The Role of Human Factors in Home Health Care
Steve Olson, Rapporteur
NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES
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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.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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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
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
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
Ethel Percy Andrus Gerontology Center, Davis School of Gerontology, University of Southern California
Robert M. Schumacher,
User Centric, Inc., Oakbrook Terrace, Illinois
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
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
Department of Industrial and Systems Engineering, Center for Quality and Productivity Improvement, University of Wisconsin–Madison
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
Microsoft Research, Redmond, Washington
Department of Industrial Engineering and Management Systems, University of Central Florida
Steven W.J. Kozlowski,
Department of Psychology, Michigan State University
Beckman Institute, University of Illinois
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)
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)
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
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
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.
INFORMAL CAREGIVERS IN THE UNITED STATES: PREVALENCE, CAREGIVER CHARACTERISTICS, AND ABILITY TO PROVIDE CARE
MEDICAL DEVICES IN HOME HEALTH CARE
INFORMATION TECHNOLOGY AND SYSTEMS IN HOME HEALTH CARE
THE PHYSICAL ENVIRONMENT AND HOME HEALTH CARE