Home/in-clinic patient oriented workflow (HiPOW): Toward integrated care delivery

University Of Colorado Denver, Aurora CO

Investigators

Linked publications & trials

Abstract

? DESCRIPTION (provided by applicant): Management of chronic health conditions involves activities that take place in both formal healthcare settings (e.g., clinics and hospitals) and informal settings (i.e., daily-living environments). Improving management of chronic health problems through systematic interventions such as health IT requires an understanding of how care management activities are performed across settings and the ways in which they are currently well-integrated (and could be supported by health IT) and are not well-integrated (which could be improved through health IT solutions). Such understanding can be achieved by systematically capturing and codifying workflow across settings. This purpose will be accomplished through two specific aims: (1) To characterize patient-oriented workflow by highlighting the process components and contextual components associated with care for chronic conditions, (2) Identify the potential disconnect between (a) care delivery activities in te clinical setting that are intended to provide/shape extra-clinical healthcare regimens and (b) activities that take place outside the clinical (i.e., daily living) setting. This study takes the workflow approach and makes it a patient-oriented workflow approach-this expands workflow examination beyond the formal workplace and incorporates the daily-living environment, yielding an integrated depiction of chronic condition management. This qualitative study includes four complementary data-collection steps: (1) patient primary interviews, (2) patient journaling using tablet computers, (3) patient exit interviews, (4) provider interviews. These data sources will allow us to characterize patient-oriented workflow, using the test case of anticoagulation treatment. Our approach will also reveal incongruities in patient-oriented workflow-i.e., when (a) clinic-based activities fail to shape daily living-based activities and (b) daily living- based activities do not inform clinic-based activities. Characterizing workflow across settings and identifying incongruities can inform the design and implementation of health IT interventions that will improve health outcomes. This study will contribute to the growing understanding of workflow in health care settings as a foundation for health IT design. The unique contribution will be to understand flows across two distinct loci of health care.