Appl Clin Inform 2016; 07(02): 211-226
DOI: 10.4338/ACI-2015-11-RA-0160
Research Article H3IT Special Topic
Schattauer GmbH

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

Dari Alhuwail
1   Department of Information Systems, University of Maryland, Baltimore County
Güneş Koru
1   Department of Information Systems, University of Maryland, Baltimore County
› Author Affiliations
We would like to acknowledge the tremendous help and support from the Maryland Health Care Commission (MHCC) and the Maryland-National Capital Homecare Association (MNCHA).
Further Information

Publication History

received: 22 November 2015

accepted: 26 January 2016

Publication Date:
16 December 2017 (online)



To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions.


A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians.


Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management.


The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks.

  • References

  • 1 Centers for Medicare and Medicaid Services. Medicare & Medicaid statistical supplement. Office of Information Products and Data Analysis. 2013
  • 2 Centers for Medicare and Medicaid Services. Home health care: What it is and what to expect [Internet]. 2014 [cited 2015-11-1]. Available from:
  • 3 Evashwick C. Creating the continuum of care. Health matrix 1989; 07 (01) 30-39.
  • 4 Fishman EZ, Penrod JD, Vladeck BC. Medicare home health utilization in context. Health services research 2003; 38 (1p1): 107-112.
  • 5 McNabney MK, Willging PR, Fried LP, Durso SC. The “continuum of care” for older adults: Design and evaluation of an educational series. Journal of the American Geriatrics Society 2009; 57 (06) 1088-1095.
  • 6 Jarousse LA. The future of care. Part II: The continuum of care. Hosp Health Netw. 2010 May; 84. (05).
  • 7 Hughes SL, Ulasevich A, Weaver FM, Henderson W, Manheim L, Kubal JD, Bonarigo F. Impact of home care on hospital days: A meta analysis. Health Serv Res 1997; 32 (04) 415-432.
  • 8 Centers for Medicare and Medicaid Services. What’s Medicare?. 2015 [cited 2015-12-31]. Available from:
  • 9 Centers for Medicare and Medicaid Services. CMS announces payment changes for Medicare home health agencies for 2015. 2014 [cited 2015-12-31]. Available from: leasedatabase/fact-sheets/2014-fact-sheets-items/2014-10-30.html
  • 10 Bureau UC. An Aging Nation: The Older Population in the United States. 2015 Available from:
  • 11 Centers for Medicare and Medicaid Services. National health expenditure projections; 2012 [cited 2015-12-31]. Available from:
  • 12 Lichtenberg FR. Is home health care a substitute for hospital care?. Home Health Care Serv Q 2012; 31 (01) 84-109.
  • 13 Pigott HE, Trott L. Translating research into practice: The implementation of an in-home crisis intervention triage and treatment service in the private sector. Am J Med Qual 1993; 08 (03) 138-144.
  • 14 Centers for Medicare and Medicaid Services. Potentially avoidable event measures (PAE): OASIS-C based Home Health Agency Patient Outcome, Process and Potentially Avoidable Event Reports; 2015 [cited 2015-12-31]. Available from: https://www.cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/09aa_hhareports.html
  • 15 Courtney MD, Edwards HE, Chang AM, Parker AW, Finlayson K, Hamilton K. A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol. BMC Health Services Research 2011; 11: 202.
  • 16 Taylor JA, Parmelee P, Brown H, Ouslander J. The falls management program: A quality improvement initiative for nursing facilities. 2005 290-00-0011.
  • 17 Stevens JA, Noonan RK, Rubenstein LZ. Older adult fall prevention: Perceptions, beliefs, and behaviors. American Journal of Lifestyle Medicine 2010; 04 (01) 16-20.
  • 18 Stevens J. A CDC compendium of effective fall interventions: What works for community-dwelling older adults. 3rd ed.. Atlanta, GA: Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Division of Unintentional Injury Prevention; 2015
  • 19 Yin RK. Case study research: Design and methods. Los Angeles, CA: SAGE Publications; 2014
  • 20 Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG. Analysing qualitative data. Routledge; 1994: 173-194
  • 21 Kitzinger J. Qualitative research: Introducing focus groups. British Medical Journal 1995; 311 (7000) 299-302.
  • 22 Parsons M, Greenwood J. A guide to the use of focus groups in health care research: Part 1.m Contemporary nurse. 2000; 09 (02) 169-180.
  • 23 Creswell J. Data collection. In: Creswell J. Qualitative inquiry and research design: Choosing among five approaches. 2nd ed.. Thousand Oaks, CA: SAGE Publications; 2007: 125-129
  • 24 Jorgensen DL. Participant observation: a methodology for human studies. Thousand Oaks, CA: SAGE Publications; 1989
  • 25 Kawulich BB. Participant observation as a data collection method. Forum: Qualitative Social Research; 2005. 06(2)
  • 26 DeWalt KM, DeWalt BR. Participant observation: A guide for fieldworkers. 2nd ed.. Walnut Creek, CA: Rowman Altamira; 2010
  • 27 Unertl KM, Weinger M, Johnson K. Variation in use of informatics tools among providers in a diabetes clinic. AMIA Annual Symposium Proceedings 2007; 756-760.
  • 28 Unertl KM, Weinger MB, Johnson KB, Lrenzi NM. Describing and modeling workflow and information flow in chronic disease care. Journal of the American Medical Informatics Association 2009; 16 (06) 826-836.
