HeartCare II: CHF

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HeartCare II CHF
Patricia Flatley Brennan, RN, Ph.D., FAANLaura
J. Burke, R.N., Ph.D., FAANPascale Carayon,
Ph.D.Ben Tzion Karsh, Ph.D.Margaret Sebern, RN,
Ph.D.Michael J. Smith, Ph.D.Roger Brown, Ph.D.
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Who Are the Study Team Members?(Right to Left)

• Patricia Brennan, RN, PhD, FAAN
• 15 years exp. evaluating impact of computer
  network-delivered services on clinical and
  functional outcomes of ill persons and families
• Laura Burke, RN, PhD, FAAN
• 11 years exp. as cardiac CNS and 11 years exp. as
  a health systems researcher for the Aurora
  system
• Marge Sebern, RN, PhD
• 7 years exp. in nursing education, 20 years exp.
  in home health care as a researcher,
  administrator, and rehabilitation CNS

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Who Are the Study Team Members?(Left to Right,
Top to Bottom)

• Pascale Carayon, PhD
• BenTzion Karsh, PhD
• Michael J. Smith, PhD
• Experts in studying human and organizational
  impact of information technology in health care
  and offices
• Roger Brown, PhD
• Expert statistician

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Study Background 1985-1992, Brennan,
ComputerLink

• Outcomes
• Reduced social isolation
• Decreased depression
• Improved confidence in decision-making
• Caregivers study
• Demonstrated that elders w/ complex health
  problems can/will use computers in the home

• Pre-WWW computer networks provided patient access
  to
• Information
• Communication
• Nurse-to-patient
• Patient-to-patient
• Decision Support
• Patient populations
• Persons living with AIDS (n60)
• Caregivers of Alzheimers Disease patients
  (n102)

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Study Background HeartCare I-CABG Recovery

• Used WWW, Web TVs
• Provided sequenced, tailored information and
  communication utilities to pts post CABG
• 6-month experiment
• Usual care (n32), audiotape care (n53),
  HeartCare (n54)

• 2,613 accesses to HeartCare
• Accesses decreased over time
• Most accesses during first 7 days
• Four patterns of use identified
• Pts. w/ access to web-based coaching
  information resources
• Recovered faster
• Fewer symptoms
• Less bothered by symptoms
• Less depression
• Less negative mood state

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Study Aims

• Conduct a work analysis of the VNA nurses
  practice using industrial engineering techniques
  to
• Identify aspects of the practice that could be
  enhanced by technology
• Better characterize aspects of the clinical
  situation likely to be altered by the
  introduction of consumer health informatics tools
• Design a suite of electronic services
  (communication, personal health records,
  educational materials) that support Auroras
  evidence-based CHF protocols for VNA.

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Study Aims

• Plan with VNA nurses, using local practical
  knowledge, how to implement Technology-Enhanced
  Practice (TEP).
• Conduct a randomized field experiment of 400
  patients assigned to 20 care teams.

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Study Design Methods Phase I (Aspect1) Work
Analysis/TEP Design

• Patient Information
• Will be informed during scheduling of first visit
  that nurse may have ride-along visitor
• Will be told purpose and asked if visitor can
  come into home
• Can opt to not have visitor come into home

• Nurse Information
• Informational meetings being scheduled for August
• 10 volunteers in Metro and/or South needed for
  ride-along observation
• Will be asked questions for clarification
• Data will be collected on Job Analysis Form
• Data will be de-identified and kept confidential
• Paid time from VNA

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Study Design Methods Phase I (Aspect 2)
Work Analysis/TEP Design

• Design of TEP
• 20-30 TEP care team nurses included
• Series of design activities led by industrial
  engineers/ nurses via feedback sessions
• Create TEP by integrating Aurora CHF care
  management tools with consumer health informatics
  tools
• Paid time from VNA

• Identification of Care Teams from Metro/South
• Teams randomly assigned to TEP or control group

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Winona Health Online (using IQ Health)An
Example of Consumer Health Information
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Winona Health Online (using IQ Health)An
Example of Consumer Health Information
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Winona Health Online (using IQ Health)An
Example of Consumer Health Information
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Study Design Methods Phase I(3) Work
Analysis/TEP Design

• Nurse Usability Testing (1)
• 3 nurse volunteers from TEP care teams selected
  by research team and VNA management, based on
  ability to provide thoughtful critique of system
• See demo and use HeartCare II CHF software for
  30 minutes
• Complete QUIS survey on computer usage,
  interviews
• Paid hourly wage by grant
• Based on comments, TEP care team materials
  (including CHF care management materials) will be
  revised.

