Leveraging Health Information Technology Effectively for Performance Improvement in Home Health Care

Abstract

Health information technology (IT) becomes a critical tool to support performance improvement initiatives in home health agencies (HHAs) as home care utilization and expenditures increase. However, effectively leveraging health IT for performance im- provement in home care'scomplex setting presents significant challenges. HHAs have limited resources and little directions on how to tackle performance improvement in their context. To date, the area of quality-driven performance improvement in home care is understudied from a health IT adoption perspective. In this research, performance improvement was interpreted from a quality perspective as advocated by major US government agencies and internationally-recognized healthcare leaders. Studying performance improvement and health IT adoption in a care delivery setting requires selecting a specific and meaningful performance improvement problem. This research focused on fall-risk management because it is an issue of high importance that challenges all HHAs in the US. Specifically, this research targeted: (i) Identifying the key performance improvement domains (KPIDs) in home health care consistent with the dimensions of quality suggested by the World Health Organization, (ii) investigating how to achieve performance improvements in the identified KPIDs in home care by responding to the information needs for better decision making and uncovering the problems associated with eliciting, exchanging, and processing information essential for performance improvement, and (iii) exploring how the health IT solutions can be leveraged effectively for performance improvement in home care. Using qualitative research methods, the research started with a series of focus group discussions with key home care leaders to identify the KPIDs. These KPIDs were used as a basis for investigating the subsequent research objectives. After identifying the KPIDs, a descriptive case-study was conducted at one HHA for detailed data collection. The results uncovered the information needs and information management issues for effective performance improvement. The evidence highlighted how the currently adopted health IT solutions supported performance improvement activities, their short- comings, and the ways to improve them. Several opportunities to leverage other health IT solutions for performance improvement were identified. The evidence from this research adds to the current body of evidence about how performance improvement initiatives can be supported by leveraging health IT purpose- fully. Findings can enable HHAs to better understand their challenges, organizations, and industry to effectively leverage health IT in their current and future performance improvement initiatives. The health IT vendors will be better positioned to respond to the specific performance improvement needs and priorities of HHAs. The findings can aid US policymakers with insights for designing future performance improvement programs and aligning health IT adoption incentives. Ultimately, when home care services improve, care quality and health outcomes will improve thereby benefiting patients and caregivers.