Health Care Comes Home

The Human Factors

Committee on the Role of Human Factors in Home Health Care

Board on Human-Systems Integration

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL
                         OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
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Committee on the Role of Human Factors in Home Health Care Board on Human-Systems Integration Division of Behavioral and Social Sciences and Education

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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 Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate 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. Library of Congress Cataloging-in-Publication Data National Research Council (U.S.). Committee on the Role of Human Factors in Home Health Care. Health care comes home : the human factors / Committee on the Role of Human Factors in Home Health Care, Board on Human-Systems Integration, Division of Behavioral and Social Sciences and Education, National Research Council of the National Academies. p. ; cm. Includes bibliographical references. ISBN 978-0-309-21236-6 (pbk.) — ISBN 978-0-309-21237-3 (pdf) 1. Home care services--United States. 2. Human engineering--United States. 3. Home nursing--United States. I. Title. [DNLM: 1. Home Care Services—United States. 2. Human Engineering— United States. 3. Equipment and Supplies—standards—United States. 4. Health Policy—United States. 5. Home Nursing—United States. WY 115 AA1] RA645.35.N38 2011 362.14—dc22 2011017463 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 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council. (2011). Health Care Comes Home: The Human Factors. Committee on the Role of Human Factors in Home Health Care, Board on Human-Systems Integration, Division of Behavioral and Social Sci- ences and Education. Washington, DC: The National Academies Press.

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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 Acad- emy 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 engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent 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 Insti- tute 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 Sci- ences 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 Coun- cil 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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COMMITTEE ON THE ROLE OF HUMAN FACTORS IN HOME HEALTH CARE David H. Wegman (Chair), Department of Work Environment, University of Massachusetts, Lowell (Emeritus) Sara J. Czaja, Department of Psychiatry and Behavioral Sciences, Center on Aging, 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 Urban Health Institute, Johns Hopkins University Center for Community Health Laura N. Gitlin, Johns Hopkins School of Nursing 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 D. Weick-Brady,2 Food and Drug Administration, Rockville, Maryland Jennifer L. Wolff, School of Public Health and School of Medicine, Johns Hopkins University Mary Ellen O’Connell, Study Director (from September 2010) Molly Follette Story, Study Director (from April 2010 through September 2010) Susan B. Van Hemel, Study Director (through March 2010) Julie Schuck, Research Associate (from September 2010) Kristina Krasnov, Program Officer (from April 2010 through December 2010) Renée L. Wilson Gaines, Senior Program Assistant 1 Resigned from the committee in March 2010. 2 Resigned from the committee in April 2010. v

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BOARD ON HUMAN-SYSTEMS INTEGRATION William S. Marras (Chair), Integrated Systems Engineering Department, Ohio State University Pascale Carayon, Department of Industrial and Systems Engineering, Center for Quality and Productivity Improvement, University of Wisconsin–Madison Don Chaffin, Industrial and Operations Engineering and Biomedical Engineering, University of Michigan (Emeritus) Nancy J. Cooke, Cognitive Science and Engineering, Arizona State University Mary (Missy) Cummings, Humans and Automation Laboratory and Department of Aeronautics and Astronautics, Massachusetts Institute of Technology Sara J. Czaja, Department of Psychiatry and Behavioral Sciences, Center on Aging, University of Miami Miller School of Medicine Andrew S. Imada, A.S. Imada and Associates Waldemar Karwowski, Department of Industrial Engineering and Management Systems, University of Central Florida David Rempel, Department of Medicine, University of California, San Francisco Matthew Rizzo, Department of Neurology, Mechanical and Industrial Engineering, and the Public Policy Center, University of Iowa Thomas B. Sheridan,1 Departments of Mechanical Engineering and of Aeronautics-Astronautics, Massachusetts Institute of Technology (Emeritus) David H. Wegman, Department of Work Environment, University of Massachusetts, Lowell (Emeritus) Howard M. Weiss, Department of Psychological Sciences, Purdue University Barbara Wanchisen, Director Mary Ellen O’Connell, Deputy Director Matthew McDonough, Senior Program Assistant (through December 2009) Christie R. Jones, Program Associate (from December 2009) 1 Resigned from the committee in April 2010. vi