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Study Design Methods Phase I(3) Work
Analysis/TEP Design

• Patient Usability Testing (2)
• 3 patients solicited from caseloads of TEP nurse
  volunteers, based on ability to provide
  thoughtful critique of system
• See demo and use HeartCare II CHF software for
  30 minutes
• Complete QUIS survey on computer usage,
  interviews
• Paid time 10/hour x 2 hours from grant

• Nurse Usability Testing (2)
• 3 different nurse volunteers from TEP care teams
  selected by research team and VNA management,
  based on ability to provide thoughtful critique
  of system
• See demo and use HeartCare II CHF software for
  30 minutes
• Complete QUIS survey on computer usage,
  interviews
• Paid hourly wage by grant

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Study Design Methods Phase I(Aspect 4) Work
Analysis/TEP Design

• HeartCare II CHF Training Module and Refresher
  Training Module Developed
• Research team members
• Marge Sebern, RN, PhD
• Gail Casper, RN, PhD
• Laura Burke, RN, PhD
• Consultants
• Joann Paulsen, RN
• Mary Hook, RN
• Al Klewin, RPh
• Mike Jaeger, MD
• Mike Gorzynski, MD
• CHF Care Management Team

• Nurse Training Module Development
• 5 volunteers selected by research team and VNA
  administration based on ability to provide
  thoughtful critique
• Complete training
• Participate in interviews
• Paid hourly wage by grant

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Study Design Methods Phase I(Aspect 5) Work
Analysis/TEP Design

If nurses choose to not participate in TEP care
teams, VNA management will make every effort to
transfer to a position delivering standard of
care.

• HeartCare II CHF Training Module
• Face-to-face training
• All nurses on TEP care teams will complete
  training
• Paid time by VNA
• HeartCareII CHF Refresher Training Module
• Web-based training
• Paid time by VNA

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Study Design Methods Phase 2(Aspect 6) Work
Analysis/TEP Design

• Eligibility Criteria
• Primary or secondary diagnosis of CHF, admitted
  to VNA service
• Clinically stable
• Able to read, speak, write English
• Live within 100 mile radius of Milwaukee
• Have a working phone line
• OASIS Cognitive Status (M0560) alert or requires
  some prompting
• OASIS Vision Status (M0390) normal vision
• Does not require continuous in-home professional
  care

• Randomized Field Experiment
• 10 TEP care teams, 200 patients (20 patients per
  care team)
• 10 standard care teams, 200 patients (20 patients
  per care team)
• 18 months allowed for subject recruitment
• Each patient is enrolled for 6 months
• Patients receive care according to care team
  assignment, but can decline study participation

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Study Design Methods Phase 2(Aspect 6) Work
Analysis/TEP Design

• Nurses determine care practices
• , frequency of visits
• Involvement of other team members
• Patient provided with computer access to
  HeartCare II CHF
• Patient can keep technology at end of study, but
  have to pay for own ISP support after study
• Computers can be removed at our cost if not
  wanted to keep
• Patients on VNA service for usual time, but in
  study for 6 mo
• Patients receive 60 in cash at the end of the 6
  months

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Patient Measurement Plan Timing
Base- line Week 1 Week 4 Week 8 or DC Week 12 Week 24
About You (Demographic Data) X
Self-Management of CHF X X X X X X
Clinical Status X X X X X
Use of Health Care Services X X X X X
Quality of Life X X X X X
Satisfaction with Care X X X X
QUIS (Software Evaluation Survey) X X X X X
Information Needs Assessment X
Technology Assessment X
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So What Does this Mean for Managers?

• Support overall project discussions at staff
  meetings
• Encourage staff to volunteer for Design/Testing
  opportunities

• Be available to answer questions as
  organizational systems are put into place

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So What Does this Mean for Staff?

• Opportunity to design technology-enhanced nursing
  practice
• Opportunity to test interventions for
  effectiveness
• Opportunity to improve patient outcomes

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Questions?