A Human Factors Approach to Support Older Chronically Ill Patients' Home Care

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DESCRIPTION (provided by applicant): The proposed research addresses the need to provide information support to older chronic heart failure (CHF) patients and their informal caregivers. Many older patients have unmet information needs related to their home care (self-care) plans, illustrated by knowledge deficits and up to 90% nonadherence to important care activities such as medication-taking, nutrition and sodium restriction, physical activity, and monitoring and responding to symptoms. The health consequences of nonadherence are tremendous and costly. We hypothesize that health information technology (HIT), when designed and evaluated using Human Factors Engineering (HFE) principles and methods, can be useful and usable for older patients and lay caregivers who must manage the complex information needed for successful home care, health, & disease management. This proposal describes how the Principal Investigator (PI) will transition to research independence and a career in aging research, building on his expertise in HFE and HIT and developing additional expertise in the: a) health relevant characteristics of older, chronically ill patients, and b) proess of user-centered HIT design for these patients and their caregivers. The proposal describes a 3-year research project developing and testing an interactive Flight Plan HIT system using the HFE approach. Flight Plan will initially be developed for and tested by older CHF patients to support a broad array of disease-specific and general self-care activities. Research Aim 1 is the Human Factors Analysis - a combination of familiarization with the geriatric CHF domain, interviews, surveys, and in-home observations. The Human Factors Analysis will yield a realistic understanding of future Flight Plan users, their tasks, contexts of use, and needs. This understanding will be critical for evidence based design of Flight Plan. Research Aim 2 is the Design and Usability Testing of a Flight Plan prototype. The prototype will be based on Aim 1 findings and the design team's vision of a patient-centered, patient-controlled, interactive Flight Plan system. The PI's career development activities will ensure that Flight Plan conforms to HFE design principles and is clinically valid. During usability testing, older CHF patients and their lay caregivers will use the Flight Plan prototype under both controlled lab and in situ conditions. Analysis of objective and subjective usability test data will verify the usability and preliminary usefulness of Flight Plan and guide further refinement. Research Aim 3 is the Pilot Test of Flight Plan's effectiveness and user acceptance. The Pilot Test will be a pre-post randomized controlled trial with baseline and 3 months post-intervention measures of health status, CHF knowledge, and CHF self-care behavior. Flight Plan is hypothesized to improve these measures relative to usual care. Flight Plan is expected to have higher HIT acceptance than other patient-facing HIT systems. Future work will include a larger randomized controlled trial to evaluate Flight Plan's effects on older CHF patients' health outcomes as well as extension of Flight Plan to other geriatric chronic disease domains.