  • 29 Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN. Paperand computer-based workarounds to electronic health record use at three benchmark institutions. Journal of the American Medical Informatics Association 2013; 20 (e1): e59-e66.
  • 30 Dawson S, Manderson L, Tallo VL, Mutharayappa R, Farkas J, Hogan D, Adesina K, Larme A, Mills M, Ibraz T. A manual for the use of focus groups. Man in India 1993; 73 (01) 17-27.
  • 31 Ritchie J, Lewis J. Qualitative research practice: A guide for social science students and researchers. 1st ed.. Thousand Oaks, CA: SAGE Publications; 2003
  • 32 Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse researcher 2011; 18 (02) 52-62.
  • 33 Srivastava A, Thomson SB. Framework analysis: A qualitative methodology for applied policy research. Journal of Administration & Governance 2009; 04 (02) 72-79.
  • 34 Emery D, Cowan A, Eaglestone B, Heyes B, Procter P, Willis T. Care plus. The University of Sheffield. 2002
  • 35 Read S, Ashman M, Scott C, Savage J. Evaluation of the modern matron role in a sample of NHS trusts. Sheffield and London UK: The Royal College of Nursing Institute and The University of Sheffield School of Nursing and Midwifery. 2004
  • 36 Gerrish K, Chau R, Sobowale A, Birks E. Bridging the language barrier: The use of interpreters in primary care nursing. Health Soc Care Community 2004; 12 (05) 407-413.
  • 37 Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology 2013; 13 (01) 117.
  • 38 Denzin NK, Lincoln YS. Collecting and interpreting qualitative materials. Thousand Oaks, CA: SAGE Publications; 2003
  • 39 Calys M, Gagnon K, Jernigan S. A validation study of the Missouri alliance for home care fall risk assessment tool. Home Health Care Management & Practice 2013; 25 (02) 39-44.
  • 40 Bowles KH, Pham J, O’Connor M, Horowitz DA. Information deficits in home care: A barrier to evidencebased disease management. Home Health Care Management & Practice 2010; 22 (04) 278-285.
  • 41 Koru AG, Alhuwail D, Topaz M, Norcio A, Mills ME. Investigating the challenges and opportunities in home care to facilitate effective information technology adoption. Journal of the American Medical Directors Association 2016; 17: 53-58.
  • 42 Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The importance of transitional care in achieving health reform. Health Affairs 2011; 30 (04) 746-754.
  • 43 Myrka A, Butterfield S, B, GJ Amin P, Ambrosy S, Woellmer C, Glock S. A systems-based medication reconciliation process: with implications for home healthcare. Home Healthcare Nurse 2011; 29 (10) 624-635.
  • 44 Agency for Healthcare Research and Quality. Chapter 3. Developing change: Designing the medication reconciliation process; 2012 [cited 2015-12-31]. Available from:
  • 45 Olsen RM, Hellzén O, Skotnes LH, Enmarker I. Breakdown in informational continuity of care during hospitalization of older home-living patients: A case study. International Journal of Integrated Care. 2014 14.
  • 46 Hellesø R, Lorensen M, Sorensen L. Challenging the information gap - the patients transfer from hospital to home health care. International Journal of Medical Informatics 2004; 73 (7–8) 569-580.
  • 47 Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: A multi-disciplinary review. British Medical Journal 2003; 327 (7425): 1219-1221.
  • 48 Campinha-Bacote J, Narayan MC. Culturally competent health care in the home. Home Care Provider 2002; 05 (06) 213-219.
  • 49 Hines D. Cultural competence: Assessment and education resources for home care and hospice clinicians. Home Healthcare Nurse 2012; 30 (01) 38-45.
  • 50 Koru G, Alhuwail D, Rosati RJ. Identifying the Key Performance Improvement Domains for Home Health Agencies. SAGE Open Medicine. 2015 03.
  • 51 Knoerl AM. Cultural awareness and home care planning. Home Health Care Management & Practice 2004; 16 (04) 269-270.
  • 52 Patterson PK, Blehm R, Foster J, Fuglee K, Moore J. Nurse information needs for efficient care continuity across patient units. The Journal of Nursing Administration 1995; 25 (10) 28-36.
  • 53 Burton LC, Anderson GF, Kues IW. Using electronic health records to help coordinate care. The Milbank Quarterly 2004; 82 (03) 457-481.
  • 54 Cipriano PF, Bowles K, Dailey M, Dykes P, Lamb G, Naylor M. The importance of health information technology in care coordination and transitional care. Nursing Outlook 2013; 61 (06) 475-489.
  • 55 Mack KA, Liller KD, Baldwin G, Sleet D. Preventing unintentional injuries in the home using the health impact pyramid. Health education & behavior 2015; 42 (10) 115S-122S.
  • 56 Ferranti JM, Musser RC, Kawamoto K, Hammond WE. The Clinical Document Architecture and the Continuity of Care Record: a critical analysis. Journal of the American Medical Informatics Association 2006; 13 (03) 245-252.
  • 57 D’Amore JD, Sittig DF, Ness RB. How the Continuity of Care Document can advance medical research and public health. American Journal of Public Health 2012; 102 (05) e1-e4.
  • 58 Taylor SP, Ledford R, Palmer V, Abel E. We need to talk: an observational study of the impact of electronic medical record implementation on hospital communication. BMJ Quality & Safety 2014; 23 (07) 584-588.