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Preface In the United States, health care devices, technologies, and care prac- tices 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 insuf- ficient 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. The rapid growth of home health care has 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 capabili- ties 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 then-Committee on Human-Systems Integra- tion of the National Research Council (NRC) 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 into the home. Its goal is to lay vii

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viii PREFACE the groundwork for a thorough integration of human factors research with the design and implementation of home health care devices, technologies, and practices. The planning and conceptual 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. 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 committee would like to thank the many people who contributed to the workshop, in particular the many experts who provided presenta- tions or wrote papers: Neil Charness of Florida State University, Richard Schulz of the University of Pittsburgh, independent consultant Carolyn Humphrey, Colin Drury of the State University of New York at Buffalo, Molly Follette Story of Human Spectrum Design, George Demiris of the University of Washington, Jon Sanford of the Georgia Institute of Technol- ogy, Steven Albert of the University of Pittsburgh, and Peter Boling of the Medical College of Virginia Hospital. The workshop included discussions led by Margaret Quinn of the University of Massachusetts at Lowell, R. Paul Crawford of Intel Corporation, and Carol Raphael of the Visiting Nurse Service of New York. Their contributions are greatly appreciated, as are the insightful comments of the many workshop attendees. Lastly, the committee is greatly indebted to the NRC staff. Throughout its work the committee depended heavily on the high quality intellectual and administrative skills of the staff under the direction, first of Susan Van Hemel and then Molly Follette Story. Committee work was further enhanced through the process of review and final revision by the experience, wisdom, and careful attention to detail provided by Mary Ellen O’Connell assisted by Julie Schuck. The workshop and its report, The Role of Human Factors in Home Health Care: Workshop Summary, represented the culmination of the first phase of the study, and this report, which contains the committee’s con- clusions and recommendations concerning the best use of human factors in home health care, is the product of the second phase. In addition, the committee oversaw preparation of a designers’ guide for the use of health information technologies in home-based health care. The landmark report, To Err Is Human: Building a Safer Health Sys- tem, 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 the preceding workshop report and this

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ix PREFACE report will motivate similar reforms for home health care, even as the ter- rain 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 com- munity. 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. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical com- ments 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 study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Ruzena Bajcsy, College of Engineering, Electri- cal Engineering and Computer Sciences, University of California, Berkeley; David W. Bates, General Medicine Division, Brigham and Women’s Hos- pital, Boston, Massachusetts; Mary A. Blegen, Center for Patient Safety School of Nursing, University of California, San Francisco; Victor Paquet, Department of Industrial and Systems Engineering, University at Buffalo, State University of New York; Marcia J. Scherer, Institute for Matching Person & Technology, Webster, New York; Howard D. Wactlar, School of Computer Science, Carnegie Mellon University, and Directorate for Com- puter & Information Science & Engineering, Division of Information and Intelligent Systems), National Science Foundation; Marlyn S. Woo, School of Nursing, University of California, Los Angeles; and David D. Woods, Institute for Ergonomics, Ohio State University. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Matthew Rizzo, Division of Neuroergonomics/Department of Neurology, Industrial Engineering, and Public Policy, University of Iowa. Appointed by the NRC, he was respon- sible 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 authoring committee and the institution.

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Contents SUMMARY 1 1 INTRODUCTION 9 2 PEOPLE INVOLVED IN HEALTH CARE IN THE HOME 19 3 WHAT IS HUMAN FACTORS? 61 4 HEALTH CARE TASKS 75 5 HEALTH CARE TECHNOLOGIES IN THE HOME 103 6 THE HOME ENVIRONMENT 141 7 CONCLUSIONS AND RECOMMENDATIONS 167 APPENDIX: Biographical Sketches of Committee Members and Staff 181 xi

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