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Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study
  1. Alicia I Arbaje1,2,3,
  2. Ashley Hughes1,
  3. Nicole Werner4,5,
  4. Kimberly Carl6,
  5. Dawn Hohl6,
  6. Kate Jones7,
  7. Kathryn H Bowles8,9,
  8. Kitty Chan10,
  9. Bruce Leff1,11,12,
  10. Ayse P Gurses2,11
  1. 1 Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3 Department of Clinical Investigation, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4 Department of Industrial and Systems Engineering, University Of Wisconsin Colleges, Madison, Wisconsin, USA
  5. 5 Department of Geriatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  6. 6 Johns Hopkins Home Care Group, Baltimore, Maryland, USA
  7. 7 College of Nursing, University of South Carolina, Columbia, South Carolina, USA
  8. 8 Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  9. 9 Center for Home Care Policy and Research, Visiting Nurse Services of New York, New York, New York, USA
  10. 10 MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
  11. 11 Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  12. 12 Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
  1. Correspondence to Dr Alicia I Arbaje, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MA 21224, USA; aarbaje{at}


Background Middle-aged and older adults requiring skilled home healthcare (‘home health’) services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition.

Objectives (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers’ perspectives and (2) Identify IM-related process failures.

Methods Multisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams.

Results We identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults’ and informal caregivers’ mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information).

Conclusions IM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions.

  • human factors
  • patient safety
  • transitions in care
  • nurses
  • qualitative research

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  • Contributors AIA had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: AIA, APG, BL. Acquisition of subjects and data: ALA, KHB, KC, DH, AH, KJ, BL, NW. Data analysis and interpretation: ALA, KC, KHB, AH, BL, APG, NW. Preparation of manuscript: AIA, AH, BL, KJ, APG. Review and revision of manuscript: AIA, AH, KC, DH, KJ, KHB, KC, BL, APG, NW.

  • Funding This study was funded by Johns Hopkins Clinical Research Scholar grant (grant number: KL2TR001077), National Patient Safety Foundation and Agency for Healthcare Research and Quality (1K08HS022916).

  • Disclaimer AIA affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Johns Hopkins University School of Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.