Devices & Technology

Aurora Health Care Targets Home Care for Cardiac Patients


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The Components of HeartCare II

The technology-enhanced nursing practice (TEP) will include four principal parts:

  1. Information: Patients and nurses will have access to selected commercially available tools.

  2. Communication: Three key tactics will be employed. Two-way patient-to-nurse secure messaging will be provided so each can send the other non-urgent email messages. The impact of this type of communication on nurse and patient communication will be carefully studied.

    Patient-to-patient communication through a study-specific bulletin board will help patients learn about and normalize their condition from others who have the similar conditions. These types of electronic support groups have been shown to improve the patient's quality of life.

    Nurse-to-nurse communication through study-specific bulletin boards, moderated by nurse and computer specialists, will help nurses learn to integrate the components of technology-enhanced practice into their workflow.

  3. Self-monitoring Tools and Decision Support: Available on a secure Web site, patients will be prompted to answer questions or fill in measurements into databases. Based on the patients' responses and algorithmic rules, patients will then see screens that will either reassure patients that they are managing their CHF well, or they will see screens asking further questions or showing specific action plans. These self-monitoring tools are modeled off of currently available paper-based best-practice guidelines. Trackers are being built to graphically display weight, sodium, fluid, activity, blood pressure, pulse and temperature data.

  4. Health Records Access: Through secure messaging, nurses will be able to share with patients the results of medical records after clarifying release of that information with the primary care provider.

By Suzi Birz, Principal, HiQ Analytics

"Patients and families who need to learn to manage the patient's chronic illness at home say it's like having a part-time job until they learn to use all of the information, people and tools they have available to them," said Laura J. Burke, RN, Ph.D., FAAN, associate director of clinical research support at Aurora Health Care in Milwaukee, Wisconsin.

"Right now, they use homemade personal health records, like yellow sticky notes, calendars, boxes or just stacks of papers to help them track important health information. They learn when they need to act on their symptoms based on knowledge they are given or through trial-and-error," she added.

Burke explained that some patients need skilled home nursing care to help them through this process.

"Home care nurses have a specific objective: to promote self-management by coaching patients to understand themselves and the resources available for self-management. The nurses have a finite number of visits that they can schedule at their discretion to help the patients achieve these goals," she said. "Home care nurses and patients can use new tools to improve self-management. However, these tools are most effective when they've been mutually designed by the patients and nurses who will use them, not just computer and health care experts."

With this in mind, Burke and Patricia Brennan, RN, Ph.D., FAAN, professor of nursing at University of Wisconsin-Madison, have secured a $1.7 million grant from the National Institutes of Health for a research study that will provide nurses and patients with congestive heart failure (CHF) the ability to be involved in the design and use of a Web site to help them set goals and find information for self-management of the patient's condition. The site will also improve communication, make outcome data available to patient or family members and focus their decision-making in one place.

Project Design

The two-phase study, called HeartCare II, targets home care nurses from the Aurora Visiting Nurse Association of Wisconsin and the patients with CHF that are assigned to them.

Phase I: Work Analysis and Technology-Enhanced Practice (TEP) Development

"In the first phase, we have work analysis specialists riding along with the nurses to see how they currently do their work, what tools they use and what tools they wish they had," Burke said.

According to Brennan, that information is then given to work redesign specialists who work with groups of nurses to clarify how they could design the workflow and current tools differently to incorporate the use of technology tools to enhance nursing practice.

"This practice will be called technology-enhanced practice (TEP)," Brennan said.

"Patients and nurses get excited when you ask them what they are doing and ask them what they want in a new system," Burke added. She encourages designers to do this type of querying to design systems that people truly use.

Simultaneously, work continues on refining an already award-winning secure Web site, My Aurora, which will be used to provide the structure for the new site.

"Additionally, based on the work analysis, we now know what is actually going on in home care nursing practice," Burke said. "There is an opportunity to 'close the gap' between actual and evidence-based practice guidelines for managing the home care of the CHF patient. Content and self-management tools from these best practice guidelines are being integrated into My Aurora and will support TEP."

Phase II: A Field Experiment

In the second phase, a randomized clinical trial will measure three outcome variables related to the patients: patient satisfaction with care, patient self-management of CHF and decreased number and/or severity of hospital admissions. Patients and Aurora visiting nurses will be trained on the use of the technology tools and how to integrate them into the self-management and nursing practices in half of the practice offices. The remaining half of the practice offices will continue to deliver standard of care, and the patients cared for by nurses in those offices will continue to have access to best practice guidelines and resources in paper form.

The design phase for the project is well underway. Patient recruitment will begin in May 2005 and continue for 18 months. The study plan calls for 200 patients to be enrolled in the TEP group and 200 patients in the control group. Each patient will be enrolled for six months.

Plans for the Future

According to Burke, this study will create a prototype for home care nursing support for other chronic diseases as well.

"There are a number of devices and technologies that could be integrated into nursing and self-management practice, such as PDAs, emergency response systems and bar-coded scanners built into kitchen appliances to provide nutritional information on products used in food preparation," she said.

"To improve self-management, the goal is to provide self-management information when and where patients want to have access to it and assure that patients actually use the information to make good decisions to manage their health."

Resources

Organizations Involved in the Study:

School of Nursing, University of Wisconsin-Madison

College of Engineering, University of Wisconsin-Madison

Aurora Visiting Nurse Association of Wisconsin, Aurora Health Care

© 2005. AMN Healthcare, Inc. All Rights Reserved.

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