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
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.
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)
"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),"
"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
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."
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.