health care delivery system is undergoing dramatic changes. In the future, individuals will play a greater role in managing their own health care needs and those of their family members at home and in the community. The extent to which human factors research is incorporated into home-based devices, technologies, and practices will have a big influence on whether greater reliance on home health care proves to have beneficial or detrimental effects on people’s lives.
The committee members identified presenters, organized the agenda, introduced presentations, and facilitated discussion, although they did not participate in the writing of this report. This summary reflects their diligent efforts, the excellent presentations by other experts at the workshop, and the insightful comments of the many workshop participants.
The planning efforts of the committee were greatly assisted by the interest and support of Kerm Henriksen, AHRQ human factors advisor for patient safety, and Teresa Zayas-Caban, senior manager, Health IT at AHRQ, which are much appreciated. Henriksen also provided some very helpful introductory remarks and closing comments at the workshop.
The workshop included discussions led by Paul Crawford of Intel, Margaret Quinn of the University of Massachusetts–Lowell, and Carol Raphael of the Visiting Nurse Service of New York. Their contributions are greatly appreciated.
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance
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The Role of Human Factors in Home Health Care: Workshop Summary
with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this report and the attached papers: Jane Behr-Lehman, Steinhardt Department of Occupational Therapy, New York University; Deborah A. Boehm-Davis, Human Factors and Applied Cognition Program, George Mason University; R. Paul Crawford, Product Research and Innovation, Digital Health Group, Intel Corporation; Steven Landers, Center for Home Care and Community Rehabilitation, Cleveland Clinic; Suzanne Mintz, President and Chief Executive Officer, National Family Caregivers Association, Kensington, MD; Marcia Nusgart, Nusgart Consulting, Bethesda, MD; Terrance J. O’Shea, Digital Health Group, Intel Corporation; Denise C. Park, Center for Vital Longevity, University of Texas at Dallas; Richard W. Pew, BBN Technologies, Cambridge, MA; Eduardo Salas, Institute for Simulation and Training, University of Central Florida; Susan Stark, Program of Occupational Therapy, Department of Therapy and Neurology, Washington University School of Medicine; and Bernadette Wright, The Lewin Group, Falls Church, VA.
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report, nor did they see the final draft of the report before its release. The review of this report was overseen by Matthew Rizzo of the University of Iowa. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution.
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The Role of Human Factors in Home Health Care: Workshop Summary
Contents
PART I:
WORKSHOP SUMMARY
1
INTRODUCTION
3
The Role of Human Factors in Home Health Care,
3
Workshop Themes,
6
Organization of the Report,
6
2
THE PEOPLE WHO RECEIVE AND PROVIDE HOME HEALTH CARE
9
Fitting People to Health Care in Their Home Environments,
9
Informal Caregivers: Family, Friends, Others,
13
Formal Caregivers,
19
Discussion,
25
3
HOME HEALTH CARE TASKS AND TOOLS
29
Home Caregiving Tasks,
29
Medical Devices and Equipment,
32
Information Technology,
39
Discussion,
45
4
THE ENVIRONMENTS OF HOME HEALTH CARE
47
The Physical Environment and Home Health Care,
47
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The Role of Human Factors in Home Health Care: Workshop Summary
The Impact of Cultural, Social, and Community Environments on Home Health Care,
53
Finance, Regulation, and Clinical Models,
58
Discussion,
63
5
CONCLUDING DISCUSSION
67
Committee Perspective,
68
Sponsor Perspective,
69
PART II:
WORKSHOP PAPERS
6
THE HEALTH CARE CHALLENGE: MATCHING CARE TO PEOPLE IN THEIR HOME ENVIRONMENTS
Neil Charness
73
The Shift to Home Health Care,
73
The Health Care Environment,
76
The Person-Environment Fit Framework,
77
Demographics of Health Care Users,
82
Perceptual, Cognitive, and Psychomotor Capabilities of Users,
91
User and Provider Attitudes Toward Health Care and Health Care Technology,
95
Examples of Constraints in Technology Use: Handheld Devices,
104
Human Factors Tools for Assessing and Designing Person-Environment Fit,
105
Gaps in Knowledge,
107
Recommendations,
108
About the Author,
110
References,
110
7
INFORMAL CAREGIVERS IN THE UNITED STATES: PREVALENCE, CAREGIVER CHARACTERISTICS, AND ABILITY TO PROVIDE CARE
Richard Schulz and Connie A. Tompkins
117
Dimensions of Informal Caregiving,
118
Roles and Responsibilities of Caregivers,
123
Ability to Provide Care,
129
Looking to the Future,
135
About the Authors,
138
References,
138
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8
MEDICAL DEVICES IN HOME HEALTH CARE
Molly Follette Story
145
Background,
146
Types of Home Health Care Devices,
148
Emergent Technologies in Home Health Care,
151
Human Factors Issues for Home Health Care Devices,
153
Application of Human Factors to Home Health Care Devices,
165
Human Factors Assessment,
166
Future Directions for the Field,
167
Conclusions,
169
About the Author,
170
References,
170
9
INFORMATION TECHNOLOGY AND SYSTEMS IN HOME HEALTH CARE
George Demiris
173
Telehealth Applications for Home-Based Disease Management,
174
Web-Based Communities for Home Care Patients,
177
Personal Health Records,
179
Robotic Applications,
181
Smart Homes,
182
Human Factors Challenges and Considerations,
183
Discussion,
191
About the Author,
195
References,
195
10
THE PHYSICAL ENVIRONMENT AND HOME HEALTH CARE
Jonathan Sanford
201
The Role of the Environment in Independent Living and Home Health Care,
203
Prosthetic Interventions: Home Modifications to Improve Activity Outcomes,
206
Therapeutic Interventions: Technologies to Improve Health Management and Treatment,
215
New Concepts in Housing: Integrating Prosthetic and Therapeutic Interventions in a Home Environment,
217
Barriers to Adoption of Housing Innovation,
221
Policy Changes to Increase Adoption of Housing Innovation,
227
Toward an Agenda for Research on the Physical Environment and Home Health Care,
232
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Conclusions,
237
About the Author,
239
References,
239
11
IMPACT OF CULTURAL, SOCIAL, AND COMMUNITY ENVIRONMENTS ON HOME CARE
Steven M. Albert
247
Home Care and the Social-Ecological Model,
249
The Cultural Context of Home Care,
251
Interpersonal Relationships,
256
Community and Neighborhood Factors,
260
Gaps and Directions for Research,
264
Hypotheses for Future Research,
268
About the Author,
270
References,
270
12
EFFECTS OF POLICY, REIMBURSEMENT, AND REGULATION ON HOME HEALTH CARE
Peter A. Boling
275
The Landscape of Home Health Care,
275
Five Serious Problems of Long-Term Home Health Care,
282
Evidence of Value from Medically Led Home Care Teams,
290
Future Policy Directions,
292
Professional Workforce Development and Other Possible Barriers,
296
About the Author,
299
References,
299
Appendix:
Workshop Agenda and Participants
303
