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Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
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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

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Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
×

THE NATIONAL ACADEMIES PRESS
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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.

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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.

Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
×

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

Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
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Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
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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.

Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
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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.

Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
×

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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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

Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
×

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.

Suggested Citation:"Front Matter." National Research Council. 2010. The Role of Human Factors in Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12927.
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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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The rapid growth of home health care has raised many unsolved 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.

To address these challenges, the National Research Council began a multidisciplinary study 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 the groundwork for a thorough integration of human factors research with the design and implementation of home health care devices, technologies, and practices.

On October 1 and 2, 2009, a group of human factors and other experts met to consider a diverse range of behavioral and human factors issues associated with the increasing migration of medical devices, technologies, and care practices into the home. This book is a summary of that workshop, representing the culmination of the first phase of the study.

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