Principal Investigator/Program Director (Last, First, Middle): / Brennan, Patricia Flatley

PROGRESS REPORT SUMMARY

/ GRANT NUMBER
R01 LM006249
PERIOD COVERED BY THIS REPORT
PRINCIPAL INVESTIGATOR OR PROGRAM DIRECTOR
Brennan, Patricia Flatley / FROM
05/15/04 / THROUGH
4/30/05
APPLICANT ORGANIZATION
Board of Regents of the University of Wisconsin System
TITLE OF PROJECT (Repeat title shown in Item 1 on first page)
Custom Computer Support: Home Care of CABG Patients (II CHF)
A. Human Subjects (Complete Item 6 on the Face Page)
Involvement of Human Subjects / X No Change Since Previous Submission
B. Vertebrate Animals (Complete Item 7 on the Face Page)
Use of Vertebrate Animals / X No Change Since Previous Submission
SEE PHS 2590 INSTRUCTIONS.
WOMEN AND MINORITY INCLUSION: See PHS 398 Instructions. Use Inclusion Enrollment Report Format Page and, if necessary, Targeted/Planned Enrollment Format Page.
Question 1: Changes in Other Support: The following key personnel have changes in Other Support (Other Support summary/explanation and detailed information sheets attached): Brennan, Brown, Burke, Carayon, Karsh.
Question 2: Changes in Effort Level: No change.
Question 3: Outstanding unobligated balance: The estimated unobligated balance for Year 2 (including Year 1 carryover) is not expected to exceed 25% of the annual budget.
Progress Report Summary:
a.Specific Aims as actually funded:
The purpose of this competing continuation is to work with Aurora Health Care Systems to expand our previously successful WWW-based information and communication network, HeartCare, from a patient-targeted home-care service to a technology-enhanced-practice (TEP) that augments the clinical care provided by home care nurses with electronic information and communication resources, and to conduct a randomized field experiment with 400 patients of Aurora’s Visiting Nurse Association (VNA) to demonstrate and evaluate the impact of the TEP.
b.Studies and Results
At the time of this report we are completing the first year of this project, the design year for the TEP intervention and experiment. We are using human factors engineering design strategies to alter the original HeartCare service with functions deemed necessary to support the home care of patients with heart failure, providing patients and nurses with relevant information and engaging patients in active self-monitoring and self-management. We conducted a Work Analysis of the home care nurses’ practice that identified aspects of the practice that could be enhanced by technology and characterized aspects of the clinical situation likely to be altered by the introduction of consumer health informatics tools. The team design engineers, investigators, and Aurora’s expert cardiac nurses used the results of the work analysis to design a suite of electronic services including communication, personal health records, and educational materials integrating Aurora’s evidenced-based heart failure protocols. The engineers, investigators, nurses, and consumers are assessing and prioritizing the electronic services suite as it is integrated into Aurora’s on-line patient and care-provider

PHS 2590 (Rev. 09/04)Page Form Page 5

Brennan, Patricia F. Progress Report Summary Continuation Page

Grant No. R01 LM006249 Custom Computer Support: Home Care of CABG Patients (II CHF)

b.Studies and Results (continued)

Tool, “My Aurora.” We are building a process through which the TEP nurses will use local “practical” knowledge to plan how they will implement the TEP intervention into their practice. At the time of this report we are developing plans for usability testing and training on the TEP for the TEP nurse group. To equalize attention for the control group, electronic copies of nursing references or guidelines and bulletin board services will be installed on their laptops. Additional online or in-person technology training will be provided to both groups. We have identified preliminary designs for randomization of nurse care teams and recruitment of patients for the experimental and control groups, experimental instruments and measures. At this writing we continue to refine these plans to conform to both experimental objectives and changing work processes at the VNA. We anticipate beginning the experiment as planned at the beginning of May 2005.

We have evaluated a range of technologies for the patients’ in-home use, and have tentatively selected a thin-client with dialup modem solution to be provided by Paragon Design Systems, Oconomowoc, WI.

c.Significance

With a national drive underway for full deployment of electronic medical records, design and implementation of a technology to support patients and nurses is exploring and demonstrating needs for, and uses of, electronic health information beyond institution-driven administrative record keeping. This project will also model the interaction of two arms of health information development, consumer and professional health tools, which have historically proceeded independently. The Work Analysis process has delineated the specific context in which consumer and professional nurse health information tools will be employed here, and a model for developing context-specific technology interventions. The PI and co-PI of the project delivered testimony to the NCVHS on January 5, 2005, on professional nursing needs for patient-involved electronic health records, based in part on results of the Work Analysis portion of this study. The TEP design process now under way with input from patients and nurses will further develop a model for using engineering practices to incorporate contextual factors in the design of these tools.

d.Plans

We plan to engage 400 patients and 20 care teams in a randomized field experiment. Key outcome variables will include patient satisfaction with care, patient self-management, and 30-day readmission rate. We are currently developing the experiment plan in conformance with both the experimental objectives and the organizational realities of the VNA. Women and Minority Inclusion: The attached table shows the gender and racial and ethnic makeup of the nurse population recruited as participants in the Work Analysis and TEP design phases of the project. We will include women and minorities in the nurse participant and patient sample groups for the experiment.

e.Publications

Brennan, P. & Burke, L. Health@Home: Personal Health Records in Support of Home Care Nursing. Testimony to the National Committee on Vital and Health Statistics (NCVHS) of the U.S. Department of Health & Human Services, Workgroup on National Health Information Infrastructure, Hearings on Personal Health Record (PHR), January 5-6, 2005. Transcript: presentation:

Sebern, M., Casper, G., Burke, L., & Paulsen, J. (2005).Translating Home Health Care Nursing Practice into Technology Enhanced Practice. Abstract submitted for research conference.

Publications are in preparation on the TEP design process (combining healthcare and human factors perspectives), work analysis process and results, on assessment of technologies in nursing practice, and on integrating consumer health informatics with nursing practice.

f.Project-Generated Resources: Brennan and Burke’s NCVHS presentation and other project resources will be posted as they become available, at

INCLUSION TABLE*

Principal Investigator/Project Director……….Brennan, Patricia Flatley

(Last, First, Middle)

Grant Number (if known): ……………………R01 LM006249

STUDY TITLE:………Custom Computer Support: Home Care of CABG Patients (II CHF)

Total Enrollment: 14 Protocol Number: UW # 1998-229

American
Indian or
Alaskan Native / Asian or
Pacific Islander / Black, not of
Hispanic Origin / Hispanic / White, not of
Hispanic Origin / Other or
Unknown / Total
Female / 7 (observation)
2 (phone interview) / 4 (phone interview) / 13
Male / 1 (observation) / 1
Unknown
Total / 10 / 4 / 14

*Note: The original proposal for the current grant for this project was submitted to NIH on June 27, 2001. We are using the pre-2002 inclusion report format to estimate racial and ethnic information for nurse participants in the Work Analysis and TEP design phases. When participant recruitment begins for the experimental phase of the project in project year 2, we will use data collection instruments that comply with the NIH Policy on Reporting Race and Ethnicity Data for Subjects in Clinical Research effective January 10, 2002.

HeartCare 2 Year 1 Progress Report

Appendix 2Sebern et al. Abstract